GEORGIA COMPOSITE MEDICAL BOARD · Kia Hargrove, Licensure Manager . Karl Reimers, Deputy Executive Director . Patricia Sherman, Enforcement Manager ... Dr. Antalis reconvened the

Georgia Composite Medical Board

Minutes of the June 8-9, 2017 Meeting

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The Georgia Composite Medical Board (GCMB) held its regular meeting on June 8 and June 9, 2017 at 1430 John Wesley Gilbert Drive, Augusta, 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 J. Jeffrey Marshall, M David Retterbush, MD Joe Sam Robinson, MD Barby Simmons, DO Ronald “Ronnie” Wallace, MBA Richard Weil, MD Board Members absent: B. K. Mohan, MD

Management and legal staff present: Bob Jeffery, MBA, Executive Director Carl Bedingfield, MD, Assistant Medical Director Tara Burks, Operations Manager William Butler, MD, Medical Director Briana Fry-Jones, Executive Assistant Kia Hargrove, Licensure Manager Karl Reimers, Deputy Executive Director Patricia Sherman, Enforcement Manager David Stubins, Senior Assistant Attorney General Doris Williams-McNeely, Senior Assistant Attorney General Janet Wray, Senior Assistant Attorney General

CALL TO ORDER Dr. Antalis called the meeting of the Georgia Composite Medical Board to order at 8:00 AM, June 8, 2017. AGENDA AND MINUTES Dr. DeLoach submitted a motion, seconded by Dr. Retterbush, to approve the agenda of the June 8-9, 2017 meeting. The motion carried unanimously. Dr. Deloach submitted a motion, seconded by Dr. Retterbush, to approve the minutes of the May 4, 2017 meeting. The motion carried unanimously. CHAIR’S REPORT Dr. Antalis presented a proposed public statement concerning the Board’s handling of cases in which licensees were found to have committed sexual misconduct and/or boundary violations. Dr. Retterbush offered a motion, seconded by Dr. DeLoach, to adopt the statement and to release it to the public after the June 2017 meeting concluded. The motion carried unanimously. The Board adopted the following statement: “It is the intent of the Board to protect Georgia patients from physicians who use coercion or power for sex by:

• EDUCATING physicians about the importance of reporting colleagues who may be committing boundary violations;

• INVESTIGATING every allegation and involving law enforcement when the investigation reveals criminal activity;



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• ENFORCING allegations that are proven by issuance of a Public Consent Order or Revocation of their medical license.”

ELECTION OF J. JEFFREY MARSHALL, MD, TO VICE-CHAIR FOR FY 2018 TERM Dr. Weil submitted a motion, seconded by Dr. DeLoach, to nominate Dr. Marshall for the position of Vice-Chair of the Board for the term beginning July 1, 2017 and ending June 30, 2017. Dr. Antalis called for any other nominations. No other nominations were submitted. Dr. Antalis called for a vote on the motion, and it passed unanimously. ELECTION OF E. DANIEL DELOACH, MD, TO CHAIR FOR FY 2018 TERM Dr. Retterbush submitted a motion, seconded by Dr. Robinson, to nominate Dr. DeLoach for the position of Chair of the Board for the term beginning July 1, 2017 and ending June 30, 2017. Dr. Antalis called for any other nominations. No other nominations were submitted. Dr. Antalis called for a vote on the motion, and it passed unanimously. CLOSED SESSION Dr. Gross offered a motion to go into closed session to discuss confidential personnel matters. The motion was seconded by Dr. Retterbush, and it carried unanimously. Upon conclusion of the Board’s discussion, Dr. Antalis declared the meeting in open session. REMARKS BY DAVID HESS, MD Dr. Antalis thanked David Hess, MD, Dean of the Medical College of Georgia, for MCG’s gracious hospitality in hosting the June 2017 Board meeting. Dr. Hess welcomed the Board to Augusta and gave a presentation about MCG and its student body. RECESS Dr. Antalis declared the meeting in recess for the purpose of holding committee meetings. RECONVENED Dr. Antalis reconvened the meeting of the Georgia Composite Medical Board at 3:00 PM, June 8, 2017. EXECUTIVE DIRECTOR’S REPORT Mr. Jeffery presented his report. The Board took the following actions: 1. Adopted a policy for the administrative approval of physician licensure applications. 2. Reviewed an inquiry from Robert Dindoffer, attorney with The Health Law Partners, asking for guidance on whether a Georgia licensee who is physically located outside the state, and who does not have primary responsibility for the care/diagnoses of a patient who is physically located in Georgia, is permitted to order laboratory testing for such patients based upon review of their medical records and without any face-to-face interaction or real-time remote communication. The inquiry further specified that the physician is not responsible for collecting samples or making diagnose of any condition, and the patient has signed proper informed consent forms. The Board asked Mr. Dindoffer to clarify who would collect the sample and interpret the results. 3. Asked Mr. Jeffery to include an article in the July newsletter concerning the new requirements for PDMP registration.



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CLOSED SESSION Dr. Gross offered a motion to go into closed session to discuss personnel and attorney/client-privileged matters pursuant to O.C.G.A. Sec. 50-14-3(b)(2) and O.C.G.A. Sec. 50-14-3(b)(4). Dr. Retterbush seconded the motion, and it carried unanimously. Upon conclusion of the Board’s discussion, Dr. Antalis declared the meeting in open session. BOARD ACTIONS 1. Upon a motion by Dr. Weil, seconded by Dr. Retterbush, asked Mr. Jeffery to the report the progress of process improvement activities to the Board in July. 2. Upon a motion by Dr. Weil, seconded by Dr. Retterbush, affirmed all hires made since June 2016. 3. Upon a motion by Dr. Gross, seconded by Dr. Marshall, empowered the executive committee to approve all personnel and contracting matters. 4. Upon a motion by Dr. Retterbush, seconded by Dr. DeLoach the Board requested the Department of Community Health’s Office of Human Resources to investigate some specific personnel matters; and to reinstate Phyllis White and place her on administrative leave with pay and to place Brianna Fry-Jones on administrative leave with pay effective June 9, 2017 pending receipt and review of the report from Department of Community Health’s Office of Human Resources. CLOSED SESSION Dr. Retterbush offered a motion to go into closed session to discuss confidential enforcement and investigation matters. The motion was seconded by Dr. DeLoach, and it carried unanimously. Upon conclusion of the confidential matters, Dr. Antalis declared the meeting in open session. LEGAL / ENFORCEMENT ACTION REPORT Mr. Reimers presented the Legal / Enforcement Action Report. Dr. Retterbush submitted a motion, seconded by Mr. Wallace, to accept the report. The motion carried unanimously. The Board took the following actions:

