SUPPLEMENTAL PUBLIC AGENDA ALABAMA BOARD OF MEDICAL EXAMINERS June 17, 2015

I

PUBLIC MINUTES OF MAY 20, 2015

II ENDORSEMENT

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Name

Medical School

Ali Jalal Badday * Jose Luis Benitez Mohammed Berrou Francisco Jose Camino Sergio Castillo * Amy Tucker Clark Johnie Joseph Cooper Jr. Cristalle Astrid Cox Kriston Leigh Drouant * Anshu Duggal Eugene Kofi Essandoh Christian Jan Fuchs David Patrick Galloway Christopher Michael Garcia Jack George Ghably * Christopher Adam Godlewski Christopher Thomas Hanlon Renata Antunes Joffe Charlene V. Kakimoto * Fatima E. Kasiah Wendy Deirdre Wasden Kriegel * Ryan Sean Mangel Serita Nicole Newton Michael Joseph Pickett Jerrid Alan Pippin Ron Benton Pitkanen * Gregory Conway Risk * Bishoy Tharwat Samuel Eric Lawrence Santiago * Walter Alan Schrading * Morgan Dianne Schulz

Drexel University College of Medicine USMLE Universidad Central Del Este (UCE) USMLE/MA University of Tishreen USMLE/MI Universidad Nacional Mayor De San Marcos USMLE/FL Universidad Central Del Este (UCE) USMLE/FL UASOM Birmingham USMLE/MS UASOM Birmingham USMLE Meharry Medical College School of Medicine USMLE/IN LA State Univ Medical Center In Shreveport USMLE/LA Rosalind Franklin Univ of Medicine and Science USMLE/MI State Uof New York Upstate Medical University USMLE/PA Vanderbilt University School of Medicine USMLE TX A&M Univ Health Science Center COM USMLE/OH U of Med & Dentistry of NJ - NJ Medical Sch USMLE/CT University of Texas Medical School at Galveston USMLE University of Texas Medical School at Galveston USMLE/OK UASOM Birmingham USMLE Fac Med Teresopolis Serra Orgaos Ed Foun USMLE/UT Tufts University School of Medicine USMLE/CA Ross University USMLE/GA UASOM Birmingham USMLE/NY American University of The Caribbean USMLE/MI Meharry Medical College School of Medicine USMLE University of Toledo College of Medicine USMLE/PA Florida State University College of Medicine USMLE University of Tennessee Memphis COM USMLE/TN Indiana University SOM Indianapolis NBME/USMLE/IN University of South Florida College of Medicine USMLE UASOM Birmingham USMLE/OH University of Pittsburgh School of Medicine NBME/PA University of Kentucky College of Medicine USMLE

ABME Public Agenda

1

Endorsement

June 17, 2015

32 33 34 35 36 37 38 39

Michael Edward Seifert Silvi Shah Nancy Sami Shinouda Jarrod Russell Smith Benjamin Arthur von Schweinitz Casey Lee Wang * Andreia Williams White Antoanela Zaharia

University of Connecticut School of Medicine Maulana Azad Medical College U of Delhi Brody SOM at East Carolina University Marshall University School of Medicine University of South Carolina School of Medicine U of TX Southwestern Medical Center at Dallas Pikeville College School Of Osteo Medicine Univ De Medicina Si Farmacie Carol Davila

USMLE/MA USMLE/OH USMLE USMLE/FL USMLE/NE USMLE/TX COMLEX USMLE/ME

Name

Medical School

Endorsement

Oumair Aejaz Osman Zaki Ahmad Nicole Denise Arthur Timothy Ryan Beals Saranya Buppajarntham Sowmya Chandra Reddy Peter Benjamin Daniel Julia Dennis De La Cruz Pena Laura Lynne Dover Colby Ryan Duckett Suneet Wander Dullet Pawel Michal Dutkiewicz Amin Gilani Harsha Canan Gondi Swati Gulati Esmeralda Bondoc Gutierrez-Asis Ewalola Ayo Ijaduola Aprajita Jagpal Kristen Peterson Jijelava Chetan Brahma Kammari Bilal Ahmad Khan Rakhshanda A. Khan Faye Violet Knowles Pongsathorn Kue-A-Pai HongVan Thi Le Samuel Ray Marcrom Sarah Margaret Mauthe Venkat Ram Rakesh Mundra John Thomas Nelson Jr.

