V. C. vs. Chanour Adrian, M.D. (GS)

Following a review of all pertinent records and discussion of the matter, it was moved by Mrs. Osborn, seconded by Doctor Zonis and unanimously carried, that the matter be filed with a letter of concern to Doctor Adrian stating that there does not really seem to be any justification for charging for an emergency room visit when that visit is devoted to the surgical procedure for which he is charging and suggesting he cancel, or refund as appropriate, the seventy-five ($75) dollar fee.

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M. R. S. (Patient - G. F.) vs. Elizabeth J. Riney~ M.D. (GP)

Following a review of all pertinent records and discussion of the matter, it was moved by Doctor Dexter, seconded by Doctor Spencer and unanimously carried, that investigation in this matter be continued with a letter of information to the Doctor, requesting that she readjust her charges and point out to her that the Board felt three-hundred ($300) dollars an hour appears to be excessive and that critical care charges are included in the usual resusci- tative efforts by other physicians in the state.

BOMEX vs. Mark Altchek, M.D. (IM)

Following a review of all pertinent records and discussion of the complaint matter involving Doctor Altchek apparently ordering an inappropriate dose of Morphine, it was moved by Mister Alexander, seconded by Doctor Dexter and unanimously carried, that based on the information presented in the August 8, 1983 Investigative Report No. 83-067-C, Doctor Altchek ordered 5cc of Morphine to be given patient D. E. S., which caused the demise of the patient and the postmortem confirmation that the diagnosis of death was by overdose of Morphine, Doctor Altchek is in violation of the Medical Practice Act under the definition of medical incompetence as outlined in A.R.S. §32-1401.6 and unprofessional conduct as outlined in A.R.S. §32-1401.8(o) and, in that, the public health, welfare and safety imperatively requires emergency action, Doctor Altchek's License No. 13300 for the practice of medicine in the State of Arizona be summarily suspended and a Summons and Complaint be issued and a hearing be conducted as required by statute.

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BOMEX vs. Stanley A. S mith~ M.D. (GP-P)

Following a review of all pertinent records and discussion of the matter, it was moved by Mister Alexander, seconded by Doctor ii~ i iii!i

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BOARD OF MEDICAL }EXAMINERS - STATE OF ARIZONA

SPECIAL MEETING

A Special Meeting of the Arizona State Board of Medical Examiners was held at 12:10 p.m., Monday, April 30, 1984, by means of a telephone conference call in the offices of the Board, Suite 300, 5060 North Nineteenth Avenue, Phoenix, Arizona; Chairman, James E. Brady, Jr., M.D., presided.

ROLL CALL

MEMBERS CONTACTED: (Conference Call)

MEMBER PRESENT:

STAFF PRESENT:

MEMBERS EXCUSED:

M. David Ben-Asher, M.D. James E. Brady, Jr., M.D., Chairman Michael R. Geyser, M.D. Gilbert L. Sechrist, M.D. Steven S. Spencer, M.D., Vice-Chairman Mario P. Valdez, M.D., Secretary Patricia J. Wiebe, R.N.

Phillip Z. Saba, M.D.

Joan E. Blackwell, Recording Secretary Jerome F. Borsch, Chief Investigator Douglas N. Cerf, Executive Director Nancy E. Opre, Assistant Attorney General

Scott Alexander Richard L. Dexter, M.D. Anna Margaret Osborn Richard D. Zonis, M.D.

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FORMAL HEARING

Mark Altchek~ M.D. (IM) - Formal Hearing

Mark Altchek, M.D., was noticed to appear at this time and place; failed to appear; nor was he represented by legal counsel.

The entire file of record having previously been submitted to the members of the Board for their review, the scheduled hearing was called by the Chair and Nancy E. Opre, Assistant Attorney General, presented the case on behalf of the State Board of Medical Examiners. i

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A Court Reporter was in attendance and a copy of the transcript will be made an official part of the record.

