How to Reduce the Risk of Being Disciplined by the State Medical Board

The tradeoff between quality and quantity of medical regulation
State medical boards are under public pressure to increase their disciplinary rates.

Manuscript Title

 

How to Reduce the Risk of Being Disciplined by the State Medical Board

Running Title

 

Medical Board Considerations

Names and affiliations of all contributing authors

 

Brett Snodgrass, M.D. DrSocial Ltd. http://drsocial.org

Contact details for Corresponding Author

 

Brett Snodgrass, M.D.
468N Camden Drive
Suite 200
Beverly Hills, California
Telephone:               1 (916) 893-1722
Fax:                   1 (877) 991-6435
Email:               brettsnodgrass@icloud.com

Manuscript words

 

341

Keywords

 

Medical board, state agency, licensure, competency, assessments

Governance, regulation, physician discipline

Funding statement

 

The author received no funding.

 

 

How to Reduce the Risk of Being Disciplined by the State Medical Board

 

Even if physicians’ provide good medical care and behave ethically, it does not guarantee that they will avoid discipline by their State Medical Board (SMB).1,2 SMBs are under public pressure to provide protection from “bad doctors,” and they appear to be doing so when they discipline physicians. The majority of research regarding the performance of SMBs is strictly quantitative.

The Missouri SMB tried to punish Dr. Paskon for prescribing opioids and benzodiazepines for chronic pain patients and for providing the standard-of-care to myriad patients.3 After four and a half years of costly litigation, the Honorable Commissioner John J. Kopp, JD, ruled that each of the SMB’s 137 charges vs. Dr. Paskon was unmeritorious.4

This author reports that the Missouri SMB made false claims against him in court regarding (1) the lumpectomy ischemic intervals of more than 20 women with breast cancer, (2) numerous Joint Commission violations, and (3) an unnecessary level of two to four b unilateral neck dissections. As a mere citizen, this author could not obtain the medical records to prove his innocence, and the SMB created a preponderance of false evidence, including perjurious depositions.

In 1985, Arnold S. Relman M.D. wrote, “Physicians brought before a state board for disciplinary actions often do experience ‘a monumentally destructive disruption’ of life. But that doesn’t alter the fact that the proceedings are likely to give the accused physicians every opportunity to clear charges against them. They can also launch legal counteraction which has a powerful dampening effect on the zeal of would-be accusers and judges.”5

The opportunities to prove innocence have dissipated with the change of laws to a lesser burden of proof.6,7 This creates a situation where a preponderance of false evidence and perjury can create a guilty verdict. In addition, physicians no longer have the powerful legal counteractions, which existed in 1985.6

Physicians are encouraged to protect themselves, and their families, from nefarious or reckless SMBs by routinely hiring an attorney when they need to interact with SMBs.

Finally, medical regulation needs to be changed from a sciolistic system, which punishes excellent care to a “just culture.”

References

  1. Mishler v. State Bd. of Med. Examiners, 849 P. 2d 291 – Nev: Supreme Court 1993.

https://scholar.google.com/scholar_case?case=5539688962490335552 Accessed October 01, 2016.

  1. Snodgrass, B. Novel Insight into the Quality of Assessment of Physicians.

Health Care: Current Reviews. 2016;4:1-4.

  1. State Board of Registration for the Healing Arts v. Paskon, No. 02-1491 HA (Mar. 27, 2007). https://archive.org/details/Missouri-SBRHA-vs-Dr-Pakson. Accessed October 01, 2016.
  2. State Board of Registration for the Healing Arts v. Paskon, Second Amended Complaint. No. 02-1491 HA (December 27, 2004). http://168.166.15.111/DataTier/Documents/Repository/0/0/7/7/8cee2b62-12fc-4084-995e-bf4cca7494ed.tif Accessed October 01, 2016.
  3. Relman AS. Professional regulation and the state medical boards. N Engl J Med. 1985;312:784-5.
  4. Alan J. Mishler, M.D. v. Nevada State Board of Medical Examiners, 94 F.3d 652 (9th Cir. 1996).
  5. Neil, C. Medical Board Investigations: Legitimate or Kangaroo Courts? Medscape. Mar 15, 2016.
How to Reduce the Risk of Being Disciplined by the State Medical Board

New Hampshire State Medical Board’s Penny Taylor Harassed and lied about Dr. Glenna C. Burton, MD

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Penny Taylor abused discretion, allegedly protected the public, and harassed Glenna C. Burton, MD for not thinking in the double jeaporady mindset – for failing to report that the Missouri Board of Healing Arts piggy-backed discipline on her for the same thing she was already disciplined for by the DEA. Penny Taylor harassed Glenna by asserting that it was poor moral character to not list the reflexive discipline made by the Missouri medical board.