Sri Deva Raj Urs Medical College St. Matthew's University Akademia Medyczna Lublin Midwestern University Downers Grove Chulalongkorn University Bangalore Medical College Medical College of Georgia School of Medicine Universidad Autonoma De Santo Domingo UASOM Birmingham Medical College of Georgia School of Medicine Dayanand Med College & Hospital Punjab U Jagiellonian University Medical College Jawaharlal Nehru Medical College Wardha Osmania Medical College Sri Guru Ram Das Inst of Med Sci & Research University of the City of Manila University of Lagos Government Medical College Patiala Emory University School of Medicine Osmania Medical College Medical University of the Americas (Nevis) Dow Medical College University of Karachi Saint Georges University Mahidol Univ Faculty of Med Siriraj Hospital LA State University SOM New Orleans University of Tennessee Memphis COM Saba University School of Medicine Osmania Medical College UASOM Birmingham

USMLE USMLE USMLE/SC COMLEX USMLE USMLE USMLE USMLE USMLE USMLE USMLE/CA USMLE USMLE USMLE USMLE USMLE USMLE USMLE USMLE USMLE USMLE/WY USMLE USMLE USMLE USMLE/LA USMLE USMLE USMLE USMLE

PROVISIONAL ENDORSEMENT

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

ABME Public Agenda

2

June 17, 2015

30 31 32 33 34 35 36 37 38 39

Katherine Andrea Orman Raphael Kobina Quansah Elie Razzouk Rayan Saab Saad Mohammed Shariff Waqar Ahmed Siddiqui Pardip Singh Benjamin Ross Snead Arthur Jordan Stanley Aline Zouk

UASOM Birmingham Inst Superior De Ciencias Med De La Havana American University of Beirut American University of Beirut Bangalore Medical College Bangalore Univ Dow Medical College University of Karachi Xavier University School of Medicine Aruba UASOM Birmingham College of Medicine University of Arkansas American University of Beirut

USMLE USMLE/TX USMLE USMLE/IN USMLE USMLE USMLE USMLE USMLE USMLE/IN

RETIRED SENIOR VOLUNTEER PROGRAM LICENSE (RSVP) Name

Facility

Location

No RSVP Licensure Applicants

SPECIAL PURPOSE LICENSE

1

Name

Location

Type of Practice

Josh Marshall Heck, M.D.

Nashville, TN

Teleradiology

II LIMITED LICENSE

1 2 3 4 5 6 7 8 9 10 11 12 13 14

Name

Medical School

Jeston Clyde Alger Benjamin Donald Hoag * Deepak Joshi Brianna Lea Kendrick Nishant Christoper Khatri Jada Michele Rhymes Efe Sahinoglu Jamie Rae Bishop Benjamin Rhett Butler Ernestine Cherisha Clements Benjamin Robert Gilliland Laura Hyer Allen Nicholas Jarzombek Andrew Annino Kuklinski

Ross University LL/AL TX A&M University Health Science Center COM LL/AL All India Institute of Medical Sciences LL/AL University of Kentucky College of Medicine LL/AL Saint Georges University LL/AL Ross University LL/AL UASOM Birmingham LL/AL William Carey University College of Osteo Med LL/AL Medical College of Georgia School of Medicine LL/AL Ohio University College of Osteopathic Medicine LL/AL University of Mississippi School of Medicine LL/AL University of South Alabama College of MedicineLL/AL University of Texas Medical School at Galveston LL/AL UASOM Birmingham LL/AL

ABME Public Agenda

3

Endorsement

June 17, 2015

15

Joshua David Wilson

Philadelphia Col of Osteo Med- GA Campus

LL/AL

IV PHYSICIAN ASSISTANTS / ADVANCED PRACTICE NURSES (2) Cover Sheet P.A. License

1 2

Name

School

NCCPA

Hannah Clark Nisha Patel

Mississippi College Christian Brothers University

1113602 1111739

School

NCCAA

School

NCCPA

A.A. License Name No A.A. License applicants

Temporary P.A. License Name No Temporary P.A. License Applicants

Temporary P.A. License to Full License

1

Name

School

NCCPA

Kerri Maxcy

Bethel University

1122662

P.A. Registration Without additional duties or remote site; Formulary: #2, #21, and #23 P.A. / Physician

Registration / Formulary Requests

(4)

1.