It was moved by Doctor Saba, seconded by Doctor Valdez and unanimously carried, that the the Board adopt the Findings of Fact, Conclusions of Law and Recommendations of the Hearing Officer which, in part, indicate that Doctor Altchek ordered an overdose of morphine sulfate to be given to patient D. E. S. which resulted in her death and the Conclusions of Law that Doctor Altchek's conduct was harmful and dangerous to the health of this patient, constituting unprofessional conduct within the meaning of A.R.S. §13-1401(8)(c) and, as such, is lacking in sufficient medical knowledge or skills, or both, to a degree likely to endanger the health of his patients and hence is medically incompetent within the meaning of A.R.S. §32-1401(6).

It was further moved by Doctor Saba that, based upon these Findings of Fact and Conclusions of Law, the Board revoke Doctor Mark Altchek's Arizona License No. 13300 for the practice of medicine in the State of Arizona, such revocation to take effect immediately. The motion was seconded by Doctor Valdez and unanimously carried via a roll call vote of 8 to 0.

THE CONFERENCE CALL ADJOURNED AT 12:25 P.M.

Respectfully submitted

for the

BOARD OF MEDICAL EXAMINERS

Douglas N. Cerf, Executive Director

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It was moved by Doctor Brady, seconded by Doctor Valdez, that Doctor Ver Steeg's application for licensure be denied. The Motion was defeated via an 8 to 2 vote.

Following discussion, it was moved by Doctor Zonis, seconded by Mister Alexander and unanimously carried, that Doctor Ver Steeg be given an application for licensure and that he submit to an oral competency examination as part of his licensing process.

HEARING

Mark Altchek~ M.D. (IM-EM) - Motion For Rehearing

Van O'Steen, counsel for Doctor Altchek, appeared on behalf of Doctor Altchek on a previously filed Motion for Rehearing.

Mister O'Steen presented his client's claims for a rehearing and Nancy E. Opre, Assistant Attorney General, presented the case on behalf of the State Board of Medical Examiners and Anthony B. Ching, Solicitor General, Attorney General's Office, sat as legal advisor to the Board of Medical Examiners.

A Court Reporter was in attendance and a copy of the transcript will be made an official part of the record.

Following review of the Motion for Rehearing, as well as the Board's determination of April 30, 1984 that the Doctor's license be revoked, in that, the Board found that Doctor Altchek's conduct in ordering an overdose of morphine sulfate given to patient D. E. S. which resulted in her death was unprofessional conduct, it was moved by Doctor Zonis, seconded by Mrs. Wiebe, that the Board grant the Motion for Rehearing. A roll call vote was taken and the motion defeated with Mesdames Osborn and Wiebe and Doctors Dexter and Zonis voting in the affirma- tive, and voting in opposition to the motion were Mister Alexander, Doctors Brady, Geyser, Saba, Sechrist, Spencer and Valdez.

It was further moved by Doctor Geyser, seconded by Mister Alexander, that the Motion for Rehearing be denied. The motion carried via a roll call vote with Mister Alexander, Doctors Brady, Geyser, Saba, Sechrist, Spencer and Valdez voting in the affirmative, Mrs. Wiebe and Doctor Zonis voting in opposition to the motion and Mrs. Osborn and Doctor Dexter abstaining from voting in this matter.

INTERVIEWS - Continued

George S. Goodwin, M.D. (FP) - Inf0rmal Interview

Doctor Goodwin was requested to appear at this date and time for an in-

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January 22, 1985 and February ;25, 1985 were approved as printed and circulated among the members, on motion by Doctor Saba, seconded by Doctor Zonis and unanimously carried.

! COUNSEL REPORTS

Vakas vs. Rodriquez

At the request of Mister Cerf, Ms. Nancy Thompson gave a brief report relative to the Vakas vs. Rodriquez matter wherein the court ruled that as long as a Board acts within the statute that authorizes it, that they are immune to individual liability.