Penny Taylor implied that Dr. Burton was trying to hide something and committing an unethical act by not listing the ~double jeapordy that Dr. Burton experienced at the hands of mindless secretaries and attorneys who piggy-back discipline for “public safety.” 

nefarious penny taylor deserves  prison time
Penny Taylor harassed Glenna C. Burton MD and abused her
I’m 

New Hampshire State Medical Board’s Penny Taylor Harassed and lied about Dr. Glenna C. Burton, MD

How to Grade Male Pattern Hair Loss and Find a Board Certified Transplant Surgeon

Before one undergoes a hair transplant surgery, they will want to know how to classify the hair loss.


Federation of State Medical Boards FCVS Considerations

CORRESPONDENCE FROM THE INTERNATIONAL SOCIETY OF HAIR RESTORATION SURGERY REGARDING CONCERNS OVER UNLICENSED PERSONS PERFORMING HAIR TRANSPLANT SURGERY The Board reviewed the correspondence from the International Society of Hair Restoration Surgery regarding concerns over unlicensed persons performing hair transplant surgery.

 

doctor-3

legally-perform-hair-restoration-surgery
I am aware and I do not care. I do not trust persons who try to create monopoly while using the term “patient safety” in a self-serving manner.
How to Grade Male Pattern Hair Loss and Find a Board Certified Transplant Surgeon

Links to Every State Medical Board

The links are below, but first consider

Patient L.T. died from gross negligence four hours after the nurse gave him seven different medicines intended for a seizure patient. LT was on dialysis and cpuld not excrete the thousands of milligrans of gabapentin and other sedating medicines. Instead of preventing this from occurring again by training the nurse to follow the standard-of-care, Dr. Jeffrey Carter MD, Kevin O’Malley JD, David Poggemeier MD, and the other Missouri Medical Board members chose to spend two years in a failed effort to blame Dt. Surendra Chaganti for the death. The aformentioned SMB members never apologized for that or for their failed five year effort to punish Dr. Chaganti for a clerical error on a job application.

O’Malley, Poggemeier, and Dr. James DiRenna are bureaucratic who caused an Honorable Administrative Law Judge Sreenu Dandamudi to write on court records that the State Medical Board of Missouri Misrepresented EvidenceExternal Linkin a failed effort to fraudulently revoke the medical license of Dr. Antoine Adem .

Links to Every State Medical and Osteopathic Board:

Alabama Board of Medical Examiners and Medical Licensure Commission of AlabamaExternal Link

Alaska State Medical BoardExternal Link

Arizona Medical BoardExternal Link

Arizona Board of Osteopathic Examiners in Medicine and SurgeryExternal Link

Arkansas State Medical BoardExternal Link

Medical Board of CaliforniaExternal Link

Osteopathic Medical Board of CaliforniaExternal Link

Colorado Medical BoardExternal Link

State of Connecticut, Department of Public HealthExternal Link

Delaware Board of Medical Licensure and DisciplineExternal Link

District of Columbia Board of MedicineExternal Link

Florida Department of Health, Division of Medical Quality Assurance (MDs)External Link

Florida Department of Health, Division of Medical Quality Assurance (DOs)External Link

