GEORGIA COMPOSITE MEDICAL BOARD · 2019-07-11 · Georgia Composite Medical Board Minutes of the January 5, 2017 Meeting 2. ATTORNEY GENERAL’S REPORT . Ms. Wray updated the Board

Georgia Composite Medical Board

Minutes of the January 5, 2017 Meeting

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The Georgia Composite Medical Board (GCMB) held its regular meeting on January 5, 2017 at 2 Peachtree Street, NW Atlanta, Georgia to consider Medical Board matters. Board members present: John S. Antalis, MD, Chair E. Daniel DeLoach, MD, Vice Chair Keisha Callins, MD, MPH Gretchen Collins, MD John Downey, DO Charmaine Faucher, PA-C (ex-officio) Alexander S. Gross, MD Alice A. House, MD, FAAFP Alice House, MD – By Teleconference J. Jeffrey Marshall, MD B. K. Mohan, MD David Retterbush, MD Joe Sam Robinson, MD Ronald “Ronnie” Wallace, MBA Richard Weil, MD

Management and legal staff present: Bob Jeffery, MBA, Executive Director Carl Bedingfield, MD, Assistant Medical Director William Butler, MD, Medical Director Carol Dorsey, Licensure Manager Briana Fry-Jones, Administrative Assistant Karl Reimers, Director, Investigations & Enforcement David Stubins, Senior Assistant Attorney General Patricia Sherman, Enforcement Manager Janet Wray, Senior Assistant Attorney General

CALL TO ORDER Dr. Antalis called the meeting of the Georgia Composite Medical Board to order at 7:30 a.m. AGENDA AND MINUTES Dr. Retterbush submitted a motion, seconded by Dr. DeLoach, to approve the agenda of the December 1, 2016 meeting. The motion carried unanimously. Dr. Deloach submitted a motion, seconded by Dr. Retterbush, to approve the minutes of the November 34, 2016 meeting. The motion carried unanimously. EXECUTIVE SESSION Dr. Gross submitted a motion, seconded by Dr. Callins, to go into executive session to discuss investigative matters. Dr. Antalis declared the meeting in executive session. Upon conclusion of the Board’s discussion of confidential matters, Dr. Antalis declared the meeting in open session. LEGAL / ENFORCEMENT ACTION REPORT Mr. Reimers presented the Legal / Enforcement Action Report. Dr. Gross submitted a motion, seconded by Dr. Retterbush, to accept the report. The motion carried unanimously. The Board took the following actions: 1. 20171129 – Approved to release a copy of investigative interview. 2. Harvey Leslie, MD – Approved order limiting to Schedule V only. 3. 20121132 – Tabled. 4. 20150463 – Approved to release a copy of investigative file. 5. David Katz, MD – Approved amendment to Public Consent order. 6. Andrew Williams, MD – Accepted Voluntary Surrender.



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ATTORNEY GENERAL’S REPORT Ms. Wray updated the Board on the status of matter that have been referred to the Attorney General for legal action. Mr. Wallace submitted a motion, seconded by Dr. DeLoach, to accept the report. RECESS Dr. Antalis declared the meeting in recess for the purpose of holding committee meetings. Upon the conclusion of the committee meetings, Dr. Antalis reconvened the meeting at 2:30 p.m. LICENSURE COMMITTEE Dr. Retterbush presented the Licensure Committee report as a motion. The motion was seconded by Dr. Weil. The Board accepted the report by unanimous vote. The Board took the following actions: Approved Waivers Request: Osuji, Obi – 360-2-.02(5) Denied Waivers Request: Talwalker, Nirupama – 360-2-.01(1) (g) Approved applications for reinstatement: 67611 Sheth, Raj Dilip, MD 59198 Simms, Martin, MD 64292 Vara, Manjula, MD 67825 Viamonte, Carlo, MD 72973 Ameredes, Theodore, DO 68986 Brownridge, Andrea, MD 19668 Doan, Terrence, MD 67294 Eppihimer, Brandon, MD 27270 Aru, Giorgio, MD 66304 Pensabene, Joseph, MD Approved Application for Administrative Physician License: Wills, Marketa, MD Approved Applications pending additional information: 76575 Andrianakos, Rosemary, DO 76111 Carroll, Catherine, MD 76325 Dahl, David, DO 76340 Gardner, John, MD Denied Applications for licensure: 1. A.W. 2. L.E. 3. A.C. (informed applicant the Board would consider a new application after Florida Cares recommendations are completed.)



