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«TENNESSEE BOARD OF MEDICAL EXAMINERS DEVELOPMENT COMMITTEE Monday, September 14, 2015 MINUTES The development committee meeting of the Tennessee ...»

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Monday, September 14, 2015


The development committee meeting of the Tennessee Board of Medical Examiners was called

to order at 5:04 p.m. in the Iris Room, Ground Floor, Metro Center Complex, 665 Mainstream

Drive, Nashville, Tennessee 37243 by Dr. Ali.

Members Present:

Subhi Ali, MD Michael Zanolli, MD Dennis Higdon, MD Neal Beckford, MD Pat Eller, Consumer Member

Staff Present:

Andrea Huddleston, Chief Deputy General Counsel Rene Saunders, MD, Medical Consultant, BME Jennifer Shell, Board Administrator

Major Item(s) on Agenda:

1.Consider development of reentry policy for MD x-ray operators who have been out of practice for two (2) or more years Dr. Ali opened the floor for further discussion of this issue. Dr. Saunders referred the Committee to two documents, the potential options open to consideration for X-Ray Operators who have been out of practice, and also a draft letter created by Ms. Martin for consideration to send to program and department directors to see if there might be a possibility of participation from others who might be able to contribute to remediation of X-Ray Operators, such that it would not be the end of the line for X-Ray Operators who were not able to secure their own remediation.

Dr. Ali asked if there was a list of the places it would be sent to. Dr. Saunders responded that staff didn't have a list of names of department directors, but that Ms. Martin may have a list of

facilities. Dr. Ali read aloud the list of questions on the letter:

1. Does your facility currently permit x-ray operators who have been out of practice for two (2) or more years to “shadow” a physician or radiologic technician in order to regain clinical competency?

2. If not, would your facility be willing to allow x-ray operators who have been out of practice for two (2) or more years to “shadow” a physician or radiologic technician in order to demonstrate clinical competency?

3. If your facility would not be willing to allow such a practice, please specify why not. For example, hospital policy, liability concerns, etc..

Dr. Ali stated that the letter addresses the two main points that the Committee was interested in, and asked for any changes suggested by the Committee. Dr. Higdon stated that there was plenty of time for responses to be compiled and asked the right questions. Dr. Beckford asked for a change to "exploring and examining" and stated that the two items were redundant and one should be removed. Dr. Zanolli made a motion to approve the letter with the change and that it is sent out. Dr. Ali seconded the motion, which was unanimously approved. Dr. Zanolli stated that he hoped some people came up that we could identify as preceptors that are not associated with the schools because the chance of channeling everyone thorough the schools is low and expensive. We just need people that are acceptable and have the qualifications to be preceptors for two weeks and come back and testify to the Board that someone knows the procedures. Dr.

Ali added that he strongly felt that that was part of the point of the discussion and decision. Dr.

Ali asked if the letter would only be sent to the schools, or and Dr. Saunders replied that she thought the intention was not just to use it for the schools, but the larger facilities in the state, such as hospitals. She also stated that the reason we need an alternative option for some people is because they can't secure a supervisor on their own. So it's not about funneling someone to one place or another just because we know that a program will accept someone, but to have an applicant say they've tried their hardest and there is a location for them to go. It would not mandate they have to go to a specific place. Dr. Ali asked how many departments are on the list to send the letter to, Dr. Saunders replied she did not know. Dr. Ali stated that in rural areas it would be difficult for the applicants to go to a city, he asked if the X-Ray Department at the Hospital in Waverly, TN, for example, be a facility that would be within our consideration. Dr.

Saunders replied that it would and that it would not be difficult to work with Healthcare Facilities to come up with facilities in the State that we could send the letter to. She does not know how many hospitals, and small rural hospitals, or clinics that are in the state, but that whatever Healthcare Facilities has, they would be willing to share that mailing list with us. Ms.

Eller stated that she thought it would be more advantageous for us to secure some hands-on clinical training in a hospital setting because at least you know that most have the state-of-the-art equipment, and if we had facilities all over the state willing to participate it would be much easier for people to do their remediation and then get back in. She thinks we need a mix of all of these things. Dr. Ali indicated hospitals and medical schools would be on the list and asked how else we could expand the list. Ms. Eller stated her concern would be do we set a minimum, and asked if we have the right to set the standard as to what each one of these MD X-Ray Operators need to do. She suggested maybe 10 X-Rays and she didn't know what else. Dr. Saunders stated that yes, as a Board, they have the right to prescribe what someone needs in order to restore their MD X-Ray Operator license, and she asked the Committee to keep in mind that we are talking about limited X-Ray license people, so if someone is limited in Chest, and we want to require them to do 30 Chest X-Rays, then yes, they can say that. It is up to that person to secure someone who will allow them to participate in positioning the patient, and explaining how the X-Ray should be shot, what settings should be on the machine, basically doing everything except causing the X-Ray machine to be operated. So if the decision of the Board is that you only needed them to perform 30 Chest X-Rays in order to be considered remediated, they can make that decision. Ms. Eller then stated there would be a letter from that supervisor, and that closes the loop. Dr. Zanolli replied affirmative, and mentioned that Dr. Higdon had talked to some people about this. Dr. Higdon explained that he had talked to radiologists and technicians in one of the large hospitals in Memphis and that that would be sufficient in their eyes to remediating someone who had a limited-scope license. Dr. Zanolli stated that he knew more about Physician's reentry and that he knows about the North Carolina reentry for Physicians, so they have a list of preceptors that they vetted. They are people that the Board recognizes as checking someone out and seeing if they are competent and the preceptor signs of on them, that's what they're looking for. It's the preceptors that need to be registered with us and he doesn't think the letter will bring us preceptors, maybe some, so if we could identify a list of preceptors, it could be in a large clinic as far as he's concerned - it doesn't have to be a hospital or teaching institution, but if the people have been vetted, and the preceptor says they have spent time with this person and they demonstrate the skills necessary to perform limited x-ray Operation in an office. Dr. Higdon asked if we have to be careful of being outside a hospital when remediating folks who don't have a license. For instance, could they work in a clinic and actually do x-rays?