Kendra Crews, PA Michael Rosemore, D.O.

Registration

(23)

2.

Billy Harmon, PA Jonas Salna, M.D.

Registration Birth Control Drugs and Devices

ABME Public Agenda

4

Recommendation

June 17, 2015

P.A. / Physician

Registration / Formulary Requests

(36)

3.

Lauren Layne, PA Darren Waters, M.D.

Registration Birth Control Drugs and Devices

(46)

4.

James Lombardo, PA Alberto Echeverri, M.D.

Registration

(59)

5.

James McNeely, PA Richard Thoma, M.D.

Registration

(66)

6.

Nisha Patel, PA Harshad Patel, M.D.

Registration Birth Control Drugs and Devices

(77)

7.

Rebekah Posey, PA Tamara Ann Mason, M.D.

Registration Birth Control Drugs and Devices

(89)

8.

Kathleen Strickland, PA Michael Patton, D.O.

Registration

(100)

9.

Katie Riegle, PA Hugh Davis, M.D.

Registration Birth Control Drugs and Devices

(113)

10.

Andrea Womble, PA Bradley Rice, M.D.

Registration Birth Control Drugs and Devices

Recommendation

Additional duties, remote site, formulary requests P.A. / Physician

Registration / Skill / Remote Site / Formulary

(122)

1.

Sheryll Coleman, PA Robert Knizley, M.D.

Registration Remote site Birth Control Drugs and Devices

(135)

2.

Linda Langston, PA Robert Knizley, M.D.

Registration Remote site Birth Control Drugs and Devices

(148)

3.

Harry Wheelock, PA Robert Knizley, M.D.

Registration Remote site Birth Control Drugs and Devices

Recommendation

A.A. Registration No AA registration applicants

P.A. Miscellaneous Requests / Reports P.A. / Physician

Skill; Formulary; Misc Requests

(161)

Documentation of training Joint injection of knee and shoulder

1.

Emily Bent, PA Thomas Johnson, M.D.

ABME Public Agenda

5

Recommendation

June 17, 2015

P.A. / Physician

Skill; Formulary; Misc Requests

Recommendation

(164)

2.

Dana Culpepper, PA Laura Tamburin, M.D.

Facial biopsies

(166)

3.

Claire Dodson, PA Joseph Sherrill, M.D.

Joint injections

(168)

4.

Phillip Farris, PA Randall Riehl, M.D.

Joint injections

(170)

5.

Nicholas Krishnan, PA R. Stacy Tapscott, M.D.

Joint injections

(172)

6.

Kerri Maxcy, PA Calvin Reid, M.D.

PA Formulary Antineoplastic agents Birth control drugs and devices Joint injections

(175)

7.

Allison Seamon, PA Joseph Sherrill, M.D.

Joint injections

(177)

8.

Emily Stewart, PA James Markert, M.D.

Documentation of training Removal of stereotactic head frames

SA (9)

9.

Lindsay Hayler, PA Albert Rivera, D.O.

Non-Ablative factional laser procedures

SA (11)

10.

Stephanie Rivera, PA Albert Rivera, D.O.

Non-Ablative factional laser procedures

P.A. QACSC Registration

1 2

P.A.

Physician

Allison Garstecki Phillip Jernigan

Matthew Barfield, D.O. Bruce Burns, M.D.

PA Limited Purpose Special Permit (180) Cover Sheet Physician / PA / Specialty

LPSP Formulary

(181)

Short Acting Hydrocodone Combinations meds Hydrocodone Cough Preparations Morphine Sulfate Immediate Release (MSIR) Oxycodone-Immediate Release meds Tapentadol-(Nucynta)

1.

Bruce Burns, M.D. Phillip, Jernigan, PA Emergency Medicine

ABME Public Agenda

6

Recommendation Approve Deny

June 17, 2015

Physician / PA / Specialty

LPSP Formulary

(185)

Short Acting Hydrocodone Combination meds; Oxycodone-Immediate Release meds

2.

Juan Ronderos, M.D. Kevin Hites, PA

Recommendation Approve Deny

Neurological Surgery SA (14)

3.