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Invite for Interview: 1. J.B. 2. J.C. 3. C.E. Other Business: 1. Anderson, Grecori – Approved licensure pending additional information. 2. J.D. - Uphold previous decision to deny licensure. 3. V.E. - Table – For additional information. 4. K.P. - Reviewed for information only. 5. Discussed reporting requirements for medical malpractice. Resolved to update the question on the application form. 6. Discussed requirements for physicians who are licensed in another state but pass USMLE on the fourth attempt or more, or have taken more than the seven-nine years to complete all three steps. Referred to the Attorney General for advice. 7. Doan, Thuy. – Informed petitioner he must complete another year of training prior to sitting for USMLE Step 3, pursuant to the rule. Granted the following applications for licensure: NAME LICENSE ABBAS, MUBASHER 77344 ABOULJOUD, MARWAN SAYED 77345 ADAM, JESSICA KIMBERLY 77346 AGRAWAL, PANKAJ 77347 ANDERSON, GRECORI EOLUS 77374 ANDRIANAKOS, ROSEMARY GEORGE 77383 ARTHUR, ALBERT 77348 BAND, ROGER 77349 BARTNIK, CATHERINE MICHELLE 77350 BEAVERS, JOSEPH BRYAN 77351 BENEFIELD, KAYSI SHAWN 77352 BEUCHERT, PHILIP A 77334 BOWEN, DAVID MATTHEW 77353 BUSTILLO, ALEJANDRA 77376 BYRD, TAMEKA DEANNE 77354 CADDELL, ERIN 77355 CARDWELL, MELISSA ELIZABETH 77336 CERVA, ELIZABETH MARIE 77356 CHORAGUDI, NAGARAJU 77338 COLMER, CECILIA 77339 CREMER, JAVIER 77357 CROMWELL, BRIAN GORDON 77340



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NAME LICENSE DAHL, DAVID NICHOLAS 77378 DAVARPANAHFAKHR, AMIR HOSSEIN 77358 DAVIS, JOSHUA ANDREW 77359 DEATRICH, DYLAN PAUL 77360 DHAKAR, MONICA BHAGWANSINGH 77361 DHINGRA, AMITHA LAUREN 77362 DOLAN, MARY LILLIAN 77363 DONNER, MITCHELL JAMES 77364 DUA, VINEET 77365 ELAMAARI, AKRAM 77341 EZEOKE, CHUKWUEMEKA CHARLES 77375 FABIANO, SARAH EMILY 77366 FAKHRI, ASIF ALI 77342 FARRELL, RUTH ANNE 77367 FOX, JOYCE 77368 GALINDO, RODOLFO JAVIER 77379 GAMMADA, YOMIYYU ZELALEM 77369 GARDNER, JOHN ALAN 77381 GHAFOURIAN, PEGAH 77370 GILL, JAMES R 77337 GORDON, LATIFFANY TENNILLE 77371 GRAHAM, ANTONIO ANDRE 77372 GROVES, CHARLES 77343 GUNTER, TREY ALEXANDER 77373 HAJJARI, JAMAL 77278 HALL, NICOLE RUDDOCK 77377 HONIG, JAIMY FIELDS 77279 HOODA, RAHUL MICHAEL 77280 HORNER, PAUL 77380 KAILES, STEVEN BENJAMIN 77284 LE, THIEN-KIM PHAN 77286 LISKO, JOHN CYRIL 77287 MABINA, ASHLEY 77289 MCLAUGHLIN, WILLIAM DAVIS 77288 MEHTA, ASHIM 77292 NICHOLS, SYDNEY 77296 OSUJI, OBI UGOCHUKWU 77281 PALLA, JYOTHSNA 77282 PARKS, MATTHEW DAVID 77283 PATEL, VIMAL HARSHAD 77285 PECHON, CATHERINE 77290



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NAME LICENSE PENZI, LEO JOHN 77291 PETERSEN, TINA A 77293 PHILLIPS, LARA LEA 77294 PRATER, MICHAEL CANAAN 77295 PRICE, CRAIG CHARLES 77297 QAISAR, ADEEL 77298 RATHJEN, NICHOLAS 77299 RIGGS, JOHN MICHAEL VIDAL 77300 RIZZO, KATHRYN ANN 77301 ROSENTHAL, JACQUELINE FAULKNER 77302 SAMARA, ALEXANDER 77305 SANCHEZ SALAZAR, ALMA JUDITH 77306 SCHMIT, KRISTINE MARIE 77307 SCOTT, DEREK SEAN 77308 SEEYAVE, DESIREE MICHELLE 77310 SHAH, HEMANG JAGDISH 77311 SHALL, JEFFREY FAIN 77303 SHAO, WANDA 77312 SIMON, SHANNON MURPHY 77313 SINGH, HARLEEN 77314 SISTER, IGOR DR 77304 SMITH, BENJAMIN DANIEL 77315 SOLEYE, OLAOLU OMOTAYO 77316 STALOCH, DUSTIN 77317 STAM, MADELEINE 77318 STEWART, JOHN 77309 SUHAG, SHIKHA 77319 TAKHAR, MANBIR K 77320 TASKAR, VARSHA SURENDRANATH 77382 THODIMA, PRADEEP REDDY 77321 VAN WONTERGHEM, OLENA 77323 VEGA BLANCO, ROGER MARTIN 77322 WALL, SIMEON H JR 77324 WELLS, J DENISE 77325 WETSCHLER, MATTHEW 77326 WILLIAMS, ANNIE LEE 77327 WILLS, MARKETA MICHELLE 77335 WILSON, DIANA LORRAINE 77328 WINSLOW, CAROLINE YANCEY 77329 WOLFE, CHRISTOPHER 77330 YAPUNDICH, ROBERT ANTHONY 77331