1. Bernard Ram, MD - Approved Public Consent Order 2. 20161640 - Approved request for copy of licensure application 3. Gary Moore, MD - Approved Public Consent Order 4. 20121132 - Withdraw request for summary suspension 5. 20091017 - Terminate Private Consent Order 6. 20162270 - Withdraw request to mirror other state action 7. Daniel Bailey, MD - Accept request for Inactive Status 8. David Katz, MD - Accepted request to lift probation 9. Richard Dukes, MD - Approved Public Consent Order 10. 20151126 - Close 11. Fred Potts, MD - Approved amendment to Public Consent Order 12. 20151229 - Deny request for information

CLOSED SESSION



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Dr. Gross offered a motion to go into closed session to discuss confidential enforcement and application matters. The motion was seconded by Dr. DeLoach, and it carried unanimously. Upon conclusion of the confidential matters, Dr. Antalis declared the meeting in open session. Representative Rick Williams RECONVENE Dr. Antalis reconvened the meeting Friday June 9, 2017 at 8:00 am Board members present: 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 J. Jeffrey Marshall, M David Retterbush, MD Joe Sam Robinson, MD Barby Simmons, DO Ronald “Ronnie” Wallace, MBA Richard Weil, MD Board Members absent: John S. Antalis, MD, B. K. Mohan, MD

Management and legal staff present: Bob Jeffery, MBA, Executive Director Carl Bedingfield, MD, Assistant Medical Director Tara Burks, Operations Manager William Butler, MD, Medical Director Briana Fry-Jones, Executive Assistant Kia Hargrove, Licensure Manager Karl Reimers, Deputy Executive Director Patricia Sherman, Enforcement Manager David Stubins, Senior Assistant Attorney General Doris Williams-McNeely, Senior Assistant Attorney General Janet Wray, Senior Assistant Attorney General

CALL TO ORDER Dr. Antalis called the meeting of the Georgia Composite Medical Board to order at 8:00 AM, June 9, 2017. LICENSURE COMMITTEE Dr. Retterbush presented the Licensure 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: Other business: 1. Approved GCMB Policy on Issuance of Physician & Educational training permits. 2. Jennifer Peer – Approved request for records of Dr. Thomas Campen’s internship verification from the University of Kentucky. 3. DD – Refer to Wellness. 4. RG – Deny or allow to withdraw. 5. HT - Clinical Skills Examination or Administrative Physician License. 6. RA – Invite for interview. 7. RM - Clinical Skills Examination.



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8. RA – Invite for interview. 9. RA – Deny. 10. RP – Clinical Skills Examination or Administrative Physician License 11. JM - Invite for interview. 12. JK - Allow to Withdraw and complete application for GA RTP. 13. JM – Approved licensure. 14. KT - Deny or Allow to Withdraw. 15. TM – Invite for interview. 16. JA - Withdrew application. Approved the following applications for reinstatement of licensure: Approved the following applications pending additional information: Approved the following applications for licensure: Approve Pending Receipt of Additional Information

77689 ABUJAKMEH, YOUSEF DO 77504 AFIELD, WALTER MD 76657 ANTOSH, IVAN MD 77019 BROWN, SETH MD 57914 CLINKSCALES, NORMAN MD 78038 COSTELLO, JUSTIN DO 78018 D' SOUZA, ADAM MD 77710 DEPEW, JAMES MD 77725 DHAND, MENAKA MD 77566 DUCHICELA, KEEGAN MD 77868 FONTIMAYOR, CHRISTOPHER MD 76873 GONZALEZ DE PENA, REYNALDO MD 76206 GRIFFIN, BRENT MD 77898 PATEL, AJAYKUMAR MD 63429 PHAM, TU THAO HAM R MD SCHROEDER, GERARD MD 76428 TAVAREZ, MARINO DE JESUS MD 51991 URSO, JAMES MD

NURSE PROTOCOL COMMITTEE Dr. Callins presented the Nurse Protocol Committee report as a motion. The motion was seconded by Dr. DeLoach. The Board accepted the report by unanimous vote.



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The Board took the following actions: Approved the following protocol agreements meet the provisions of OCGA 43-34-25:

APRN DELEGATING PHYSICIAN Barnes, Sangduan Clayton, Mitzi MD Bennett, Tracy Allen, Paul MD Blanks, Evelinn Edmonds, Kevin MD Bobbitt, Charlotte Westmoreland, Heather MD Boodhoo, Jacqueline Lyday, William MD Brock, La-Urshalar Goginini, Keerthi MD Calloway, Shelby Rehman, Obaid MD Chastain, Mary Ajibowo, Olalekan MD Coleman, Marion Jones, David MD Coleman, Marion Pinera, Emile MD Conner, Danielle Cottrell, Leslie MD Dahlmann, Ashley Gretz, Kenneth MD Demby, Taheerah Nwosu, Hillary MD Dill, Winston Morton, David MD Garcia, Rosa Raju, Shveta Hemmings, Colette Yancey, Arthur MD Jenkins, D’Etta Nayak, Gururaj MD Johnson, Lari Howard, Kenneth MD Johnson, Lowanda Banks, Terry MD Marshall, Shawanda Brown, Eric MD Martinez, Nancy Dawson, Leia DO McDuffie, DeAndra Ketterl, Petra MD Ogelsby, Amber Williams, Byron MD Parker, Sarah Ajibowo, Olalekan MD Pittman, Bonnie Laney, Jason MD Rhodes, Kristen Yen, Andrew MD Roberts, Megan Sofianos, D’Mitri MD Shaw, Kyla Bills, Elbridge MD Showalter, Rebecca Hall, Jerry MD Slaughter, Traci Guy-Craft, Wanda MD Spangler, Sydney Joyner, Andrea MD Spivey, Jennifer Davis, William MD Sullivan, Caitlin Durham, Megan MD Swiger, Nicole Asbury, Gregory MD Turk, Christy Patel, Kashyap MD Tyus, Angela Surratt, Darrell MD Van Dellen, Stephanie Harris, Rashante MD Walker, Erica Raol, Nikhila MD Wilke, Kimberly Rogers, Stephen MD Wills, Valerie Frank, Karen DO