Stanley H. Zoslow~.M.D. vs. BOMEX

Laurie Downey, Assistant Attorney General, gave a status report on the Stanley H. Zoslow~ M.D. vs. BOMEX matter, indicating that a successful oral argument was held recently and the Superior Court ruled in the Board's favor; however, Doctor Zoslow has since filed a Notice of Appeal to the Court of Appeals.

Jesse E. Jacobs, M.D. - Appeal

Ms. Opre reported to the Board that Doctor Jacobs' appeal was taken under advisement after oral argument on February 6, 1985. Ms. Opre hopes to have a decision on this matter prior to the next meeting of the Board.

Mister Cerf also informed the Board that Doctor Jacobs has been provided an application for reapplication of licensure.

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Mark Altchek, M.D. -.Appeal of Board Order

Ms. Opre reported on the status of Doctor Altchek's Administrative Review of the Board's Order of Revocation of his medical license and indicated that the court has remanded the matter back to the Board for further hearing and for the taking of additional testimony and evidence.

Open Meeting Law

ON MOTION BY DOCTOR SABA, SECONDED BY DOCTOR GEYSER, THE BOARD MOVED INTO EXECUTIVE SESSION TO SEEK ]LEGAL ADVICE FROM LEGAL COUNSEL, NANCY E. OPRE, ASSISTANT ATTORNEY GENERAL.

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MINUTES

The Minutes of the Regular Meetings held June 5, 6, 7 & 8, 1985 were approved with the following amendments on motion by Doctor Spencer, seconded by Doctor Sechrist and unanimously carried:

Minute Entry "Wesley A. McEldoon, M.D. (P-PYM) - Informal Interview" on Page 184 of June 6, 1985 Regular Meeting Minutes were amended to indicate that Doctor Ben-Asher was excused from participating in the interview with Doctor McEldoon.

Minute Entry "Max Baumeister, Jr., .... M.D. (AN) - Informal Interview" on Page 193 of June 7, 1985 Regular Meeting Minutes were amended to indicate that Doctors Ben-Asher and Dexter were excused from participating in the interview with Doctor Baumeister°

Minute Entry under "Ex Parte Contacts" on Page 2, Lines 11, 12 and 13 were deleted as duplicatory material in the Executive Session Minutes of June 6, 1985.

OLD BUSINESS

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! Rajagoplan Ravi, MoD. & Ranjit K. Sood~ MoD. - Request for Termination of Board Stipulations & Orders

Following discussion regarding the new and appropriate angiography equipment currently being utilized at the Hoemako Hospital (now known as the Casa Grande Regional Medical Center), it was moved by Doctor Dexter, seconded by Doctor Ben-Asher and carried by a majority vote, that if such equipment is in place and functioning satisfactorily, the Stipulations and Orders issued to Doctors Sood and Ravi be terminated.

FORMAL HEARINGS

Mark Altchek, M.D. (IM)

Mark Altchek, M.D. was noticed to appear at this time and place; failed to appear, but was represented by legal counsel, Van O'Steen.

The scheduled hearing was called by Chairman, Michael R. Geyser, M.D.~ Nancy Opre Logan, Assistant Attorney General, presented the case on

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behalf of the State Board of Medical Examiners~ and Anthony B. Ching, Solicitor General, Attorney General's Office, sat as legal advisor to the Board of Medical Examiners.

A Court Reporter was in attendance and a copy of the transcript will be made an official part of the record.

ON MOTION BY MISTER ALEXANDER, SECONDED BY DOCTOR VALDEZ, THE BOARD MOVED INTO EXECUTIVE SESSION TO OBTAIN LEGAL ADVICE FROM LEGAL COUNSEL, ANTHONY B. CHING, SOLICITOR GENERAL, ATTORNEY GENERAL'S OFFICE.