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NAME LICENSE YOUENS, KENNETH EMORY 77332 ZALZALA, SAJAD 77333

NURSE PROTOCOL COMMITTEE Dr. Antalis presented the Nurse Protocol Committee report as a motion. The motion was seconded by Dr. Marshall. The Board accepted the report by unanimous vote. The Board took the following actions:

The Board determined that the following protocol agreements meet the provisions of OCGA 43-34-25: APRN DELEGATING PHYSICIAN Alegre-Guzman, Melissa Lloyd, Edward MD Allen, Terrie Metts, Jeffrey MD Arenas, Georgia Ann Molina, Fernando MD Baker, Tracy Coker, Mark MD Beckles, Saphia Patel, Satishchandra MD Bennett, Carie Tan, Corazon MD Boggs, Heather Capes, James MD Borders, Amber Glasson, Julie MD Brinkley, Josephine Williams, Rebecca MD Chagani, Salimah Pirani, Aziz MD Cheely, Terre Johnson, Craig MD Cheeseman, Karen Johnson, Craig MD Cheeseman, Karen Dutta, Eamon MD Cheeseman, Karen Kahn, Neil MD Cheeseman, Karen Reddy, Svathi MD Childress-Rodriguez, Robin Ladipo, Olanrewaju MD Durr, Laura Katner, Harold MD Fish, Alisa Josephson, Cassanora MD Gebreyonas, Samuel Co, Carter MD Getsinger, Patricia Frederick, Alison MD Harrell, Roy Vayalapalli, Sreevedi MD Hartley, Daniel Oddi, Bernard MD Head, Ashley Shaner, John MD Hernandez, Emily Deshpande, Shriprasad MD Jackson-Randall, Marjay Vayalapalli, Sreevedi MD Jackson-Randall, Marjay Katragadda, Suneel MD Johnson, Angela Kahn, Neil MD Jones, Casey Soltero-Diaz, Augusto MD Keys, Callie Obua, Anedi MD Madden, Katherine Slivkha-Villalon, Laura MD Marbut, Holly Gul, Afaq, MD Marcel, Solange Noragbon, Leo MD McCall-Gaston, Natalie Rogan, James MD



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McCier, Khelsea Lennon, Vivian MD McKinney, Leila Tan, Corazan MD O’Connor, Reagan Dukes, Richard MD Patterson, Katisha Gordon, Stephanie MD Roberts, Rebecca Henderson, Scott MD Scarborough, Michele Nulph, Michael MD Slaughter, Genevieve Guest, Thomas MD Smith, Kem Owens, Crystal MD Snowden, Viva Canady, Sheryl MD Stephens, Bryan Ahmed, Mushtaq MD Stough, Ashley Steis, Richard MD Sturdivant, Shuconda Reddy, Svathi MD Sturdivant, Shuconda Dutta, Eamon MD Tanner-Torres, Barbara Dalvi, Anant MD Taylor, Delisha Gartmond, Cindy MD Thompson, Andrea Soltero-Diaz, Augusto MD Thornton, Amanda Khurana, Ritu MD Tickle, Kelly Sidonio, Robert MD Uwazie, Nkeiru Vayalapalli, Sreevedi MD Uwazie, Nkeiru Reddy, Svathi MD Waddell, Karen Johnson, Craig MD Woolfolk, Kalemah Co, Carter MD Yates, Susan Hare, Joshua DO Young, Glenda Ajayi, Ganiat MD Kapatkin, Maureen Baker, Alison MD Krekenburger, Denise Siegfried, Martin MD

Administrative Approvals:

APRN DELEGATING PHYSICIAN Allen, Jane Kearns, Stratton MD Anderson, Karen Dega, Sreevalli MD Asmerom, Mussie Patel, Pikalkumar MD Barbee, Kimberly Chapman, Thaddeus MD Barber, Ronald Omarova, Saida MD Barnes, Stacey Black, Jamess MD Bartha, Zsuzsanna Castellano, Maria MD Bastia, Jean Otis, Powell MD Beck, Stacy Case, Joshua MD Belouche, Renato Ille, Mihaela MD Berry, Kelly Howard, Anthony MD Besse, Jennifer Davidson, Nicole MD Bobb, Brittney Kheda, Mufaddal MD Bond, Barbara Rheaume, Maki MD Boyette, Kelly Rill, Matthew MD Boyette, Kelly Greene, James MD Brisibe, Modupeola Ahmed, Mohonned MD