Nilam Patel, M.D. Chelsea Bares, PA

Short Acting Hydrocodone Combination meds; Hydrocodone Cough Preparations Oxycodone-Immediate Release meds

Emergency Medicine

APN Miscellaneous Requests / Reports (186) Cover Sheet Skills Request Within Protocol Physician / APN

Skill; Restricted Drug; Misc Requests

(188)

1.

Deepak Acharya, M.D. Allen W. Mellow, Jr., CRNP

Antineoplastic Agents

(191)

2.

Gerald B Belopolsky, M.D. April M. Lee, CRNP

CVL: Remove and replace over guide wire

(195)

3.

Wayne P. Cockrell, M.D. Brittany McElhaney, CRNP

Trigger point injections below T-12

(198)

4.

Harry P. Erba, M.D. Ellen D. Lazarre, CRNP

Antineoplastic Agents

(200)

5.

Clifton E. Garris, M.D. Karie Ann Bowers, CRNP

Trigger point injections below T-12

(203)

6.

Charles Edward Hall, M.D. Brandy L. Lunsford, CRNP

Trigger point injections below T-12

(206)

7.

Christopher Harmon, M.D. Stacy L. Davidson, CRNP

Antineoplastic Agents

(208)

8.

Paul Maertens, M.D. Matthew E. Barnes, CRNP

Antineoplastic Agents Anti-Rheumatic Drugs: Non-BIologic DMARDS Biologic DMARDS

(212)

9.

Rami Owera, M.D. Nikki Kelley, CRNP

Antineoplastic Agents

10.

Joshua Smith, M.D. Amy S. Riley, CRNP Kristian E. Coon, CRNP

Mid-Level Critical Specialty Protocol

(233) (237)

ABME Public Agenda

7

Recommendation

June 17, 2015

Physician / APN

Skill; Restricted Drug; Misc Requests

11.

Karen E. Stone, M.D. Domineek Guice, CRNP Bonita G. Helms, CRNP

Antineoplastic Agents Anti-Rheumatic Drugs: Non-BIologic DMARDS Biologic DMARDS Non-tNF Inhibitors

(247)

12.

Jonathan A. Storey, M.D. Stacey S. Holman, CRNP

Antineoplastic Agents

(250)

13.

Sudahaker Madanagopal, M.D. Kevin L. Patterson, CRNP

Orthopedic Specialty Protocol

(241) (244)

Recommendation

Skills Requests Outside of Protocol / Miscellaneous Physician / APN

Skill; Restricted Drug; Misc Requests

Recommendation

1.

Gerold B. Belopolsky, M.D. Douglas Stephens, CRNP Whitney B. Holland, CRNP

Mid-Level Critical Care Specialty Protocol Previously approved under other agreement CVL, Remove and replace over guide wire

(300)

2.

Brett Franklin, M.D. Tracy Lynn Porter, CRNP

Documentation of training: Shoulder - 4 Knee - 14 Greater Trochanteric Bursa - 5 Ankle - 1 Elbow - 1

(314)

3.

Eric McCraney, CRNP Maria Murdock, CRNP

Request for pre-approval of CME for QACSC: Pri-Med Chronic Pain, Pain Management CME Modules I - VI

(334)

4.

Gena Kelley, CRNP Robin Hand, CRNP

Request for pre-approval of CME for QACSC: NetCE - Prescription Opioids: Risk Management and Strategies for Safe Use

(392)

5.

FSMB Prescibing CME

Request for pre-approval of CME for QACSC: Safe Prescribing of Extended Release / Long Acting Opioids FSMB Polices on Opioid Prescribing and Office Based Opioid Treatment Responsible Opioid Prescribing

(257) (272)

Collaborative Practice No Collaborative Practice Registration No Collaborative Practice Registration Modifications SA(15)

Collaborative Practice Covering Physician Applicants

ABME Public Agenda

8

June 17, 2015

APN QACSC Registration SA(20)

CRNP / CNM QACSC Registration Applicants

APN Limited Purpose Special Permit (396) Cover Sheet Physician / APN / Specialty

LPSP Formulary

(399)

Shortacting Hydrocodone combination meds Hydrocodone Cough Preparations OxycodoneImmediate Release meds ADHD meds

1.

Alaino Amato, M.D. Lloyd Stokes, CRNP Internal Medicine

(400)

2.

Saadat Ansari, M.D. Julie Boehme, CRNP IM, FP, Pain Management

(402)

3.