THE BOARD WENT INTO OPEN SESSION TO CONTINUE THE FORMAL HEARING REGARDING DOCTOR ALTCHEK.

It was moved by Mister Alexander, that the Board adopt the following Findings of Fact and Conclusions of Law as presented by the Hearing Officer: Findings of Fact: (I) Mark Altchek is a medical doctor licensed to practice medicine in the State of Arizona and is the holder of License No. 13300; (2) on or about June 23, 1983, D. E. S. was brought to the East Mesa Emergency and Family Care Center by a Mr. O. R. complaining of pain in her hip. Mrs. S. was concerned that she might have broken her hip. Mrs. S. was examined by Doctor Altchek and assisted by Lisa Oliver, then a practical nurse; (3) Ms. Oliver took the patient's vital information and the patient was then taken to be x-rayed, whereupon the patient was returned to the clinical room where she waited while the x-rays were developed; (4) upon examining the x-rays, Doctor Altchek wrote out a prescription for the patient and stated that she could be returned to the automobile in which she came. The patient was then wheeled out to said automobile in a wheelchair by Nurse Oliver and Doctor Altchek. As the nurse, the patient's neighbor and Doctor Altchek were attempting to place the patient into the automobile, the patient continued to complain of pain. At this point, Doctor Altchek directed the nurse to obtain 5 cc's of morphine sulphate. The nurse then asked Doctor Altchek whether he meant 5 cc's of morphine or 5/10 of Icc of morphine. Doctor Altchek then stated that he meant 5 cc's~ (5) Nurse Oliver went inside the clinic and returned to Doctor Altchek advising him that only 2 and 3 cc syringes were available, as she could not find any 5 cc syringes at the desk. Again, Nurse Oliver asked Doctor Altchek whether he wanted 5 cc's and not 5/10 cc. Doctor Altchek once again stated to her that he wanted 5. Doctor Altchek then directed Nurse Oliver to get the larger syringe from a technician assigned to work in the laboratory and received from the technician a 10 cc syringe, whereupon she placed 5 cc's of morphine sulphate inside said syringe a~d brought the syringe out to the car where the patient, the patient's neighbor and Doctor Altchek had been waiting for her; (6) Nurse Oliver then proceeded to the laboratory inside the clinic and received from L. T. a 10co syringe, whereupon she placed 5cc's of morphine sulfate inside the syringe and brought the syringe out to the car where the patient, the patient's neighbor and Doctor Altchek were waiting; (7) Doctor Altchek then directed Nurse Oliver to inject the 5 cc's of morphine sulphate into patient's arm, which she did. Doctor Altchek then told the patient to take it easy