Georgia Composite Medical BoardExternal Link

Hawaii Board of Medical ExaminersExternal Link

Idaho State Board of MedicineExternal Link

Illinois Department of Professional RegulationExternal Link

Medical Licensing Board of IndianaExternal Link

Iowa Board of MedicineExternal Link

Kansas State Board of Healing ArtsExternal Link

Kentucky Board of Medical LicensureExternal Link

Louisiana State Board of Medical ExaminersExternal Link

Maine Board of Licensure in MedicineExternal Link

Maine Board of Osteopathic LicensureExternal Link

Maryland Board of PhysiciansExternal Link

Massachusetts Board of Registration in MedicineExternal Link

Michigan Board of MedicineExternal Link

Michigan Board of Osteopathic Medicine & SurgeryExternal Link

Minnesota Board of Medical PracticeExternal Link

Mississippi State Board of Medical LicensureExternal Link

Missouri Board of Registration for the Healing ArtsExternal Link

Montana Board of Medical ExaminersExternal Link

Nebraska Board of Medicine and SurgeryExternal Link

Nevada State Board of Medical ExaminersExternal Link

Nevada State Board of Osteopathic MedicineExternal Link

New Hampshire Board of MedicineExternal Link

New Jersey State Board of Medical ExaminersExternal Link

New Mexico Medical BoardExternal Link

New Mexico Board of Osteopathic Medical ExaminersExternal Link

New York State Board for MedicineExternal Link

North Carolina Medical BoardExternal Link

North Dakota State Board of Medical ExaminersExternal Link

State Medical Board of OhioExternal Link

Oklahoma Board of Medical Licensure and SupervisionExternal Link

Oklahoma State Board of Osteopathic ExaminersExternal Link

Oregon Medical BoardExternal Link

Pennsylvania State Board of MedicineExternal Link

Pennsylvania State Board of Osteopathic MedicineExternal Link

Rhode Island Board of Medical Licensure and DisciplineExternal Link

South Carolina Board of Medical ExaminersExternal Link

South Dakota Board of Medical and Osteopathic ExaminersExternal Link

Tennessee Department of HealthExternal Link

Tennessee Board of Ostepathic ExaminationExternal Link

Texas Medical BoardExternal Link

Utah Division of Occupational and Professional LicensingExternal Link

Vermont Board of Medical PracticeExternal Link

Vermont Board of Osteopathic PhysiciansExternal Link

Virginia Board of MedicineExternal Link

Washington State Medical Quality Assurance CommissionExternal Link

Washington Board of Osteopathic Medicine and SurgeryExternal Link

West Virginia Board of MedicineExternal Link

West Virginia Board of OsteopathyExternal Link

State of Wisconsin Medical Examining BoardExternal Link

Wyoming Board of MedicineExternal Link

Patient L.T. died from gross negligence four hours after the nurse gave him seven different medicines intended for a seizure patient. LT was on dialysis and cpuld not excrete the thousands of milligrans of gabapentin and other sedating medicines. Instead of preventing this from occurring again by training the nurse to follow the standard-of-care, Dr. Jeffrey Carter MD, Kevin O’Malley JD, David Poggemeier MD, and the other Missouri Medical Board members chose to spend two years in a failed effort to blame Dt. Surendra Chaganti for the death. The aformentioned SMB members never apologized for that or for their failed five year effort to punish Dr. Chaganti for a clerical error on a job application.

Medical Board Members sneaky
Medical Board Investigator willing to win his case against a doctor at any cost. He is planning and plotting how to conceal evidence and make his department look good.
Medical Board Bureaucrats made false promises.
MedicalnBoard Members vowed to protect the public, but instead exploited killed patient LT, lied about care of breast cancer patients, and

issues related to job applications.

Links to Every State Medical Board

Missouri State Board of Healing Arts Ethics Complaint

Dear Missouri Ethics Commission,

Ethics Complaint Fell on Deaf Ears

State Board of Registration for the Healing Arts of Missouri
Systematic Dysregulation of Public Safeguards and Potential Solutions

This ethics complaint is being filed against the Missouri (MO) State Board of Registration for the Healing Arts (SBRHA),1 the SBRHA Executive Director Connie Clarkston, and the SBRHA Attorney – Counsel, Frank Meyers, JD. This complaint is structured into 10 major areas of unethical regulatory conduct. Each section contains this writer’s opinion regarding what the SBRHA should do to correct their unethical conduct, and this is described in a manner that illustrates the nature of the unethical conduct. Many of the SBRHA’s unethical actions continue to cause harm as they have propagated disinformation about patient care and they refuse to acknowledge their publicly filed false claims. The SBRHA refuses to tell the truth about cancer testing and unnecessary surgery – important aspects of care which they already filed lies about in court. By concealing the truth about patient care and punishing honesty, the SBRHA committed acts which are the exact opposite of their legislated duty. The SBRHA has a responsibility to address the numerous instances of unsafe and unethical conduct committed by their licensee Dr. Kamani Lankachandra (Dr. KL) e.g. she provided disinformation to the ACGME about months of patient care, committed perjury in her April 2014 deposition about unnecessary surgery, misrepresented Dr. Snodgrass’s 2011 academic status at UMKC in a Spring, 2013 postgraduate reference letter that she sent to the Georgia Composite Medical Board, and she committed perjury when she testified under oath on about July 2nd or 3rd, 2014. Residents at UMKC that were placed on probation were supposed to, per university policy, be able to appeal the decision. Dr. KL was asked why she wrote Dr. Snodgrass was on probation on about 12 29 2010. A few minutes later she said, still under oath, that probation and remediation are the same, something that is not supported by the subsequent testimony of Dr. Jill Moormeier, which occurred less than two hours after the court teleconference with Dr. Lankachandra. Dr. Moormeier is UMKC’s Accreditation Council on Graduate Medical Education (ACGME) Designated Institution Official (DIO), and she is the leader in charge of the residency programs at UMKC.