Muhammad Ata, M.D. Cathy Olinger, CRNP

Recommendation Approve Deny

Shortacting Hydrocodone combination meds Hydrocodone Cough Preparations Morphine Sulfate longacting Oxycodone longacting Shortacting Hydrocodone combination meds Hydrocodone Cough Preparations ADHD meds

Internal / Family Medicine (403)

4.

Gabrielle Baldwin, M.D. Christyl Hines, CRNP

Hydrocodone Cough Preparations OxycodoneImmediate Release ADHD meds

Pediatrics / Family Practice (404)

5.

Joseph Clark, M.D. Christine Cottrell, CRNP

Shortacting Hydrocodone combination meds OxycodoneImmediate Release meds

Orthopedic / Hand Surgery Acute Care (405)

6.

Gregory Cummings, M.D. Delores Bray, CRNP

ADHD meds

Psychiatry / Mental Hlth / FP 7. (406)

Leesha Ellis-Cox, M.D. Sarah Gilreath, CRNO

ADHD meds

Psychiatry / Mental Hlth / FP (407)

8.

Sanjay Malhotra, M.D. Billie Russell, CRNP

ADHD meds

Psychiatry / Family

ABME Public Agenda

9

June 17, 2015

Physician / APN / Specialty

LPSP Formulary

(408)

Emergency / Family Med

Shortacting Hydrocodone combination meds Hydrocodone Cough Preparations OxycodoneImmediate Release meds Hydromorphone

Jeffrey Todd Smith, M.D. Sara Thompson, CRNP

Morphine Sulfate Immediate Release Tapentadol

Orthopedics / FP

Modification to already approved LPSP formulary

Melissa Thompson, M.D. Paige Harris, CRNP

Shortacting Hydrocodone combination meds Hydrocodone Cough Preparations Morphine Sulfate Immediaterelease OxycodoneImmediate Release meds ADHD meds Fentanyl longacting HydrocodoneER/LA Hydromorphone Morphine Sulfate longacting Oxycodone long acting Oxymorphone longacting

(410)

(411)

9.

10.

11.

Max Shiver, M.D. Sherry Williams, CRNP

FP / Hospitalist / Hospice / Acute Care

(413)

12.

Terry Jay True, M.D. Tabitha Clemons, CRNP

Recommendation Approve Deny

Shortacting Hydrocodone combination meds Hydrocodone Cough Preparations ADHD meds

Family Medicine (414)

13.

Nicholas Vetrano, M.D. Holly Freeman, CRNP Emergency / Family Med

Shortacting Hydrocodone combination meds Hydrocodone Cough Preparations OxycodoneImmediate Release meds ADHD meds

Joint Committee for Advanced Practice Nursing Joint Committee for Advanced Practice Nursing Meeting - June 16, 2015, 6:00 p.m.

V CURRENT BUSINESS (2) (6)

1. 2.

Administrative Rule 540-X-7-.26, Limitations upon Utilization of a PA Administrative Rule 540-X-8: .01, .04, .06, .07, .08, .11, .12, .14, .18, .20, .21, .22, .25, .26, .28

ABME Public Agenda

10

June 17, 2015

(60)

3.

(63) (76) (83) (120) SA(22) SA(23) SA(33) SA(35)

Administrative Rule Chapter 540-X-11, Use of Lasers - Request for opinion 4. Administrative Rule Chapter 540-X-17, Utilization of Controlled Substances for Weight Loss - Request to amend 5. Ethics and Boundaries Assessment Services, LLC 6. Interstate Medical Licensure Compact 7. Telehealth - Med Call Assist Presentation - Wed., June 17, 2015, 10:00 a.m. 8. Administrative Rule 540-X-12, Appendix B Administrative Rule 540-X-18, Appendix B 9. Administrative Rule 540-X-17-.03, Controlled Substances for Weight Reduction 10. Advisory Committee on Administrative Rules Regarding QACSCs for CRNPs and CNMs 11. FSMB - Potential forgery of medical qualifications

PERSONNEL No personnel items

VI HEARINGS (2)

ABME Hearing Schedule

(3) 1. Morris Wayne Cochran, M.D., Birmingham Wednesday, June 17, 2015, 12:30 p.m. Show Cause Hearing

ABME Public Agenda

11

June 17, 2015