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Brooks, Alexandria Estevez, Lester DO Brown, Ludella Bauer, Lauren MD Cannova, Dawn Coto-Puckett, Wendy MD Chambers, Donna Wolfson, Ilya MD Chambers, Natalie Hall, Jonathan MD Clark, Ann Marie Norquist, Grayson MD Coffee, Shanon Campbell, Robert MD Coffey, Jacey Sogade, Felix MD Comer, Lauren Kallianos, George MD Cooper, Miranda Levit, Ronald MD Cothern, Stephanie James-Peters, Catherine MD Cravey, Amy Ibezi-Enendu, Alexander DO Cruz, Morales Esmerardo Soyoola, Emmanuel MD Dailey, Jake Conner, Franklin MD Davis, Anastasia Dega, Sreevalli, MD Davis-Evans, Chassidy Fain III, Guy MD Dedo, Sarah McBarron, Jan MD Dillon, Laura Lamp, Jeffrey MD Dimmerling, Miranda Grossman, Jenny MD Douthit, Melissa Kaur, Onkar MD Drye, Mark Wood, John MD Dykeman, Elizabeth Lamp, Jeffrey MD Efik, Udeme Bashir, Khalid MD Farris, Scott Lin, Cliff MD Fenelon, Snavly Kong, Stephanie MD Finney, Charlene Kludt, John MD Fitzgerald, Kimberly Doran, John MD Flood, Vernell Alvarado, Anastasia MD Ford, Deborah Lane, Kayln MD Frawley, Stacy Perkins, Jonathan MD French, Heather Renz, Barry MD Fussell, Elizabeth Rengifo-Moreno, Pablo MD Garofano, Philip Thopu, Anuradha MD Geller, Daniel Schapiro, Lillian MD Giuliano, Keri Wachsmuth, Rhonda MD Gloster, Charles Smith, LaMont MD Grindley, Ashley Jasti, Jayanti MD Hallen, Caroline Katz, Michael MD Hamrick, Denise Austin, Jack Jr., MD Haney,Daniel Patel, Bhavish MD Hargraves, Andrea Stubley, Robinson MD Harris, Betti Richardson, Matthew MD Hayes, Rebekah Hanowell, Alison MD Helms, Rachel Adisa, Wasiu DO Hogue-Kinahan, Janice Kloster, Gilber MD Holley, Nelda Garrison, Joel DO



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Huggins, Kharism McHenry, Michael MD Hustad, Catherine Harris, John MD Jarrett, Jared Holder Jr., Dennis MD Jernander, Brandi Ibezi-Enendu, Alexander DO Johnson, Kimberly Ibezi-Enendu, Alexander DO Jolly, Erin Karia, Parshak MD Jurado, Steffanee Smith, Dustin MD Kasper, Lauren Doran, John MD Kirshner, Caroline Coleman, Holly MD Koho, Mary Chapman, Thaddeus MD LaCoste, Kathelina Erdman, Pamela MD Lemons, Maria Uzzle, Raulnina MD Little, Deborah Wood, John MD Marder, Judith Copeland, Jack MD Marder, Judith Gibbs, Marti MD Massey, Emily Orig, Maria MD Mayberry, Shara Golub, Lucas MD McCloud-Davis, Donna Garrison, Joel DO McCollum, Joyce Little, Stephen MD McKenzie-Ming, Tania Huggins, Michelle MD McMahon, Angela Rougeou, Glendon MD McNair, Deborah Beckford, Rita MD McNeely-Strickland, Summer Tankersley, William MD Merritt, Cathy Elmore, Kathryn MD Miles, Kia Hutchings, Warrron MD Mishra, Margeret Ho, Chen-Kung MD Mobley, Mary Khan, Zia MD Moreland, Kayona Watkins, William MD Nessing, Cynthia Souza, John MD Newby, Jessica Campbell, Robert MD Nguyen, Hong Diem MgBodile, Francisca MD Obialor, Naomi Roy, Deanna MD Okibedi-Ahanotu, Alphonsa Del Pozo, Robert MD Onoh, Anthony Lacoste, Marcel MD Osborne, Lauren Orr, Stephen DO Owens, Cheryl Ann Griggs, Lisa MD Oyerinde, Mercy Erdman, Pamela MD Parent, Marie-Andree Naik, Jayesh MD Parr, Kathryn Bender, Jonathan MD Patti, Farrah Sheth, Darshana MD Paulk, Rhonda Souza, John MD Payne, Erica Capo, George MD Perdomo, Kelly Brownlow, Roy MD Perkins, Deana Ellis, Rueben MD Peterman, Gerald Greene, Dwayne MD Powell, Silona Watkins, William MD



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Ray, Rita Novak, Joseph MD Reeves, Merrilea Capo, George MD Reid, Verona Sabom, Michael MD Reinhardt, Jessica Cowart, Loy III MD Rivas, Marie Patel, Chirag MD Robinson, Antwala Mihalovits, Karl MD Roe, Robin L. Griggs, Lisa Irene MD Saulsby-Smith, Amy Sotus-Nawar, Athena MD Scully, Rosemarie Trammel, Demaree MD Simpson, Leigh Wheeler, James MD Sissom, Kasey Geravis, John MD Smith, Daniel Smith, LaMont MD Smith, Lorna Bashir, Khalid MD Sperduto, Erica Olliff, Stacy MD Splawn, Brenda Parrado, Carlos MD Stewart, Jacquelyn Smith, Dustin MD Stewart, Letitia Smith, LaMont MD Strickland, Thomas Sangapu, Sahithi MD Stroud, Melissa Long, Eugene MD Tatum, Lindsey Nayak, Kalpana MD Taylor, Jodi Bashuk, Robert MD Thomson, Susan Watkins, Clyde Jr., MD Tippens, Julie Yamamoto, Christopher MD Tur, Louisa Bradley, Steven DO Vernon, Jennifer Rehme, Suzanne MD White, sharon Henry, Heather MD Whittenberg, Kerri Howard, Raymond MD Williams, Tina Kini, Sarvotham MD Wilson, Elizabeth McCollum, Barbara MD Wilson, Lavona Beckford, Rita MD Woods, Beverly Erdman, Pamela MD Woods, Shakira Pointer, Melanie MD Woo-Shefield, Marci Gerguis, Angela MD Wright, Denise Shah, Mobin MD Yandel, Susan Walton, Richard MD Young, Angelique Bonsu, Felix MD