In addition to witnessing Dr. KL commit perjury during court, the SBRHA reviewed Dr. Snodgrass’s resident evaluations created by Dr. KL and discovered numerous bizarre and incompetently documented assessments of Dr. Snodgrass, and yet they remained complicit in enabling her incompetent resident evaluations. Dr. KL’s written evaluations often contained vague, harsh criticism; e.g. she wrote claims stating that Dr. Snodgrass lacked energy, that he blamed others, and that he refused to learn. There was not a single example documented to illustrate any of the aforementioned claims from April 2011. Furthermore, Dr. KL’s incompetently documented resident assessments were not limited to April 2011. The SBRHA acted unethically by (1) identifying the aforementioned bizarre documentation but not disciplining Dr. KL’s medical license for incompetence and then by (2) filing the incompetent assessments in court as if they were legitimate. Instead of addressing Dr. KL’s dishonesty or areas of demonstrated incompetent documentation, the SBRHA acted unethically by concealing the dishonesty. Furthermore, the SBHRA violated professional ethics even more by punishing Dr. Snodgrass for his true reports about unsafe patient care.

The SBRHA failed to address the dishonesty and corruption, the routine lying about academic matters as well as patient care, and they have punished a physician for honestly reporting unsafe patient care. Please provide your kind consideration to the following four sections of this complaint (1) the overview of the complaint, (2) the details of the complaint, (3) the references, and (4) the enclosed supplementary materials.

Overview of the 10 aims – the SBRHA should

I. Acknowledge the lies about months of reckless breast cancer testing and that they did not disclose this to their recent auditor – who gave them a rating of “good.”

II. Acknowledge that Dr. Snodgrass faithfully reported several patient care standards violations to The Joint Commission2 in 2012 and that it was unethical for the SBRHA to exploit unsafe patient care to berate him as a liar during his 2014 trial.

III. Acknowledge that Dr. Kamani Lankachandra (Dr. KL) made false claims about Dr. Snodgrass’s academic status in 2013 and 2014 to different state medical boards. The false claims appear to be disparate to each other, i.e. inconsistent and were related to whether Dr. Snodgrass was on probation or remediation when he was at UMKC.

IV. Acknowledge Dr. Snodgrass completed 44 months of ACGME accredited training,3 and that Dr. KL made misleading claims in 2013 to the MO SBRHA regarding her ability to document his clinical competency. It was unethical of the SBRHA to contest this, and it was unethical of them to refuse to accept prior documentation of training as well as for them to refuse to address the dishonesty of Dr. KL. In her letter written on May 25, 2011, Dr. KL documented the quality of Dr. Snodgrass’s patient care as appropriate for his level of training and that he completed 34 months of pathology training. However, in the fall of 2013, when Dr. Lankachandra was asked to document Dr. Snodgrass’s clinical competency on a different form, the Postgraduate form provided by the SBRHA, Dr. Lankachandra wrote that she was unable to answer the question of whether he was clinically competent because he left the residency program (June 27, 2011). Dr. Lankachandra could have informed the SBRHA that she documented the same information about patient care on the form that she signed on May 25, 2011.

In contrast to Dr. Lankachandra’s sudden inability (2013) to report that Dr. Snodgrass was competent for his level of training, she maintained her ability to write negative statements about him.

Dr. Lankachandra was able to evaluate Dr. Snodgrass’s performance negatively in several other areas such as his professionalism and his work with peers.

Connie Clarkston and Frank Meyers, JD, were informed about the postgraduate training letter signed on May 25, 2011 by Dr. Kamani Lankachandra. Instead of addressing the highly questionable evaluations made by Dr. Lankachandra, Ms. Clarkston and Mr. Meyers repeatedly berated Dr. Snodgrass as incompetent.

Dr. Snodgrass in other performance domains such as his interactions with peers.

It was unethical of the SBRHA to facilitate this additional dishonesty and refuse to redress it. The SBRHA should acknowledge the deception and apologize for abusing discretion and relying on a doctor who committed perjury (April 2014 and July 2014) to assess Dr. Snodgrass while concomitantly rejecting the earlier letter Dr. Lankachandra wrote, a letter which contained information that answers the critical question about physician competency on the SBRHA’s postgraduate training form.

In retrospect, Dr. Snodgrass should have had Dr. Lankachandra sign and mail the “SBRHA’s postgraduate training form” in 2011. Given that Dr. Snodgrass had witnessed Dr. KL make numerous false claims in evalautions during residency training, he did prudently ask the UMKC GME Office run by Dr. Jill Moormeier to store the “ACGME Postgraduate training form.”

The SBRHA should not change their assessment of the quantity of training because a pathologist who committed perjury changes her mind.

 

 

V. Acknowledge that the April 2014 deposition of Dr. KL contained multiple false claims about patient care.

VI. Acknowledge that it was unethical for the board members to have Connie Clarkston, the SBRHA’s Executive Director, to communicate shocking news via only formal letter without any competent explanation. Ms. Clarkston wrote Dr. Snodgrass an official letter on 11 20 2013 with instructions to obtain a ($10,000) multidisciplinary evaluation without specifying why, other than the bizarre and unfounded belief that such an evaluation could be “very insightful.”4 It was grossly unethical to communicate shocking information in such a manner and without competent rationale. These acts of dysregulation are discussed further in the detail section of this report.