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and rest, advising her that the medication would cause her to go to n sleepl (8) the bottle from whiclh the morphine sulphate in question came l is represented in the photographs comprising Exhibits Two through Nine. The records of the treatment; of the patient at the clinic are represented in Exhibit Ten; (9) The neighbor then drove the patient home, stopping at a pharmacy to fill the prescription that Doctor Altchek had written for her that day. Upon arriving at the trailer park in Queen Creek, Arizona, where the patient resided, the patient was unconscious and three or four people had to carry her to her trailer; (10) C. C., part-owner of the Pleasant Valley Mobile Home Park in Queen Creek, Arizona, where Mrs. S. resided, had learned at approximately 6:00 p.m. on the evening of June 23, 1983, that Mrs. S. had been taken to the clinic earlier that day by Mr. R. At approximately 9:00 that same evening, Mrs. C. was told by another resident of the trailer park that Mrs. S. was still sleeping and had not awakened to go to the bathroom all that day; (11) at approximately 10:00 p.m. on the evening of June 23, 1983, Mrs. C. received another call from a resident of the trailer park advising Mrs. C. that Mrs. S. had apparently stopped breathing. Mrs. C., a retired registered nurse, then went to Mrs. S.'s house trailer and examined Mrs. S., took her pulse, could find no vital signs, tried to apply mouth-to-mouth resuscitation, and noted that Mrs. S. was cold and gray. Mrs. C. then waited for the police to arriw~; (12) business at the clinic had been slow in June 1983; (13) On June 23, 1983, Nurse Liver made a hand-written entry on the medical chart of D. E. S. indicating that she i had administered 5cc's of morphine sulfate to D. E. S. on that day; | (14) after Doctor Altchek had treated D. E. S. on June 23, 1983 he was not busy for the rest of the day; (15) for no apparent reason, Doctor Altchek failed to complete his portion of the medical chart relating to D. E. S. on June 23, 1983; (16) On June 24, 1983, Doctor Altchek was not present at the clinic; (17) on the afternoon of June 24, 1983, the clinic received a telephone call from the coroner who advised that D. E. S. had died and further advised the cause of death; (18) Allen M. Jones, M.D., Chief Deputy Examiner, Pima County, Arizona, and Clinical Assistant Professor of Pathology, College of Medicine, University of Arizona, performed an autopsy on the body of D. E. S. at the Office of the Medical Examiners, 190 West Pennington Street, Tucson, Arizona, at 8:35 a.m. on June 25, 1983; (191) the determined cause of death of D. E. S. was that of an overdose of morphine. The autopsy revealed a confirmation of a needle puncture in the decedent's right arm; the presence of other natural disease processes which were of some importance. Most significant results of toxicological studies; and provided information relating to the strength of the morphine sulphate solution given to the decendent -- all of which formed the basis for the medical examiner's opinion submitted to the Board; (20) there was no evidence, either grossly or microscopically, that the decendent was addicted in any way to drugs of any kind, including opiates. In the toxicological laboratory, the immounoreactive test performed on the blood of the decendent revealed 850 nanograms per milliliter; (21) aside from relieving pain, one side effect of morphine in the case of a mm person with any degree of respiratory compromise is to cause depression | or difficulty with the cardiorespiratory center of the human brain,

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creating a respiratory depression which can cause a slowing down of the proper functioning of the lungs and can lead to death; (22) a dosage of 5 cc's of morphine sulphate would represent a lethal dosage when given to a non-addicted adult. A person could possibly survive such an overdose through supportive treatment, including the use of various drugs to counteract the effects of the morphine and the use of respiratory assistance through mechanical means to relieve the respiratory depression~ (23) it was the medical examiner's opinion that any doctor having knowledge to make an order of the administering of 5 cc's of morphine sulphate had committed a gross error that was negligent because of the potentially severe life threatening consequences of such a large dosage; that morphine is not even generally administered or ordered to be administered by the cc, but rather by the grain or milligram; and that the continued medical practice of a doctor who would order such a dosage of morphine to be administered for severe pain would constitute a danger to the health and safety of that doctor's patients and the public; (24) a safe dosage of morphine sulphate that should have been given to the decendent would have been approximately 1/10 of the dose given, or approximately 8 to 10 miligrams; (25) the news of the death of D. E. S. was upsetting to Lisa Oliver who, at the end of that working day, left the clinic neither to return to work at the clinic nor to return to the nursing profession thereafter; (26) Lisa Oliver's next appearance at the clinic was in late Fall 1983 for the purpose of obtaining her individual income tax W-2 form; (27) on the evening of June 24, 1983, Lisa Oliver received telephone calls from P. W., apparent head nurse at the clinic, and Doctor Stavros, owner of the clinic. The purpose of each of those telephone calls was to make inquiry as to her emotional state as a result of the D. E. S. tragedy. Implicit within the making of those telephone calls was the fact that by Friday evening, June 24, 1983, both P. W. and Doctor Stavros were demonstrating awareness of their knowledge of the cause of D. E. S.'s death and the fact that Lisa Oliver was directly connected with those events which led to the death of D. E. S. It was for those reasons that nurse P. W. and Doctor Stavros chose to console Lisa Oliver by calling her at her home that evening; (28) aware of the contents of the telephone call received on the afternoon of June 24, 1983 at the clinic from the coroner, L. J. H. visited Doctor Altchek at his apartment on the evening of the same day to discuss the situation with him; (29) aware of the cause of death of D. E. S., Doctor Altchek telephoned Lisa Oliver on the evening of June 24, 1983 for the ostensible purpose of reassuring her that she would be able to continue with her life despite the fact that the injection she administered to D. E. S. constituted a fatal overdose; and (30) at not time during the course of the Friday evening (June 24, 1983) telephone call from Doctor Altchek to Lisa Oliver did Doctor Altchek suggest or assume responsibility for the dosage of morphine sulfate administered to D. E. S. At all times, regardless of manner of presentation, Doctor Altchek suggested to Lisa Oliver that she was totally to blame for the death of D. E. S. and that he was totally free of culpability. Conclusions of Law~ (I) This matter is within the jurisdiction of the Board of Medical Examiners for the State of Arizona, as Doctor Altchek is the holder of License No. 13300 for the practice of medicine in the