The Board determined that the following protocol agreements meet the provisions of OCGA 43-34-25 with additions/changes:

APRN DELEGATING PHYSICIAN James, Cindy Wheeler, Richard MD Jobe, Susan Beckford, Rita MD Johnson, Angela Kahn, Neil MD McNair, Deborah Sabom, Michael MD



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Mistry, Hunaiza Vermeer, Todd MD Nelson, Melissa Taj, Jabeen MD Nofzinger, Angel Bullington, Karen MD Painter, Susan Kahn, Neil MD Payne, Cynthia Beckford, Rita MD Randolph, Bridget Yahanda, Alan MD Rhymes, Monica Burton, Frederick MD

Other Business: APRNs cannot perform mini-liposuction procedures. Board to advise Committee which Georgia statute to refer to. Adding Procedures:

1. Approved - Jennifer Lovell, NP –add joint injection procedure to agreement with Davin Mitchell, MD.

PHYSICIAN ASSISTANT COMMITTEE Dr. Antalis presented the Physician Assistant Committee report as a motion. The motion was seconded by Dr. Marshall. The Board accepted the report by unanimous vote. The Board took the following actions: Approved the following applications for initial licensure: Name License# Supervising Physician Brown, Margracious L 8243 Carney, Kenneth Jeff Hall, Morgan Janelle 8242 Roddy, Stephanie Hamilton, Caroline Adele 8230 Sudduth, Colman David Nelson, Erik C 8232 Black, Robert Phillips, Melanie Elaine 8233 Buelvas, Raul Pool, Miranda Jalene 8244 Lavender, Allen Randolph, Elizabeth 8231 Coopersmith, Craig Simpkins, Lindsay Nicole 8234 Heiss, Erik Thomas, Charlsie Anna 8235 Lovell, Tracy Wallace, Trevor 8236 Chen, Ryan

Approved the following applications for initial licensure without a supervising physician: Name License# Campbell, Dereck G 8237 Leard, Taylor A 8238 Meza, Kate 8245 Pankowski, Laura 8239 Smith, Stuart 8240 West, Erica J 8241



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Approved the following request for additional duties: PA PHYSICIAN Erica Campbell Jeffery Miller

- Endoscopic vein harvesting Omar Ortega Laurence Busse - Pulmonary artery catheter - Chest tubes - Arterial lines - Central lines - Thoracentesis - Intubation

Invite for interview: D.J. Approved Quarterly report: J.W. Other Business: 1. Jennifer Jones – Tabled request. Approved the following applications to add/change supervising physicians: Physician Assistant License # Supervising Physician Abazeri, Natalia 7592 Carter, Richard Ackerman, Jaime 4056 Anand, Girish Ackerman, Jaime 4056 Hon, Huiming Amorello, Jessica 8212 Guy, Amorello Anderson, Christine Ann 4789 Harmon, Khary Oronde Anderson, Lorenzo 5655 Nguyen, Jacqueline Ann Bailey, Melissa 6852 Rathinam, Alfred Vijay Beacham, Laura Colier 7924 Stonecipher, Marcus Randall Berman, Kathryn Suzanne 8064 Opanuga, Ademola Adebayo Bishop, Margaret Dolores 7392 Pruitt, Russell Franklin Blench, Anne Kagey 5911 Alizadeh, Diana Maria Blomenkamp, Melaina 8119 Vargas-Morris, Faye Brand, Cynthia Steward 2664 Walker, Justin Wayne Breeden, Amanda 6596 Hall, Patrick Anthony Xavier Casanova, Pedro Juan 2333 Richman, Daniel Casanova, Rosemarie 5231 Hatmaker, David Larry Cottrell, Morgan Taylor 8135 Omeruah, Chiazom Chinwe Dacey, Christina Michelle 7597 Oddi, Bernard Francis Davida, Naresh 7937 Thomas, Joshua