VII. Acknowledge that the SBRHA demonstrated numerous instances of unethical conduct against the cardiologist Dr. Antoine Adem. The SBRHA should implement a plan to prevent similar misconduct from occurring in the future.

VIII. Acknowledge that the SBRHA committed numerous unethical and incompetent acts against the psychiatrist Dr. Surendra Chaganti. The SBRHA should devise a plan to prevent similar unethical conduct from occurring in the future. For example, many medical boards might ensure that the board members know how to read FDA drug labels and identify that Marinol is acceptable for use in elderly patients.

IX. Acknowledge that it was unethical to show partiality by trusting a pathology program director who lied under oath in court. According to Johnson and Chaudhry, state medical board members should have a passion for the judiciary, and that means the board members should evaluate reports of patient harm without showing partiality.5 Being a program director who commits perjury does not mean that one’s expertise in looking at cells under the microscope transfers to an increase in integrity and honesty. The SBRHA appears to have a conflict of interest related to their plans to build collegial relationships with medical school deans in order to increase the primary care workforce and their refusal to uphold the statutes as it relates to a physician who is a department chair and program director at one of those universities. It is unethical for the SBRHA to selectively enforce the statutes and enable some doctors to be above the law, to commit perjury repeatedly about patient care and then for the SBRHA to help conceal the dishonesty. If the SBRHA Board Members had a passion for the judiciary as Johnson and Chaudhry assert is important for board members, then they probably would be more concerned with the truth about patient care and stop exploiting patients who were harmed or received unnecessary surgery in order to conceal the errors and dishonesty of a physician who has significant clout at the university.

X. Acknowledge that the phrase “lives are at risk,” does not justify the SBRHA’s repeated acts of lying about patient care. The SBRHA should acknowledge that repeatedly lying about patient care does not improve the integrity of the profession, does not make patients safer, and may decrease patient safety.

 

Details of the 10 categories of ethical complaints including suggestions for consideration

I. The SBRHA should acknowledge that the breast cancer specimens at the UMKC Pathology Department were routinely subject to prolonged ischemic times from January-to-June 2011. The SBRHA should apologize for wrongfully exploiting months of unsafe patient care in an effort to punish Dr. Brett Snodgrass for his credible and accurate reports to regulators such as the ACGME.6 The SBRHA should apologize for not addressing UMKC’s lies about breast cancer testing as well as for filing the false claims in court against Dr. Snodgrass on July 3, 2014.

The SBRHA used their state-given investigative authority to prevent evidence of their dishonesty from being evaluated by the auditor. The SBRHA did not disclose that they have enabled a physician to repeatedly commit perjury, that they filed many lies about patient care into court, and that they still, as of March 1, 2016, refuse to tell the truth about the months of reckless breast cancer testing.

According to the American Society of Clinical Oncology, 2010 Guidelines for testing for estrogen receptors on breast cancer specimens, “The time from tumor removal to fixation should be kept to ≤ 1 hour.”

Frank Meyers, JD, withheld the medical records and the allegedly documented breast lumpectomy “ischemic times” from the court. This withholding of medical records from court while filing false claims about patient care in court is unethical and manipulative. It can mislead others to form erroneous conclusions about the quality of care that patients with breast cancer received. Misleading others to believe something that is not true is particularly relevant to the subject of medical regulation. In medical law cases, the burden of proof is not “beyond a reasonable doubt,” but it is “more likely than not.” Thus, one can create a convincing argument by utilizing many lies and withholding the relevant medical records to deceive another person sufficiently to think that the lie is more probable than the truth. Since concrete evidence is not needed in such cases, making false claims about medical facts and patient care in court has been a recurring theme for the SBRHA and has been done against physicians such as Dr. Chaganti, Dr. Adem, and Dr. Snodgrass. This is particularly relevant as the dishonesty and unethical conduct committed against physicians does not merely harm the physician, but it also can harm patients and create an unsafe healthcare system. The dysregulation has helped foster a culture of dishonesty and condoned unsafe patient care. The SBRHA has repeatedly enabled a Missouri physician to lie about patient care as well as academic matters, and they have given no guarantee that there will be a foreseeable end to the dishonesty.