Dr. Zanolli reminded the Committee that Dr. Saunders stated that they don't actually turn the switch, that's his concept. Dr. Higdon stated that Dr. Ali must certainly think that the Waverly hospital would be a great place, and he suggested looking at the list and sending out many letters across the state and seeing what response we get, and he asked if that would be a great starting point, to see who would be willing. Dr. Zanolli stated that he didn't think hospitals would want anything to do with this, so he doesn’t know what the response will be. Ms. Eller stated we won't know until we do it. Dr. Zanolli reiterated he didn't think hospitals would do this. Dr. Saunders asked how he would suggest getting to the preceptor. Dr. Beckford stated to Dr. Zanolli that the individual would be working under the egess of the institution, and if that individual does not get the buy-in from the institution then he would not be able to do that. Dr. Zanolli agreed they would have to have permission to do it but he does not believe we will get the institutions to sign-off on it, to allow someone to be there under the preceptor, that is the way it might fly. Ms.

Eller stated that if we have major facilities across the state who agree to do it, such as teaching institutions, because that is part of their mission, at least it would spread out the capability of sending these people to those areas without making them travel all the way across the state. She thinks we need to try it and at least see how it goes. Dr. Ali stated that the state has a list of facilities that are approved, so that is the starting point, and he's sure we have the names of directors to who these will be made out to, and a list of clinics outside who have to register with the state and are examined, so we have a database and we will see what we get. Dr. Zanolli brought back up the list of options, if the Committee was ready to move on, but Dr. Ali sated we need to vet the first issue completely. Dr. Zanolli stated we need further refinement on what shadowing means and we need to have institutions that agree to it and the preceptors need to be veted out or approved. Referring to the second box under variations, under preceptors, he mentioned that they had previously discussed that half the number of hours seemed excessive.

He would prefer a period of time, rather than hours. Dr. Higdon noted that the professionals he had talked to recommended a week or two, rather than two weeks and that it would be overbearing to expect someone to accept, and for a student to easily perform a long drawn out exam, but he thinks that examining someone in multiple procedures of the same type over and over again, that they had been trained in before, would be enough. Dr. Ali asked if it would help to place a minimum, give a range of time, such as no less than one week, or a range of one to three weeks, etc. Dr. Beckford suggested 40 hours. Dr. Saunders stated that the reason we talked about half the number of training hours was because according to the rules, there is a certain number of hours of clinical training required to obtain certification in the first place, and those were the hours that were referred to when they refer to half the number of clinical training hours.

So for instance, someone who has a limited license to shoot Chest X-Rays, if the Board wants him to go for two weeks, that's fine, but all that's required initially is 30 clinical hours, so all we would be asking for is 15 hours. The person who will suffer is the person who has all the limited qualifications. So someone who does all the qualifications will have to do many more hours. Dr.

Zanolli stated that this is not re-training someone; it is for reentry, so he doesn't mind if it's one week or two weeks. We aren't sending them back to school; we are seeing that they have proficiency. Ms. Huddleston reiterated Dr. Beckford's recommendation of forty hours, as terms like "a week" is unclear. Dr. Beckford stated forty hours is clear. Dr. Saunders explained that someone in a physician’s office for forty hours who was previously license only in chest, vs someone who had chest, extremities, and spine, Dr. Zanolli stated this is reentry, not retraining.

Ms. Eller stated that it would be advantageous for the person to go where they need to get the most out of their time. Dr. Saunders explained to the Committee that many limited X-Ray Operators do not apply for all four of the main qualifications, so that if a number of hours is required, it might be more specific. Ms. Huddleston suggested that might come in during the vetting process. Dr. Zanolli stated that we would have a list of preceptors which would include their background, just like the physician reentry in North Carolina. Ms. Eller asked to be reminded about what they ladies from RES said and Dr. Saunders stated we didn't poll them on the clinical component, as they don't handle the clinical component. Ms. Eller stated the purpose of the remediation is to ensure that someone is ready to go back, and how they do it, that's what the Committee was struggling with. Dr. Zanolli wanted to remind the Committee of the practical nature of the remediation. He mentioned that he would prefer the language "regain" in the letter to "demonstrate". He then stated that the committee does not need to finalize anything until they have more information. Dr. Higdon agreed with Dr. Zanolli that the language in the letter should be changed to demonstrate. Dr. Zanolli made a motion to reconsider the letter and to change the language in item number two from regain to demonstrate. Dr. Higdon seconded the motion, which passed unanimously.

2. Consider development of policy/rules to address applicants from “unapproved” medical schools Dr. Ali read the next item on the list to the Committee. Ms. Huddleston directed the members to their materials which include the current policy, the memo from Ms. Martin, a list of the schools from NCFMEA, LCME. The committee has been looking at this issue a lot, applicants who are neither on the approved or disapproved California list, and the policy just addressed the California list. Other accrediting agencies have been discussed at prior meetings. Dr. Zanolli stated that one of the main questions is what other organizations is the Board going to accept as far as accreditation bodies or agencies that can sanction accreditation bodies that they can use to expand the currently limited list. NCFMEA reviews the accreditation for countries and they do have a list of countries that they feel have appropriate accreditation of their medical schools and he thinks we should expand the California list to include the countries that are on the NCFMEA list since they have met the criteria that is similar to or equal to the LCME as far as entry into their schools. Dr. Saunders clarified that the NCFMEA accredits the countries, not the schools.

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