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Physician Assistant License # Supervising Physician Delozier, Daniel Patrick 3119 Wilkes, Joseph Sheppard Deveal, Maria 7845 Bailey, Amy Elizabeth Deveal, Maria 7845 David, Leslie Alvin Deveal, Maria 7845 Loomes, Rebecca Joan Diaz, Lindsey Christina 5627 Golden, Stephen Charles Evbuomwan, Enoma 6473 Omarova, Saida Fontimayor, Richard John 7785 Tiernan, Steven M Freeman, Leslie 1861 Dynn, Joel Gillespie, Brittney 6857 McCartney, Daryl Grogan, Deana Lee 5379 Gantomasso, John Harris, Valerie 7050 Roach, Michael Hemingway, Allison Winn 3089 Banu Anam, Sharmin Hubbarth, Justin B 5765 Raffoul, Julian John Irwin, Rebecca Anne 2355 Badre, Shenon Elaine Langeman, Tiffan 4980 Mangrum, Shane Lovvorn, Crystal 5561 Wynn, Brett Miltz, Danielle Christine 7749 Patel, Vishal Mimbs, Nancy 7396 Coffey, Mark Francis Modi, Pratik Denendra 6993 Amin, Kaushik Mohammed, Nadia 6154 Fletcher, Taylor Gard Mora, Joanne 7808 Smith, Lamont Charles Ncho, Clement 6000 Donnelly, Cassandra Oakley, Thomas 5430 Kushins, Stephen Orcuttm, Susan 4483 Brown, Benjamin Ortega, Omar A 6996 Busse, Laurence Osedo, David 4945 Nguyen, Jacqueline Ann Panchetti, Fabiola Nneka 7543 Nguyen, Jacqueline Ann Pettis, Shalonda 4248 Pettus, Charles William Phillips, Heidi Nicole 7612 Hallerbach, Marco Pointer, Michael 4134 Steinwachs, Paul Ricketts, Francine 4218 Nguyen, Jacqueline Ann Sallusti, Andrea Marie 6017 Arellano, Martha Lucia Shah, Nidhi Anil 7900 Shack, Richard Keogh Jr. Sheth, Ferrin P. 7158 Greenberg, Joel I Sikes, Robert 7607 Jackson, Ralph Snipes, Steven 3586 Wendland, Scott Strickland-Tillman, Denise A 2165 Barczak, Brian Edward Sullivan, Richard 7161 Gibbs, Marti Takkallapalli, Akhila 7163 Jonnala, Geetha Tatum, Ricky O 2235 Kennedy, Scott Herbert Tatum, Ricky O 2235 Kennedy, Scott Herbert



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Physician Assistant License # Supervising Physician Trogdon, Virginia Balkcom 7723 Rusu, Daniela Wheeler, Courtney 6404 Kallianos, George William, Tanya 4633 Jones, Christopher Witsiepe, Kara Nisbet 7256 Tan, Corazon Cabrera Zeemer, Patrick Lee 5357 Patel, Reena

PERFUSION COMMITTEE Dr. Gross presented the Perfusion Committee report as a motion. The motion was seconded by Dr. Mohan. The Board accepted the report by unanimous vote. The Board took the following actions: Approved applications for Initial licensure: Name License# Bruno, Melissa 280 Tilahun, Daniel 279

Other Business: Appointed Milton Wilkes and Yancey Mooney to serve on the Perfusion Committee. RESPIRATORY CARE COMMITTEE Dr. Collins presented the Respiratory Care Committee report as a motion. The motion was seconded by Dr. Downey. The Board accepted the report by unanimous vote. The Board took the following actions: Approved the following applicants requesting a 12-month permit: Name License# Bowman, James Lee Jr 10484 Burns, David C 10513 Butler, Latoya 10462 Clay, Midale I 10488 Darnell, Shayla Rebecca 10467 Dryden, Tiffany R 10511 Gibson, Emily Lynn 10494 Hamilton, Joey 10463 Hand, Amber Lorraine 10468 Hannah, Kierre Lashawn 10464 Hilton, Connie 10478



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Hopper, Christopher Lloyd 10489 Horne Jr, Stephen Wayne 10479 Howell, Shelby Lynn 10469 Jackson, Samyia L 10510 Jarrett, Rachael Annette 10480 Jones, Jaclyn J 10472 Jordan, Candice Patrice Nicole 10466 Kalala, Gisele M 10486 Key, Rebecca Lynn 10512 Konitzer, Stephanie Bullard 10499 Legard, Roshena Quinnea 10481 Lumpkin, Corey 10495 Mize, Megan A 10482 Muller, Eileen Bridget 10496 Osei Baah, Alice 10483 Pruitt, Randall Scott 10473 Riceman, Bethany 10503 Rivera, Luvenia R 10487 Sanders, Kayla Erin 10465 Stalvey, Cassie Jae 10474 Stefani, Carrie Marie 10501 Thrift, Kayla Angelynn 10470 Tran, Jeremy Hien 10475 Trotter, Shavakia Kenyata 10506 Waters, Ladundra Shamer 10471 Williams, Victoria Elizabeth 10476 Woodworth, Ronald Wayne 10477 Wright, Amber Nicole 10508

Approved Applicants requesting licensure by Reciprocity: Name License# Brown, Breyanna Shontae 10509 Burton-Mahdi, Aliah 10515 Coe, Michael Allen 10505 Connor, Harley Arthur Ii 10502 Cresswell, Keith Gerald 10490 Culp, Michael 10498 Fabish, Chantal Monique 10491 Glass, Madelene 10514 Gray, Patty R 10497 Guatelli, Ralph Lawrence 10485