The SBRHA passed their 2015 audit with a rating of “good.” It is worthy of consideration, and possibly further evidence of unethical conduct that the state medical board has used their authority as an investigator of Missouri to conceal or “keep hidden” relevant records regarding patient care. With regards to the SBRHA’s enablement of dishonesty by Dr. KL, and punishing Dr. Snodgrass for his truthful reporting, the SBRHA used their state-given investigative authority to selectively investigate reports of unsafe patient care in order to prevent evidence such as medical records that would prove their dishonesty from being retrieved from TMC and then being evaluated by the auditor.

E. The SBRHA could deceive the auditor either passively or actively. An example of passive deception or tacit collusion would be that none of the SBRHA mentioned that they needed to obtain the reports from TJC to uphold the statutes. This lack of investigation would occur because no member wanted to provide evidence of their dishonesty or the false claims that they filed in court. Active concealment would be having The Joint Commission reports, finding out about the audit, and then shredding them. Hopefully, the dishonest claims about patient care that the SBRHA filed in court are a result of passive deception, which is less deceptive and less unethical. This can occur when the investigators and board members choose not to look for records that they know will likely reveal that the SBRHA has done the opposite of the legislature’s intent.

The SBRHA probably did not want others or the auditor to know about the numerous standards violations that occurred or that Frank Meyers and the SBRHA tried to frame Dr. Snodgrass as having lied to TJC. However, a state agency such as the Missouri Ethics Commission can prove that the SBRHA has been passively or actively concealing numerous records of wrongdoing and dishonesty. A regular citizen can provide no evidence of the dishonesty regarding patient care because the medical records belong to the hospital, and the standards violations are kept out of the hands of the public by The Joint Commission.

The SBRHA did not disclose to the auditor or to the public – in spite of their numerous false claims against Dr. Snodgrass – that they have enabled a physician to repeatedly commit perjury, that they filed the many lies about patient care into court, and that they still, as of March 1, 2016, refuse to tell the truth about the months of reckless breast cancer testing. The board manipulated the evidence – prevented the related medical records and claimed documentation from entering the court, and this may have generated false impressions about patient care. Again, since the burden of proof in medical regulatory cases is “probable cause,” or “more likely than not,” their false claims about patient care are able to create a healthcare culture characterized by deceit instead of the expected integrity and excellence.

The prolonged “ischemic times” for the lumpectomy specimens occurred because the breast tissue would often sit on the counter in the “Gross Room” for more than an hour while waiting to be accessioned by the Gross Room Attendant. Even when a lumpectomy sat on the counter without formalin for less than an hour, the ischemic time could still be greater than an hour because the specimen has to go from the surgical operating room to radiology, and then to the counter top or table until it was accessioned.

Accessioning occurs when a specimen is entered into the pathology computer system and given a specimen number. It was not until after the accessioning that the lumpectomies were permitted to be placed in formalin. Therefore, accessioning of a lumpectomy means that the excised piece of the breast, also known as a lump of breast tissue, is “logged in” to the pathology computer system and given a surgical pathology number. “Ectomy” means to excise or remove, and “lump” is a part of something. Thus the word, “lumpectomy” means to remove a lump, and the words “breast lumpectomy” mean to remove a lump of breast tissue. This is different from a mastectomy where the entire breast is removed.

After being accessioned, the lumpectomy was placed in 10% Neutral Buffered Formalin. The excessive time that the lumpectomy spent sitting on the gross room counter created a normative practice of guideline-discordant care, which is an ischemic period of greater than one hour. Furthermore, the ischemic time was not always less than 30 minutes as the UMKC GME Office misled the ACGME to believe. Sitting on the Gross Room counter waiting to be accessioned and then placed in formalin certainly would not permit an ischemic time of less than 30 minutes, and it is unethical for Mr. Meyers to file such claims in court against Dr. Snodgrass. The SBRHA has a duty to their patients, not a duty to win in court by exploiting patients that received unsafe care. This is grossly unethical as Mr. Meyers exploited unsafe patient care to punish Dr. Snodgrass for accurately reporting reckless cancer testing that he had disclosed twice to Dr. KL and as he also informed Dr. Jill Moormeier in 2011. Even if a lumpectomy only spent 45 minutes sitting on the gross room counter without formalin, the overall ischemic time may be more than an hour. This occurs because after being removed from the patient, the lumpectomy is brought to the radiology department where x-rays are taken to ensure that the tumor was removed. The radiologist looks at the x-ray to make sure that they see the tumor and that the surgeon removed the tumor instead of normal breast tissue. Then the lump of breast tissue would be carried on a radiographic board, usually accompanied by a developed x-ray, in plastic wrap to the Pathology Department at Truman Medical Center.7 Dr. Snodgrass estimates that the mean ischemic time was somewhere between one and two hours.