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State of Arizona; (2) these proceedings have been instituted pursuant to Title 32, Chapter 13, Arizona Revised Statutes, commonly known as m the Arizona Medical Practice Act~ (3) the conduct of Mark Altchek, M.D., was harmful and dangerous to the health of his patient, D. E. S., and constituted unprofessional conduct within the meaning of A.R.S. §32-1401(8)(o); and (4) the conduct of Mark Altchek, M.D., establishes that he is lacking in sufficient medical knowledge or skills, or both, to a degree likely to endanger the health of his patients, and, hence, Mark Altchek, M.D., is medically incompetent within the meaning of A.R.S. §32-1401(6).

The motion was seconded by Doctor Ben-Asher and carried via a roll call vote of 6 to 5, with Mister Alexander and Doctors Ben-Asher, Dexter, Geyser, Sechrist and Spencer voting in the affirmative and Mrs. Jeppesen and Doctors Saba, Stein, Valdez and Zonis voting in opposition.

On motion by Doctor Zonis, it was moved that based upon the Findings of Fact and Conclusions of Law, the Board vacate their previous Order of Revocation dated April 30, 1984 and issue a Decree of Censure to Doctor Altchek. The motion carried via a roll call vote of 7 to 3, with Mrs. Jeppesen and Doctors Ben-Asher, Dexter, Saba, Stein, Valdez and Zonis voting in the affirmative and Mister Alexander, Doctors Sechrist and and Spencer voting in opposition.

Oscar J. Blinde, M.D. (Retired) - Formal Hearing

Mrs. Opre Logan informed the Board that this matter was initially set for a formal hearing but that Doctor Blinde's counsel had contacted her and a negotiation was entered into for Doctor Blinde to consent to the cancellation of his license with an admission that his license had been revoked in the State of Washington. Mrs. Opre Logan further reported that she very recently had received information that the Washington Board reconsidered the action it originally took against Doctor Blinde and rescinded its revocation of his license for humanitarian reasons and entered into a Stipulation with Doctor Blinde that he retire completely from the practice of medicine in that state. Due to the Washington Board's most recenlb action, she was unable to present evidence or documents relative to that Board's action at this meeting.

It was moved by Doctor Zonis, seconded by Doctor Dexter and unanimously carried, that this matter be tabled until the Boardts December meeting, to allow staff to obtain certified documentation from the State of Washington.

Francisco Pena, M.D. (FP) - Formal Hearin~

Mister Cerf reported to the Board that Mrs. Opre Logan and Doctor Pena's legal counsel had previously agreed to stipulate to revocation

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FORMAL HEARING

Mark Altchek, M.D. (GP)

Mark Altchek, M.D., was noticed[ to appear at this time and place; did not appear but was represented by legal counsel, Van O'Steen regarding his Motion for Rehearing

The scheduled hearing was called by the Chair and Nancy Opre Logan, Assistant Attorney General, presented the case on behalf of the State Board of Medical Examiners and Robert A. Zumoff, Attorney, Solicitor General's Office, sat as legal advisor to the Board of Medical Examiners.