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Yerke, Julie Desmond, John MD Zanghi,Wila Al-shroof, Mohammad Zelano, Patricia Harris, Rashante MD Ratified the following administrative approvals: APRN DELEGATING PHYSICIAN Abebe, Mahlet Mihalovits,Karl MD Abel, Janinne Little, Williams MD Anderson, Melissa Palmer, Kristopher MD Andrews, Lekita Subramanian, Ram MD Barrett, Kasie Duddleston, Leland MD Benson, Ellen Gibson, Donald MD Boone, Karene Ross, Brian MD Brinkley, Ashley Harbison, Kamesha MD Brooks, Alexandria Shelton, Timothy MD Brooks, Deborah Walker, Paul DO Bryzkcy, Sara Keating, William MD Capps, Lindsay Monacha, Anuj MD Cole, Kimberly Ayer, Robert MD Coleman, Angelica Copeland, Jack MD Coleman, Angelica Reisman, Andrew MD Contiero, Rafael Lee,Peter MD Conyers, Shanika Pantin, Jeremy MD Corbin, Traci Nussbaum, Julian MD Crane, Christina Saunders, David MD Daniels, Michael Darji, Jaykrishna MD Darling, Meagan Gluckman, Richard MD Davis, Sarah Terry, Jeffrey MD Downey, Gloria Merai, Prakash MD Ebanga, Agbor Moore, Charles MD Elango, Theresa Chay, Wesley MD Evans, Kimberly Velasquez, Jonathan MD Faudree, Cyndi George, Vijia MD Fenderson, Lavon Dubs, Tyler MD Ferry-Redmond, Erin Bailey, Marion Md Forter, Kelsey Driskell, Amber MD Gallardo, Eduardo Dubs, Tyler MD Gibson, Christy Makomber, Scheri-lyn MD Gibson, Kyle Richart, Charles MD Gilmer, Anna Gebhart, Charles MD Glover, Petra Hubbuch, Sebastian MD Gohacki, Robin Shroff, Sahir MD Gorgoglione, Caroline Jaffal, Andy MD Green, Nathalie Johnson, Miles MD



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Gunawan, Alyssa Woodward, Maribel MD Hammond, Rebecca Simpson, Michael MD Harper, Katharine Orquia, Amber MD Harrell, Cori Maxa, Richard MD Hasty, Angel Jansen, Phillip MD Henry, Sheridan Jaffal, Andy MD Hensley, Pamela Minor, Russell MD Herring, James III Bailey, Brian MD Huggins, Sandra Van Schuyver, Donna DO Ikonne, Blessing Purdie, Allan MD Jackson, Elizabeth Shah, Neha MD Jamison, Dallarie Strunk, John MD Jarrett, Jared Nulph, Michael MD Jefferson, Chari Saxena, Abhinav MD Joiner, Kimberly Upshaw, Thomas MD Jones, Shangrila Lascar, Mihai MD Jurgensen, Katharine Abboud, Elia MD Knight, Krystal Avery, Naila MD Ko, Jung Jaffal, Andy MD Kuo, Michael Hawes, Robert MD Lipcomb, Cheri Ross, Brian MD MacCullum, Eileen Cassimatis, Dimitri MD Madden, Joann Sharma, Sarita MD Mahmoud, Rita Bhuyan, Iffat MD Martinez, Frances Simon, Dawn MD Massey, Megan Shah, Neha MD McCaslin, Christine Miller-Sanders, Kyauna MD McConnell, Derick Coleman, Holly MD McCook, Joyce Rudolph-Watson, Lisa MD McGahee, Emily Bray, David MD McGhee, John Hendricks, Mark MD McKinney, Leila Asreal, David MD McLaurin,Nancy Kingman, Amy MD McMillan, Shadae Allen,Radcliff MD Middleton, Travis Currier, Steven MD Miller, Tashana Lefkowitz, Janet DO Montgomery, Kristen Edwards, Michael MD Moon, Matthew Valancius, Daniel MD Myers, Robin Bond, Toby MD Nicome, Karlystra Robertson, David MD Novett, Barbara Haller, Jeffrey MD Okeh, Jennifer Sheth, Darshana MD Oniyirimba, Esther Oluwole, Olugini MD Pair, Sarah Elliot, Raizes MD Pasley, Jennifer Spandofer, Philip MD Pass, Sherry Weksler, Alicia MD



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Peavy, Jessica Jeshuran, Winston Pierson-Elam, Sylvia Thakore, Hetal MD Pitts, Billy Urbonols, Arunas MD Plant, Kelley Goodman, Patrick MD Poole, Katy Dinges, David MD Potter, Amanda Johnson, Steven MD Prayter, Susan Paritz, Brandon DO Quinn, Brandi Onwuanyi, Anekwe Quyen, Le Zudong, Zhang MD Reeder, Sally Bendeck, Kirsten MD Revely, Arleen Ahmad, Kashif MD Rice, Crystal Tuyl, Ronald MD Rice, Cynthia McDowell, Angela MD Ricker, Gail Madrazo, Nelson MD Rivers, Tammy Zafar, Mozhgan MD Rogers, John Dinatti, Louis MD Sanders, Jessica Oskins, Christina MD Sariev, Michelle Costley, Chad MD Schiffbauer, Christopher Oester, John MD Schneider, Cynthia Akhlaghi, Mohsen MD Scroggins, Sherri Weksler, Alicia MD Scruggs, Haley Veale, Jr., William MD Sharova, Yelena Zarandy, Joy DO Simpson, Alicia DeVeau, Joseph Singh, Pushpa Galea, Charles MD Sinnott, Anita Alford, Brady MD Smith, Elizabeth Alford, Brady MD Soles, Stanley Saxena, Abhinar MD Spell,Kaylin Lanclos, Kevin MD Spruill-Barton, Tamu Rahman,Afroz MD Stamegna, Lynn Fadia, Toral MD Standefer, Kimberly Jansen, Phillip DO Stephens, Amanda Bond, Toby MD Stout, Mandy Saunders, David MD Strange, Haley Lyons, Lynn DO Sumner, Melissa Austin, William MD Symonnett, Mary Mukund, Raja MD Taylor, Lauren Denton, Whitney MD Teal, Oscar Rengifo-Moreno, Pablo MD Thomas-Cloud, Rosemary Dara, Tanvir MD Tuberville-Trujillo, Linda Lea, Janice MD Vantress, Niambi Akbashev, Mikhail MD Verme, Mirose Paritz, Brandon MD Vincent, Jessica Wyrzkowski, Amy MD Wahl, Kimberly Shivdat, John MD Ward, Tekeia Nwoke, Mary MD