The importance of minimizing the ischemic time was emphasized in 2010 when additional evidence was published showing that the longer the ischemic interval, the greater the amount of false negative tests for estrogen and progesterone receptors.8 In 2010, the American Society of Clinical Oncology and College of American Pathologists published a guideline recommending that the ischemic intervals should be less than one hour in order decrease the “false negative” testing of the breast cancer for estrogen receptors (ER) and progesterone receptors (PR).9

  • Parenthetically, Dr. Lankachandra had a meeting with the residents in the fourth quarter of 2010, and she informed them about the importance of placing specimens in formalin as soon as possible. Thus, she was concerned about the quality of patient care and took efforts to ensure that the quality was improved. However, she did not appear as concerned about the matter when I informed her, in person, in the gross room, about the prolonged ischemic times in January 2011. After being informed that breast lumpectomy specimens were sitting on the counter without being processed in a timely fashion, she replied that she would address it at the upcoming faculty meeting.

  • The prolonged ischemic time placed the breast lumpectomy specimens at increased

    risk for testing as “falsely negative” for estrogen and progesterone receptors by the test method known as immunohistochemistry (IHC).8 IHC was the method used to test breast cancer specimens for the presence of ER and PR at TMC-HH in 2011. The pathology department sent some of the specimens to an outside lab for additional testing for ER and PR using another method, but there is no guarantee that this method would be performed on the lumpectomy specimens that had the longest ischemic times. The send-out tests were usually carried out on the breast cancers that appeared indeterminate, or in-between the positive and negative cut-off values as determined by the IHC method. If a lumpectomy specimen should have tested as weakly positive if it were given a brief ischemic time, then a prolonged ischemic time could cause that specimen to test as completely negative. Thus, specimens that should have tested as positive may have tested as negative due to the prolonged ischemic times. This particular negligence probably did not cause any deaths, but it may have subjected some women to more aggressive treatment regimens without the benefit of the less toxic hormonal therapies.

N. Regardless, UMKC lied about this testing to the ACGME and the SBRHA punished Dr. Snodgrass for his accurate report to the ACGME by berating him a liar before the Honorable Commissioner. The SBRHA filed UMKC’s blatantly false letter in court to portray Dr. Snodgrass as a liar, and the SBRHA did this at the expense of patient safety and honesty.

O. The UMKC Pathology Department did most of their work at the Truman Medical Center (TMC)– Hospital Hill TMC Pathology Department. The address was

Truman Medical Center – Hospital Hill
2nd Floor Pathology Dept.
2301 Holmes Street
Kansas City, MO 64108

The medical records are electronically preserved, easily accessible, and they belong to TMC.

Due to the recalcitrant nature of the medical board, and their repeated refusal to communicate with me, I reluctantly shared accurate information regarding their regulatory misconduct and that related to the dishonesty about patient care online.10 Mr. Meyers refused to talk with me over the phone as I politely asked him via email in December 2013. The SBRHA exploited patients that received unsafe care and filed false claims against me, at the patient’s expense, in court. Therefore, I shared true and verifiable information online about the unsafe breast cancer care.10 My aim was to provide the public with sufficient information to evaluate the SBRHA’s claims for themselves. Considering that the SBRHA disciplined me for performing my fiduciary duty, and withheld the medical records preventing me from being exculpated about the allegations of lying about breast cancer, I thought it necessary to share truthful information with the public. Patients are therefore able to consider the SBRHA’s publicly filed false claims along with accurate reports of patient care as they evaluate physicians. The SBRHA will assert that this is not professional, but they call lying about patient care professional. Furthermore, patients have a right to evaluate accurate information along with the false claims about patient care that the SBRHA filed in court. The information shared online about the SBRHA’s dishonesty originated in parallel with that of the Veterans Administration Healthcare Scandal of 2014. The scandal at the VA consisted primarily of lies about the “wait times” of ignored veterans. The breast cancer scandal at UMKC and propagated by the SBRHA was predominately related to untruthfulness about the “ischemic times.” of neglected breast lumpectomies.

On July 3, 2014, the SBRHA filed verifiably false claims in court against Dr. Snodgrass regarding months of reckless breast cancer testing that occurred at the UMKC Pathology Department from January-to-June 2011. The SBRHA falsely berated Dr. Snodgrass as a liar for his 2011 faithful report to the ACGME regarding months of reckless breast cancer testing characterized by prolonged ischemic times. The prolonged ischemic times risk false negative tests for estrogen and progesterone receptors, a factor that influences treatment and quality of life, but not overall survival.