A Court Reporter was in attendance and a copy of the transcript will be made an official part of the record.

Following a discussion and review of materials and arguments provided by Mr. O'Steen and Mrs. Logan, it was moved by Doctor Stein, that the Board's Findings of Facts and Conclusions of Law in this matter remain as previously adopted by the Board. The motion was seconded by Doctor Valdez and carried by a roll call vote of 8 to 2 with Mister Alexander, Doctors Dexter, Geyser, Saba, Sechrist, Stein, Valdez and Zonis voting in the affirmative and Ms. Jeppesen and Doctor Ben-Asher voting in opposition.

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| COMPLAINT REVIEWS - Continued

BOMEX Inquiry - Daniel L. Neel~ M.D. (FP)

Following a review of all pertinent records and discussion of the matter, it was moved by Doctor Zonis, seconded by Doctor Saba and unanimously carried, that the matter be filed for information.

BOMEX Inquiry - R. J. S.~ M.D.

Following a review of all pertinent records and discussion of the complaint matter, it was moved by Doctor Ben-Asher, seconded by Doctor Valdez and unanimously carried, that this matter be filed for information.

St. Mary's Hospital & Health Center vs. G. L. H.~ M.D.

Doctor Ben-Asher was excused from participating in the discussion of this complaint.

MINUTES

The Minutes of the Regular Me~.txngs held June 27 & 28, 1986 were approved as printed and circulated among the members, on motion by Doctor Sechrist, seconded by Doctor Dexter and unanimously carried.

It was further moved by Doctor Sechrist, seconded by Doctor Dexter and unanimously carried, that the June 26, 1986 Regular Meeting minutes be approved with the following amendments~

Amendment to the June 26, 1986 Minute Entry under "Irvin~ Puziss~ M.D. (GS) - Informal Interview" on Page 143, Paragraph 3, Line I, should read as follows: "...and carried by majority vote, ...".

Amendment to the June 26, 1986 Minute Entry under "Clifton Jack Alexander, M.D. (FP) - Informal Interview" on Page 143, Paragraph 2, Line 3, should read as follows: "...moved by Mister Alexander, ...".

Amendment to the June 26, 1986 Minute Entry under "Sidney Julius Axelrod~ M.D. (FP) - Informal Interview" on Page 146, Paragraph 2, Line 5, should read as follows: "...Saba, Stein, Valdez, Young..."., Page 147, Paragraph 2, Line 4, should read as follows: "...Stein, Valdez, Young and Zonis...; and, Paragraph 3, Line 3, should read as follows~ "...Saba, Stein, Valdez, Young and...".

COUNSEL REPORT

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I Licensing Requirements for Federal Employees - Postal Services

Mister Cianci reported that, generally, the United States Constitution, Supremacy Clause, exempts federal employees from state licensing requirements. Therefore, the rule is that the state does not have jurisdiction to take disciplinary action or require licensure for federal employees. However, there may be certain cases wherein the state has jurisdiction and such cases may be those where a physician is performing duties outside his scope of employment. A case by case analysis must be made.

George W. Gannon~ ' M.D. vs. BOMEX

Mister Cianci reported to the members of the Board that a Summary Judgment in this matter had been entered in the Board's favor.

Mark Altchek~ M.D. vs. BOMEX

Mister Cianci indicated that the Court modified the Board's Findings of Fact and Conclusions of Law in this matter, but did uphold the Decree

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,of Censure imposed by the Board as regards the commitment of unprofessional conduct by Doctor Altchek, in that he did not properly supervise his nurse. Mister Cianci further indicated that he will be discussing with staff the possiblity of an appeal, and that he would be filing a response to Doctor Altchek's Petition for Attorney's Fees.