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Williams,Thomas Velez, Rachel MD Wilson, Sandra Brown, James MD Woods, Melanie Khan, Muhammad MD Woods,Deidre Prasad, Vijitha MD Woo-Sheffield, Marci Pohl, Stephen MD Wright, Karen Hussain, Hina MD Young, Michelle Bailey, James MD Youngstrom, Carol Caruso, Michael MD Zodarecky, Krista Lightfoot, Harry MD Determined the following protocol agreements meet the provisions of OCGA 43-34-25 with additions/changes: APRN DELEGATING PHYSICIAN Duvall, Lee McCormick, Gerald DO Kennedy-Howell, Phyllis Pandey, Ajitabh MD Lehr, Nicole Mahle, William MD Mangum, April Leimbach, Mark MD Mathis, Kimberly Gordon, Stephanie MD Murner, Danette Killian, Colleen MD Peacock, Leah Killian, Colleen MD Rotramel, Elise Granville, Robert MD Patrick, Jessica Ray, Alpa MD Yerke, Julie Desmond, John MD Zanghi, Wila Al-Shroof, Mohammed MD Other Business: 1. Mackenzie King, NP – Approved request to US Guided Thoracentesis to approved agreement with Praveen C. Reddy, MD PHYSICIAN ASSISTANT COMMITTEE Dr. Antalis presented the Physician Assistant Committee report as a motion. The motion was seconded by Dr. Callins. The Board accepted the report by unanimous vote. The Board took the following actions: Approve the following applications for initial licensure with a supervising physician: PA Supervising Physician Baker, Kirsten Elaine Hartley, Charles Bryce Ii Ball, Sarah Melinda Gaitan Rueda, Juan Israel Brooker, Katelyn Michelle McCartney, Donald Keith Brown, Katrina Elizabeth York, Michael Jonathan Carr, Lindsay Tompkins McGee, Tracy Scott Cowart, Kinsley Marie Gaitan Rueda, Juan Israel Eppert, Lauren Nicole Lassiter, Richard Gray Fullerton, Ashley Angela Bosley, Michael Thomas



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Grand Pierre, Karl Yves M Matricia, Daniel James Harvey, Amelia Mccane Coker, Mark A Houston, Jordan Thomas Wiggins, Travis Frank Janus, Olivia Irene Ogbu, Ogbonna Chigozie Jones, Mallory Kenney, Jeffrey Ronald Kolkowski, Katherine Hunter, Matthew Thomas Liu, Elizabeth Yung Hui Hazen, Matthew Lewis Loutzenhiser, James Matthew Rubin, Raymond Amory McEwen, Michael Noonburg, Greer Edwin Mesinger, Ramona Elena Gaitan Rueda, Juan Israel Miller, Clayton Morris Velky, John Robert Newberry, Kelsey Alden Ashfaq, Salman Nguyen, Tan Duy Nguyen, Thomas Aiquoc O'Brien, Megan Christine Fowler, Donald Edward Iii Okerblad, Courtney Lynn Coley, Curtis James Ii Okusaga, Olutosin Brewbaker, Carey Owens, Christi Sheree Pandit, Lotika Parker, Stefanie Mashell Hall, Eric Lee Perkins, Regina Manley, Valarie Wright Ridge, Rachael Schlessinger, Cynthia Shelton, Mackenzie Grace Elkin, Gary Joseph Soule, Gina Christy, Jonathan Michael Tavolieri, Nathan David Kilbourne, Michael Van Putten-Laguerre, Alana Sherman, Roby Angelina Hirst Williams, Ashley Kornblatt, Benjamin

Approved the following applications for initial licensure without a supervising physician: PA Cooke, Thomas Ryan Foster, Allison Taylor Johnson, Colin Wayne Monroe, Mary Seals, Tyler Chase

Approved the following application for reinstatement with a supervising physician: PA Supervising Physician Johnson, Cheri Kay Dugal, James Joseph Approve the following application for reinstatement with a supervising physician, pending additional information: PA Supervising Physician Stewart, Tammy Ann Manley, Suzanne C Williams, Mary Alison Babcock, Melissa Dawn



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Administratively approve the following application for initial licensure: PA Supervising Physician Hoffman, Bethany Ann Daniels, Craig Edward Approve the following Add/Change applications: PA Supervising Physician ADUSEI, PATRICK 7426 BENDECK, KIRSTEN 66456