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Joseph, Sony 10500 Kinneer, Gabriel 10492 Smith, William Edward 10504 Steubing, John-Mark N 10507 Thomas, Deion Deangelo 10493

Approved Applications for Reinstatement: Name License# Allred, Jean M 2535 Clemons, Mia Branetta 9074 Davis, Michael 8285 Meyers, Zanna Peterson 1375 Patel, Neha Mukund 8117 Ray, Marilyn 7948 Rosema, Pamela Eisel 286 Sapateh, Marie Bintu 8670 Taylor, Courtney Lynn 9306 Taylor, Juan Serrell 6093 Washburn, Timothy Thomas 8841

Tabled: ST – Refer to AG Office Administratively approved upgrades from 12 month permits to full RCP license: Adams, Christina Brantley, Eric Brooks, Erica Carter Michelle Colbert, diamond Davis, Jennifer Dixon, Amber Engram, Doris Garcia, Gayle Harper, Shakia Henry, Ann Hughes-Macey, Mary Minter, Tiffany Ortega-McGriff Ringold, Carrie Sellers, Jordan Sagnibene, Nicholas Thomas, Martha Tingero-Rodriguez, Yulinda



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Westmoreland, Summer Williams, Alison Wynn, Jecolean Yang, Stephanie Youngblood, Rebekah Zavala, Pedro R. Other Business: 1. Approved to add two Committee members. Larry Arnson Jan Fernandez 2. Beginning January 2017, the Committee will review application files mid-month as well as at Board meeting time. Those approved mid-month will be licensed and then added to monthly agenda as admin-approved applications. 3. Clemons, Nia – Approved reinstatement with a Consent Order. COSMETIC LASER PRACTITIONER COMMITTEE Dr. Gross presented the Cosmetic Laser Practitioner Committee report as a motion. The motion was seconded by Dr. Mohan. The Board accepted the report by unanimous vote. The Board took the following actions: The Committee went into closed session to discuss Advisory Committee matters. Dr. Gross declared the meeting in open session. Approved Applications for Assistant Laser License: Name License# Allen, Savannah G 749 Charania, Rukshar N 750 Ding, Ruolan 751 Duckworth, Loretta L 752 Estes, Sarah E 753 Figal, Tanya 766 Gutierrez, Aurora 754 Hatzenbeller, Sara 755 Jackson, Mary P 756 Kirk, Lauren B 757 Macolino, Karen Karpers 758 Maldonado, Lorena 759 Nasir, Qura-Tul-Ain 760 Rigdon, Brittney 761 Saccoccia, Sharon Lynn 762



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Name License# Taylor, Molly B 763 Towsley-Fields, Rebecca 764 Williams, Kehia 765

Tabled Assistant Laser Applications: T.B. C.T. Approved Applications for Senior Laser License: Name License# Cooper, Debra Denise 243 Figal, Tanya 244 Gregory, Kristin Marie 118

Other Business: Approved accepting verifications from the Alabama Cosmetology Board’s website. PAIN MANAGEMENT CLINIC COMMITTEE Dr. Weil presented the Pain Management Clinic Committee report as a motion. The motion was seconded by Dr. DeLoach. The Board accepted the report by unanimous vote. The Board took the following actions: Approved Initial application: 412 – Comprehensive Spine and Pain Clinic, LLC Approved Applications to add or change practitioners, managing employees, or business hours.: 312 – 313 Pain Care, LLC Delete Practicing Physician: Nazario Villasenor pending additional information. 398 – Roswell Pain Specialist Add Practicing Physician: Nazario Villasenor 153 – Pain Management and Wellness Center Revise Business Hours 422 – Center For Spine and Pain Medicine – (Gadnesville2) Delete APRN: Kalita Rollins 381 – Ancora Pain Recovery Add Physician assistant: William Brandon Newby Revise hours of physician assistant: Britttany Fox Revise hours of practicing physician: Chinonye Orizu Revise hours of APRN: Lori Leonard 146 – Ancora Pain Recovery Revise hours of physician assistant: Brandon Newby Revise hours of physician assistant: Britttany Fox



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Revise hours of practicing physician: Chinonye Orizu Revise hours of practicing physician: Dawnetta Janene Holladay Revise hours of APRN: Lori Leonard 144 – Ancora Pain Recovery Add: APRN Lori Leonard Revise hours of physician assistant: Brittany Fox Revise hours of practicing physician: Chinonye Orizu 116 – Georgia Pain and Spine Care – Peachtree Add APRN: Kelly Perdomo Delete Practicing Physician: Mrylyn Delille Other Business: 1. Board clarified: that a clinic is not required to submit an application or form to utilize a practitioner at any new location or to revise his/her hours if that practitioner is already approved by the Board to work at one of the clinic’s locations. ACUPUNCTURIST COMMITTEE Dr. Downey presented the Acupuncturist Committee report as a motion. The motion was seconded by Dr. Weil. The Board accepted the report by unanimous vote. The Board took the following actions: Approved applications for Initial licensure: Name License# Moksa Battle, Jameel Mikal 394 Wolf, Rachel 395

Approved a quarterly report and upgraded from Limited Licensure to Full Licensure: Name License# Tran, Hannah Hanh 378

Approved request for reinstatement of license: Name License# Choi, Han Ah 309

Approved physician request for Acupuncture privileges: Granger, James MD Other Business: 1. Confirmed that apprenticeship through the NCCAOM guidelines satisfies the education portion of Acupuncture Limited License Education requirement. 2. Tabled revision of FAQ’s on board website. 3. Accepted as information – the list of limited licensees and supervisors.