Jorge A. Tabora ~ M.D. vs. BOMEX

Mister Jones informed the Board that this matter was won on appeal. The complaint in this matter was that the Board did not make specific Findings of Fact and the Court ruled that the Board's Findings of Fact were indeed sufficient. The issue regarding the restitution of fees in this matter was overturned in that the Board could not order restitution for all of his 1983 cases that were handled by Doctor Tabora, as insufficient notice was given to Doctor Tabora, since he was originally questioned only about cases handled during February 1983. In addition, the Court determined that the Board could not put the Doctor in a position which would require him to interpret the order and then possibly incriminate himself if the Board disagrees with his interpretation.

Remote Imaging Systems

Mister Cianci indicated, in response to the Board's inquiry regarding the jurisdiction of the Board to regulate non-Arizona licensed physicians interpreting x-rays or performing diagnostic tests sent by mail from Arizona to another state, that the answer cannot be stated succinctly as a general rule, as it depends upon the factual basis of each case.

Questio n Regarding Liability °f B0ard Members

Mister Cianci informed the members of the Board that, in response to their concerns regarding the liability of Board members arising out of the performance of Board duties, Board members have statutory immunity for actions performed during the course of their official duties as long as they act in good faith. This immunity may be applied in some federal lawsuits; however, federal courts may not be required, in all cases, to apply state immunity laws to civil rights and anti-trust suits.

Good Samaritan Medical Center vs. "Jane Doe"

Mister Cianci informed the Board that the Nursing Board had won a partial summary judgment in this case and that Samaritan Health Service

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the medication was taken; (c) The name of the prescribing physician; and, (d) The reason for the medication.

COUNSEL REPORTS

Mark Altchek~ M.D. vs. BOMEX

Stipulated Settlements

ON MOTION BY DOCTOR DEXTER, SECONDED BY DOCTOR VALDEZ, THE BOARD MOVED INTO EXECUTIVE SESSION TO OBTAIN LEGAL ADVICE FROM LEGAL COUNSEL, MICHAEL J. CIANCI, JR., ASSISTANT ATTORNEY GENERAL.

THE BOARD WENT INTO OPEN SESSION TO CONTINUE WITH THE BOARD'S AGENDA.

INTERVIEWS - Continued

Seneo Mila~ros Arbaje-Ramirez~ M.D. (IM-GE) - Informal Interview

Doctor Arbaje-Ramirez was requested to appear at this date and time for an informal interview; did appear and was interviewed by the members of the Board relative to a complaint from patient E. C. alleging excessive fees.

Mister Hecker was excused from participating in the interview with Doctor Arbaje-Ramirez.

ON MOTION BY DOCTOR BEN-ASHER, SECONDED BY MS. JEPPESEN, THE BOARD MOVED INTO EXECUTIVE SESSION TO OBTAIN LEGAL ADVICE FROM LEGAL COUNSEL, MICHAEL J. CIANCI, JR., ASSISTANT ATTORNEY GENERAL.

THE BOARD WENT INTO OPEN SESSION TO CONTINUE THE INFORMAL INTERVIEW WITH DOCTOR ARBAJE-RAMIREZ.

Following a review of all pertinent records and discussion of the complaint matter, it was moved by Doctor Dexter, seconded by Ms. Jeppesen and carried via majority vote, that the Board find that the information presented may warrant suspension or revocation; that staff prepare a Complaint and Notice of Hearing and schedule this matter to be heard by a Hearing Officer; and, that the Hearing Officer be instructed to prepare recommended Findings of Fact and Conclusions of Law for consideration by the Board at a Formal Hearing.

COMPLAINT REVIEWS - Continued

BOMEX Inquiry - J. W. Cortner~ M.D. (ORS)

Following a review of all pertinent records and discussion of the complaint matter, it was moved by Doctor Zonis, seconded by Ms.