AHMADI, FARIDA 7505 MARCHAL, MATTHEW WALTER 70678

ALBRITTON, JULIAN 7996 HAVILAND, KEITH FRANCIS 69010

BAUER, ANNA MARIE 1950 ALBERT, JEFFREY JAY 39030

BECK, JESSICA 8221 WALKER-BLAKE, TAMEKA 62448

BERGS, KARA ROSE 8128 BOND, TOBY MAUGANS 43880

BIRON, EDWINA STRICKLAND 1987 CARTER, DAVID JAMES 77979

BIRON, EDWINA STRICKLAND 1987 KILBOURNE, MICHAEL 77825

BIRON, EDWINA STRICKLAND 1987 STOUFFER, CHADWICK WILLIAM 74786

BIRON, EDWINA STRICKLAND 1987 STOUFFER, CHADWICK WILLIAM 74786

BOATRIGHT, PHILLIP GREGORYJR 8107 RAY, JAMES L 16126

BRADSHAW, TOBIAS WAYNE 4187 HALL, DARRYL CROSSWRIGHT 71802

BROWN, LINDSEY MICHELLE 7130 HARRIS, RASHANTE 62706

BRUNIERA, TIAGO 7644 STOUFFER, CHADWICK WILLIAM 74786

BRUNIERA, TIAGO POLESELLI 7644 CARTER, DAVID JAMES 77979

BRUNIERA, TIAGO POLESELLI 7644 KILBOURNE, MICHAEL 77825

BRUNIERA, TIAGO POLESELLI 7644 STOUFFER, CHADWICK WILLIAM 74786

BUTLER, MOLLY ANN 7839 HARRIS, RASHANTE 62706

BUZZETTI, DAVID MARK 2978 BRODERICK, DANIEL KIM 74476

CHIARIELLO, SHERYL CABALZ 4023 BRODERICK, DANIEL KIM 74476

CLARK, SARAH JEANNE 6073 BENDECK, KIRSTEN 66456

COLLINS, JESSICA ELLA 4460 S IDDIQUI, MAHMOOD ABDUL QADIR 77779

COSTE, ROBERT CLARK 6907 BRODERICK, DANIEL KIM 74476

COX, THOMAS MITCHELL 7652 NELSON, JEREMY 72048

CULVER, ROBERT LEE 2849 SWAMI, RAJENDRA VIPIN 30226



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DAYA, UMA TRIVEDI 5779 PHILIP, ALICE JYOTHI 61320