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RULES COMMITTEE Dr. Gross presented the Rules Committee report as a motion. The motion was seconded by Dr. Retterbush. The Board accepted the report by unanimous vote. The Board took the following actions: 1. Sent a draft of a proposed amendment to Rule 360-15-.01 to require physicians to complete continuing medical education in the prescribing of controlled substances for the treatment of pain. 2. Posted an amendment to Rule 360-3-.07 for public comment. 3. Resolved to discuss revisions to proposed standards for the practice of providing specialized intravenous medications or supplements. EXECUTIVE SESSION Dr. Retterbush submitted a motion, seconded by Dr. DeLoach, to go into executive session to discuss investigative matters. Dr. Antalis declared the meeting in executive session. Upon conclusion of the Board’s discussion of confidential matters, Dr. Antalis declared the meeting in open session. WELLNESS COMMITTEE Dr. Gross presented the Wellness Committee report. Dr. Gross submitted a motion, seconded by Dr. Retterbush, to accept the report. The Board accepted the report by unanimous vote. The Board took the following actions: 1. PHP report received from Paul Earley, MD. 2. DS – Refer back to PA committee for Peer assessment 3. PH – Refer back to Licensure to grant license 4. PJ – Refer back to Licensure to grant license 5. TJ – Refer to Georgia PHP 6. HM – Table for interview. INVESTIGATIVE COMMITTEE Dr. DeLoach presented the Investigative Committee report as a motion. Dr. Weil seconded the motion. The Board accepted the report by unanimous vote. The Board took the following actions: INVESTIGATIVE INTERVIEW REPORT

Daniel DeLoach, M.D. presented the Investigative Interview report as a motion, and was seconded by David Retterbush, M.D. The Board accepted the report by unanimous vote. The Board took the following actions.

20160727 Tabled 20161777 Refer to AG 20160734 Refer to AG 20161912 Letter of Concern 20161360 Letter of Concern 20162398 Close/No Action



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20161633 Refer to AG 20162450 Close/No Action INVESTIGATIVE COMMITTEE The Investigative Committee report was presented as a motion by David Retterbush, M.D., and was seconded by Daniel DeLoach, M.D. The Board accepted the report by unanimous vote. The Board took the following actions.

Close: 20150420 20150654 20150953 20161951 20162022 20162131 20162388 20170165 20170345 20170351 20170355 20170403 20170453 20170594 20170627 20162032 20151012 20160448 20161850 20161976 20162032 20162109 20162255 20162262 20162377 20162448 20162455 20170034 20170056 20170057 20170104 20170340 20170341 20170346 20170350 20170354 20170356 20170395 20170399 20170407 20170438 20170454 20170456 20170457 20170460 20170462 20170465 20170466 20170504 20170589 20170591 20170680 20170789 20170963 20171068 20171135 Further Investigation 20162490 Close with Letter of Concern: 20150983 20161165 20161167 20161426 20161671 20170201 20170362 20170409 20170591 Invite for Investigative Interview: 20161226 20161278 20161485 OMPE 20162026 20162238 Table 20160820 20170797 20162258 INITIAL COMPLAINT EVALUATIONS

The Board approved the following recommendations.

20170919 20170920 20170925 20170931 20170932 20170936 20170937 20170938 20170940 20170941 20170950 20170958 20170959 20170968 20170970 20170972 20170974 20170975 20170980 20170981 20170982 20170983 20170985 20170997 20170999 20171004 20171005 20171008 20171010 20171013 20171014 20171016 20171033 20171034 20171042 20171043 20171045 20171050 20171051 20171057 20171065 20171069 20171072 20171073 20171074 20171096 20171104 20170716

RECUSALS



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Antalis 20161777 20161912 20162238 20170716

DeLoach 20161912 20160820 20162262 20170716 20170925 20171010

Downey 20161278 20161633 20161671 20170351

Gross 20162450

Marshall 20161951

Mohan 20170341 20170465

Retterbush 20162022 20170589 20170716

There being no other business, Dr. DeLoach submitted a motion, seconded by Dr. Weil, to adjourn the meeting. The motion carried unanimously. Dr. Antalis adjourned the meeting at 4:15 pm. ____________________________ ________________________________ John Antalis, MD Robert Jeffery, MBA Chairperson Executive Director

Documents

GEORGIA COMPOSITE MEDICAL BOARD · 2019-07-11 · Georgia Composite Medical Board Minutes of the January 5, 2017 Meeting 2. ATTORNEY GENERAL’S REPORT . Ms. Wray updated the Board