DENMARK, GAVIN HEATH 6778 DEPERSIO, KENNETH PATRICK 53329

DINH, ELIZABETH ANN 8222 GANJAM, SATISHKUMAR

MUDDURANGANATH 61583 DIRUGGIERO, DOUGLAS

CHARLES JR 3061 CHUNG, JOHN YOHAN 41532

DUTLINGER, ROBERT CHRISTIAN 8139 CARTER, DAVID JAMES 77979

DUTLINGER, ROBERT CHRISTIAN 8139 STOUFFER, CHADWICK WILLIAM 74786

DUTLINGER, ROBERT CHRISTIAN 8139 STOUFFER, CHADWICK WILLIAM 74786

DYER, MATTHEW CHARLES 4783 ROBERTSON, JAMES VAN 16544

ELDER, TORRA YEVETTE 3553 MCELLIGOTT, THOMAS JOSEPH 37617

ESHLEMAN, BRANDON LEE 6606 WALKER, MARIA LATANYA 25306

EVERETT, SARAH KATHERINE 6098 CARTER, DAVID JAMES 77979

EVERETT, SARAH KATHERINE 6098 KILBOURNE, MICHAEL 77825

EVERETT, SARAH KATHERINE 6098 STOUFFER, CHADWICK WILLIAM 74786

EVERETT, SARAH KATHERINE 6098 STOUFFER, CHADWICK WILLIAM 74786

FARRELL, KATHRYN KRAMER 6260 RICHMAN, DANIEL 70765

FOGELGREN, LAUREN BLANKSTEIN 6485 PATEL, KAVITA 68850

FORRESTER, MICHELLE CONKLIN 5879 PATEL, NIPUN BALDEVBHAI 46800

GOLDBERG, AMBER 6074 MESSNER, STEPHEN ANTHONY 59282

GUNTER, CLIFTON III 2562 HALL, DARRYL CROSSWRIGHT 71802

HAJKHAN, REZA 3911 ODAME, ISABELLA ZITA 77276

HOWELL, DAWN C 6180 GEORGE, VIJIA P 68161

HOWELL, DAWN C 6180 SLAUGHTER, CHAD CHRISTOPHER 62003

HURST, LUSHUNDA MARIE 4402 OWENS, CRYSTAL DENISE 48854

JAMES, GRIER MARSHBURN 5153 BRODERICK, DANIEL KIM 74476

JENNINGS, DONNA FAYE 6577 GARST, STEVE WILFRED 48047

JONES, GARY PAUL 3366 WEIGANDT, PAMELA 51609

KHAN, REJA 7794 OMERUAH, CHIAZOM CHINWE 75091

KINNEY, GABRIELLE POTTS 7815 ZADOFF, ANDREW DAVID 23419



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LANDRY, ERIN MOSKOS 7022 RHYANT, RODERICK HARDING 53560

LOWRY, ELIZABETH LEE 5579 SILLAH, CHERINOR 58222

LYNCH, JEFFREY PAUL 3072 LEHMAN, ERIC 32231

MATADI, SHIDIGA FRANCINE 4525 PARROTT, THOMAS BRINKLEY 63514

MCCALL, RACHEL DIANE 6519 RUDY, MATTHEW 70904

MCCORMICK, MICHAEL T 5405 KHAN, NABEEL A 56847

MEHTA, BHAVIK DHYANESH 7751 PATTON, KIMBALL FRANKLIN 34435

MELKUS, CAROLYN MCLAUGHLIN 7894 CARSON, JOHN DAVIDSON 16321

MILAM, DEBORAH J 3018 PATTERSON, PATRICIA FAYE 31176

MOHAMMAD, SHAMIM ARA 5475 OWENS, CRYSTAL DENISE 48854

MOHAMMED, EKLAS I 3642 WILSON, ALVIN T III 33494

MORGAN, E ALLEN JR 999 PREVOSTI, LOUIS GREGORY 34923

MULDER, PATRICIA CHU 7610 AJABOR, KENNETH 70846

MURPHY, AIMEE MARIE 8354 PETERS, CRAIG G 46212

OSEDO, DAVID 6034 POLK, REYNALDO ANTOINE 48928

PARDUE, ALISON STOERI 6943 SWAMI, RAJENDRA VIPIN 30226

PARKS, MORGAN WENDELL 8188 AKHLAGHI, MOHSEN 56672

PATEL, ALYSSA PRAVIN 8308 PIRZADA, JEHANGIR TANVEER 72082

PERRY, ALLISON NICOLE 7830 KINNEBREW, PATRICK SILER 76075

PISHGOU, MAHBOUBEH 7119 FERGUSON, CATHERINE LOWRIE 62692

PORTER, DEANA JEAN 7550 SADEGHI, RAMIN 73808

PRASAD, KAPILDEV 5687 TAKAWIRA, NGANO TONGESAI FRANK 73500

QADRI, ISHTYAQ YASIEN 7448 KHAN, ZIA L 62533

RADEMACHER, ERIKA LEIGH 7878 SIMON, STUART JAY 32053

RECTOR, MEAGAN 8325 DELOACH, BRIAN MIXON 51216

RENFROE, BRITTANY WHEELER 6168 BROWN, BARBARA LYNN 49878

ROBB, DANIELLE LINDSEY 5722 SALZBERG, BRUCE ANDREW 29775

ROSENTHAL, JOSEPH ARYEH 7439 TAKAWIRA, NGANO TONGESAI FRANK 73500

SAEZ, LOUIS C 3785 KINNEBREW, PATRICK SILER 76075



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SILVERMAN, SHAWNA LEE 5319 THAMPY, KISHORE JULIAN 46504

SMITH, JAWAUNA MARIE 6455 HUSSAIN, HINA 55063

SMITH, JAWAUNA MARIE 6455 WOLFSON, ILYA 51860

SNYDER, MELODY DELINA 6395 COLLIER, MILLARD J JR 28114

STUBBS, ELIZABETH JEAN 6225 KHAN, NABEEL A 56847

TAYLOR, ADAKY CHIBUNDO 8285 DELL'AGLIO, DAMON MICHAEL MD 55940

VAUGHN, MICHAEL ALAN 1573 ROBERTSON, JAMES VAN 16544

WALL, FREDA ELLEN 2766 BATEMAN, JOE WILLIAM 51019

WATKINS, ANGELA C 3237 AYERS, RUSS ROBERT 64500

ZAYAS, TEDDI T 3274 HANNA, MARK WESLEY 49359

Approved the following add/change applications, pending additional information:

ADEBISI, RASAKI 6902 KINNEBREW, PATRICK SILER 76075

GOODNER, ANDREW WADE 6047 KLEIN, ANDREW JOHN 74671

MILLER, EBONI CHAUNTAE 7152 PIERLUISI, GUILLERMO JOAQUIN 53314

NEMATOLLAHI, SHEKOFE 6300 KIMES, DAMON CHRISTIAN 50322

Approved the following Additional Duties Request: 1. Suzanne Bressler PA-C—with Dr. Praveen Reddy

Abdominal Pleurx

2. Christine Ertley PA-C—with Dr. Robert Klafter

Moderate Sedation

3. Hilary Karp PA-C—with Dr. John Prologo

CT Bone Marrow Biopsy

CT Guided Bone Marrow Biopsy

Pleurx Drain Placement

4. Shekofe Nematollahi PA-C—with Dr. Damon Kimes

Botox

5. Catherine Patterson PA-C—with Dr. Robert Klafter

Moderate Sedation

Bone Marrow Biopsy and Aspiration



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6. Kelly Summers PA-C—with Dr. Mark El-Deiry

Fine Needle Aspiration Biopsy without image guidance

Open Incisional Biopsy of the head and neck

Flexible Fiberoptic Laryngoscopy

7. Courtney Wheeler PA-C—with Dr. George Kallianos

CT Guided Bone Marrow Aspiration

US Guided Paracentesis

Fluoroscopic Lumber Puncture with Myelogram/Chemotherapy

8. Mary Williams PA-C—with Dr. Melissa Babcock

Botox Injections

Facial Fillers

Tabled Additional Duties Request:

1. Shekofe Nematollahi PA-C—with Dr. Damon Kimes

Facial Fillers –specify type of fillers

BHRT (bio-identical hormone placement therapy) –clarify

Other Business:

1. Graduates of Campbell University may be eligible for licensure in Georgia if the school is accredited and graduates are eligible for the examination administered by either the NCCPA or NCCAA or their successors. 2. Kara Nisbett Witsiepe, PA- Request to dispense does not meet the requirement outlined in OCGA 43-34-23 which specifies the situations in which a physician may delegate to a PA the authority to dispense. 3. Lisa Cardenas Perkins, PA- Must reapply in order to be considered for reinstatement of license, since application has expired. Application can then be approved with non-disciplinary consent order to complete 240 shadowing hours with quarterly reports to be completed within 6mths. Shadowing hours must be completed under a Board approved physician in a doctor office, not a school. If not completed within required time-frame, license may be revoked without the option of appearing before the Board to contest the revocation. 4. Jacqueline Phillips, PA- Approve initial licensure application; physician must see all of her patients for 1 month and submit quarterly reports for 6 month period. RESPIRATORY CARE COMMITTEE Dr. Collins presented the Respiratory Care Committee report as a motion. The motion was seconded by Dr. Callins. The Board accepted the report by unanimous vote.



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The Board took the following actions: Approved request for Initial Licensure: MAYDEN, REGINA

Approved the following applications for licensure by reciprocity: ARRINGTON, TERRI AUGUSTE, STEPHANIE BELL, SHARELL BOLES, TIFFIANY DILLARD, JESSICA HILL, ZENONNA MCCANN, SCHAFFER MORRIS, TERESA MURRAY, DOREEN PATTERSON, ASHLEY RICE, LILLIAN ROBUSTELLI, JASON STOLTZ, JAMI THOMAS, SAMEIKA WILLIAMS, CHRISTOPHER BOLTON, MICHELE JOHNSON, KIMBERLY OSEN, SOUMAYA GRAHAM, RON – pending additional information Approved the following applications for Reinstatement: BARBER, STEFANIE HUNTER, KENNETH KELLAR, TAMMY MINER, JOANNA MCCAIN, CARRIE Approved the following applicants requesting a 12-month permit: ARMSTRONG: OVERSTREET, LARISHA WILEY, CHRISTINA AUGUSTA UNIVERSITY: BLUME, MATTHEW BOUTWELL, CHIRSTINA BRANTLEY, MICHAEL BRAYBOY, LATERRIA COGHLAN, ALLYSON DOYLE, SHELBY FOSKEY, COREY GEBREEGZIABHAR, ABUSH



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GINN, MEGHAN GEORGE, SANGLEY HALLMAN, LEIGH HOWRD, COURTNEY PAOILIN, MARISSA SALTER, CHELSEA SAVAGE, KIMBERLY SUPPA, CHRISTINA CALIFORNIA COLLEGE: LYNCH, MICHAEL DALTON STATE: WALLS, ANDREA OCONEE TECH: GREEN, JESSICA HALL, KARONDA HALL, KIMBERLY HOLLAND, CHELSEA KILLINGSWORTH, KAITLYN MORGAN, BLAKE RHODES, CHRISTINA ROYAL, BRITTANY THOMAS, RAMAHD ZANDERS, VALERIA BRIGHTWOOD CAREER INSTITUTE: DOUGLAS, SHOSHANNA DALTON: AKIN, CARRINGTON Ratified the following administratively approved upgrades to full RCP license: AYRAKWA, MARY BOHANNON, DEIDRA BOWMAN, JAMES CARROLL, HALEY CHIAPPETTO, CHARLES CLEVENGER, PHONEPASEUT DYER, CASSANDRA EJIGU, ETSEGENT FIELDS, JONATHAN FOUNTAIN, BROOKE FRENYA, BRYAN FERGUSON, SHAREECE GOPAUL-BATES, OLIVIA



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HOWELL, SHELBY JORDAN, LEAH JOYNER, BRITTANY KALALA, GISELE KENNEDY, SEKINA MARSOCCI, NICOLE MORENCY, VALERIA NOBLES, AMELIA PEACOCK, BENJAMIN PRUITT, RANDALL RICHARDSON, KENDRA ROGERS, KIZZEL SANDIFORD, SHATEQUE SMITH, ANNA SMITH, NICOLETTE SUTTON, MANJORIE THRASHER, DONALD WEST, STEPHANIE Other Business:

1. Discussed temporary permit holders’ petitions to waive Rule 360-13-.03 to extend their twelve-month permit. The petitions were granted to 4 out of 5 RCPs who are currently working; the extension is for 3 months from the date of their request to allow them enough time to complete the 90-days requirement to obtain their permanent license: Giibons, Tishira- 8/11/17 Gilmore, Kimberly- 8/15/17 Frenya, Bryan- 8/12/17 Drumgoole, Keisha- 8/23/17

2. Jennifer White’s – Denied petition to extend the permit for an additional twelve months because

of the substantial amount of time requested and not having secured employment.

3. Reviewed Harold J. A. Oglesby’s request to fill RCP Advisory Committee members’ vacant seats: Candidates are chosen for upcoming vacancies.

4. Approved to interview two candidates at the July 13, 2017 Board Meeting for the open positions

on the RCP advisory committee.

5. Reviewed - “Scope of Practice” question and concluded that there are no provisions for a non-licensed individual in Georgia law or rules.

6. Discussed the possibilities of free CEUs and recommended the following: 1. Manufactures websites 2. Georgia Society of Respiratory Care (GSRC) provides 6-7 free CEUs 3. American Association for Respiratory Care (AARC) with membership will provide up to 26 free CEUs.

COSMETIC LASER PRACTITIONER COMMITTEE



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Dr. Gross presented the Cosmetic Laser Practitioner 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: Approve the following Assistant Laser Practitioner applications for licensure:

Lanequa Anders Stephanie Baker Lisa Danette Baxter Danielle Davis Mehtap Drayton Roxie Ellis Ingoglia, Elisa Maureen Flynn Ansley Gatlin Jennifer Hatcher Jennifer Hogan Renata Jackson Dawn Katz Sonia Martinez-Palmore Sherry Massey Shermeen Merani Rozina Nassar Michelle Padgett China Plotts Kelsey Poteet, tabled for certificates Tara Salley Michelle Sacco Summer Simpson Angela Tyler

Allison Thompson Kathryn Williams Maya Williams

Approved the following Senior Laser Practitioner applications for licensure:

Caitlin Briscoe Nicole Camp J. Nicole Miller

Amy Villano Julie Willis

Other Business: 1. Donna Kaufmann requested information to obtain required credits for ALP license. Board replied CEU’s for Laser Renewal license, are available from many sources. Use the internet to search them out.



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2. The Board accepted LA rosters for Lanequa Anders showng doctors signature with certification and approved licensure. PAIN MANAGEMENT CLINIC COMMITTEE Dr. Weil presented the Pain Management Clinic Committee report as a motion. The motion was seconded by Mr. Wallace. The Board accepted the report by unanimous vote. The Board took the following actions:

Approved the following applications for initial licensure: Name License#

Approved the following applications for change of ownership and clinic name:

Name License# New Name

Approved the following applications for location change: Name License#

Other Business:

ACUPUNCTURIST COMMITTEE Dr. Downey presented the Acupuncturist Committee report to the Board as a motion. Dr. DeLoach seconded the motion. The Board accepted the report by unanimous vote. The Board took the following actions: Approved the following application for limited licensure: Approved the following application for initial licensure: Monica Hilton

Approve application for Reinstatement: Soon Ae Kim Other Business: 1. Reviewed as information —the list of limited licensees and supervisors.

PERFUSION COMMITTEE Dr. Retterbush presented the Perfusionist Committee report. Dr. Weil submitted a motion, seconded by Mr. Wallace, to accept the report. The Board accepted the report by unanimous vote. The Board took the following actions: Approved the following applications for provisional licensure: Margaret Fortenberry



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Mesfin Yana Other Business: 1. Reviewed resumes for possible new committee members - Yancey Mooney and Milton Wilkes.. RULES COMMITTEE Dr. Gross presented the Rules Committee report as a motion. Dr. Mohan seconded the motion. The Board accepted the report by unanimous vote. The Board took the following actions: CLOSED SESSION Dr. DeLoach submitted a motion, seconded by Dr. Retterbush, to go into executive session to discuss investigative matters. Upon conclusion of the Board’s discussion of the matters, Dr. Antalis declared the meeting in open session. ATTORNEY GENERAL’S REPORT Janet Wray, Senior Assistant Attorney General, updated the Board on the status of matter that have been referred to the Attorney General for legal action. Dr. Retterbush submitted a motion, seconded by Dr. Weil, to accept the report. The motion passed unanimously. INVESTIGATIVE INTERVIEWS Richard Weil, M.D. presented the Investigative Interview report as a motion, and was seconded by Jeffrey Marshall, M.D. The Board accepted the report by unanimous vote. The Board took the following actions.

20161278 Further Investigation 20162030 Letter of Concern 20170525 Close/No Action 20170676 Close/No Action

INVESTIGATIVE COMMITTEE The Investigative Committee report was presented as a motion by Jeffrey Marshall, M.D., and was seconded by Joe Sam Robinson, M.D. The Board accepted the report by unanimous vote. The Board took the following actions.

Close:

20140907 20160020 20160491 20162073 20162316 20170036 20170305 20170342 20170357 20170383 20170491 20170532 20170626 20170688 20170739 20170865 20170984 20171035 20171081 20171091 20171109 20171117 20171138 20171166 20171177 20171181 20171224 20171277 20171290 20171294 20171300 20171303 20171327 20171343 20171352 20171364 20171372 20171373 20171374 20171378 20171379 20171380 20171382 20171383 20171402 20171403 20171410 20171415 20171421 20171433 20171435 20171442 20171449 20171450 20171454 20171461 20171466 20171474 20171488 20171492 20171495 20171527 20171528 20171530 20171531 20171532 20171538 20171542 20171545 20171550 20171554 20171558



23

20171566 20171574 20171587 20171593 20171598 20171651 20171822 20171826 20171927 20171980

Close with Letter of Concern:

20160747 20171285 20171325 20171426 20171453 20171510 20171511 20161044 20171539

Invite for Investigative Interview:

20162326 20171161 20171316 20161010

Further Investigation

20171607

Table

20160857 20170962 20171436

Mirror Action from Other State

20171607

Attorney General’s Office

20170451

INITIAL COMPLAINT EVALUATIONS

The Board approved the following recommendations.

20171742 20171836 20171837 20171846 20171847 20171848 20171850 20171854 20171857 20171858 20171859 20171863 20171872 20171875 20171877 20171878 20171882 20171883 20171887 20171892 20171898 20171900 20171904 20171906 20171908 20171912 20171914 20171916 20171918 20171924 |20171925 20171928 20171931 20171932 20171933 20171935 20171937 20171948 20171955 20171956 20171958 20171960 20171962 20171967 20171985 20171987 20171992 20171994 20172003 20172009 20172013 20172015 20172017 20172025 20172030 20172031 20172036 20172037 20172041 20172045 20172047 20172050 20172052 20172054 20172056 20172058 20172059 20172062 20172066

RECUSALS

Deloach 20160020 20160857 20170048 20171091 20171161 20171859 20171985 20172030

Downey 20161278 20171224

Gross 20171402

Marshall 20171378 20171449 20171495 20171566 20171826



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Simmons 20170688 20171364 20171410

Weil 20170451

WELLNESS COMMITTEE Dr. Collins presented the Wellness Committee report. Dr. DeLoach 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, M.D. 2. 20121183 – Refer to Attorney General for Order for Physical/Mental Examination. 3. 20100768 - Termination of Private Consent Order granted. RULES HEARING Dr. Gross convened the Public Hearing concerning the following proposed Rules amendments: Rule Chapter 360-13-.01, “Requirements for Board Certification.” Dr. Gross asked if anyone was present to address the Board on the posted Rules amendments. Dr. Retterbush made a motion to amend Rule Chapter 360-13-.01, “Requirements for Board Certification.” that the Board find the formulation and adoption of these rules do not impose excessive regulatory cost on any licensee and any cost to comply with the rule cannot be reduced by a less expensive alternative that fully accomplishes the objectives of the applicable laws; that the Board finds that it is not legal or feasible to meet the objectives of the applicable laws to adopt or implement differing actions for businesses as listed in O.C.G.A. 50-13-4(A) (3)(A),(B),(C), and (D). Dr. Weil seconded the motion, and it carried unanimously. Rule Chapter 360-32-.01, “Definitions.” Dr. Gross asked if anyone was present to address the Board on the posted Rules amendments. Dr. Retterbush made a motion to amend Rule Chapter 360-32-.01, “Definitions.” that the Board find the formulation and adoption of these rules do not impose excessive regulatory cost on any licensee and any cost to comply with the rule cannot be reduced by a less expensive alternative that fully accomplishes the objectives of the applicable laws; that the Board finds that it is not legal or feasible to meet the objectives of the applicable laws to adopt or implement differing actions for businesses as listed in O.C.G.A. 50-13-4(A) (3)(A),(B),(C), and (D). Dr. Retterbush seconded the motion, and it carried unanimously. Rule Chapter 360-37, “Military Spouses and Transitioning Service Members Licensure.”



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Dr. Gross asked if anyone was present to address the Board on the posted Rules amendments. Dr. Retterbush made a motion to amend Rule Chapter 360-37, “Military Spouses and Transitioning Service Members Licensure.” that the Board find the formulation and adoption of these rules do not impose excessive regulatory cost on any licensee and any cost to comply with the rule cannot be reduced by a less expensive alternative that fully accomplishes the objectives of the applicable laws; that the Board finds that it is not legal or feasible to meet the objectives of the applicable laws to adopt or implement differing actions for businesses as listed in O.C.G.A. 50-13-4(A) (3)(A),(B),(C), and (D). Dr. Downey seconded the motion, and it carried unanimously. There being no other business, Dr. Deloach submitted a motion, seconded by Dr. Callins, to adjourn the meeting. The motion carried unanimously. Dr.Deloach adjourned the June 2017 meeting at 10:00 am. ___________________________ __________________________________ John Antalis, MD Robert Jeffery, MBA Chairperson Executive Director Recorded by Diane Atkinson

Documents

GEORGIA COMPOSITE MEDICAL BOARD · Kia Hargrove, Licensure Manager . Karl Reimers, Deputy Executive Director . Patricia Sherman, Enforcement Manager ... Dr. Antalis reconvened the