Lies filed in court against Dr. Snodgrass in 2014 –Unethical Conduct of Mr. Meyers
Frank Meyers, JD, the Missouri (MO) State Board of Registration for the Healing Arts’ (SBRHA) attorney, was informed in court on about July 03, 2015, that the UMKC Graduate Medical Education Department lied to the ACGME in late 2011 or 2012 about months of reckless and unsafe breast cancer testing at Truman Medical Center – Hospital Hill. In addition, Mr. Meyers witnessed the UMKC Pathology Chair and Program Director, Dr. Kamani Lankachandra, make false claims under oath in court, via telepresence (video conference before the honorable commissioner) on or about July 2 or 3, 2014. Mr. Meyers nonetheless filed her previous deposition claims – from April 2014 in court against Dr. Snodgrass to berate his moral character. It was unethical of Mr. Meyers to rely on the deposition testimony of a known perjurer as evidence to try to punish Dr. Snodgrass and “protect” the public. It was unethical of Mr. Meyers and the SBRHA to permit the dishonesty and to propagate the lies – especially egregious was their propagation of lies about patient cancer care.

Dr. Snodgrass disciplined for reporting unsafe patient care
Systemic dishonesty in healthcare regulation. Neither the LCME, ACGME, nor the Missouri SBRHA opened a single patient chart.

The false claims about breast cancer testing were written by the UMKC GME Office in a letter signed by Dr. Jill Moormeier, to the ACGME around late 2011, or possibly early 2012 – Dr. Snodgrass was not provided with a copy of this letter, but was only shown it during the pre-trial deposition and then asked about it again during the trial. Although the falsified letter about breast cancer testing was signed by the UMKC GME Office’s Dr. Moormeier, it was probably written based on intentionally false information provided by the UMKC Pathology Chair and Program Director, Dr. Kamani Lankachandra (Dr. KL).
1. The lies were written by the UMKC-GME office to Amy Dunlap (married and now her name is Amy Beane) of the ACGME and the letter signed by the UMKC Designated Institution Official (the ACGME-DIO), Dr. Jill Moormeier. The date was in the latter half of 2011 or in early 2012. The SBRHA did not provide Dr. Snodgrass with the letter. Dr. Snodgrass first became aware that the UMKC GME office lied to the ACGME about months of breast cancer testing during his pretrial deposition in June 2014.

2. State agencies can inquiry of Dr. Jill Moormeier and ask how she concluded, as described in her letter written to the ACGME, that the UMKC Pathology Department was often documenting the ischemic time, including during the months of January to June 2011.

T. UMKC made, at least, two lies to the ACGME (in late 2011 or early 2012), and Frank Meyers, JD, of the SBRHA, filed these lies in court against Dr. Snodgrass on July 3, 2014. The lies that were made by UMKC to the ACGME were
1. We always have an ischemic time of less than 30 minutes.

2. The Pathology Department “often [sic]” documents the ischemic time.

U. This is how one can determine that the claims made by UMKC to the ACGME about breast cancer testing were not true:
a. Ask the UMKC Pathology Department to show you the surgical pathology reports of 10 breast lumpectomy specimens from January-to-June 2011 so that you can calculate the mean “ischemic time” to make sure that it was less than 30 minutes as was claimed in the letter to the ACGME.

b. Ask the SBRHA to provide you with the letter that UMKC wrote to the ACGME about breast cancers in 2011.

c. If the SBRHA “lost” the letter, ask the ACGME -acgme.org – or UMKC for it.

V. The SBRHA should acknowledge that forcing physicians into years of litigation with them for reporting months of reckless cancer testing is unethical.4 The transcripts and letters of Snodgrass v. SBRHA are available online at The exhibits were not uploaded by the Administrative Hearing Commission. The letter about breast cancer that UMKC sent to the ACGME was an exhibit, but should be available by contacting the SBRHA, UMKC, or the ACGME. The Shortened URL is http://bit.ly/BoardReform. Full link https://archive.org/stream/Snodgrass-v-SBRHA/Snodgrass%20v%20SBRHA%202013%202014#page/n0/mode/1up

II. The SBRHA should acknowledge that Dr. Snodgrass faithfully reported several standards violations to The Joint Commission (TJC). Also, they should apologize for trying to make his true statements appear as if they were lies. The SBRHA should also acknowledge that the April 2014 deposition of Dr. KL regarding TJC standard violations was not necessarily perjury, but was vague and misleading. The SBRHA should apologize for making Dr. Snodgrass appear as if he were a liar for his faithful and true reports to TJC. Specifically, Dr. KL was not asked if my reports were correct, but she mentioned other, irrelevant information – that the administration at TMC helped her in dealing with TJC.

A. This explains how to determine the claims about The Joint Commission Reports by Dr. Snodgrass were true:
1. Contact The Joint Commission (TJC) on Accreditation for Healthcare and inform them that you are an agency of the state of Missouri. Their website is http://www.jointcommission.org/

2. Ask TJC about the Truman Medical Center Lakewood laboratory and/or pathology department from the first half of 2011 – ask whether there were any standard violations, specifically with reference to the microbiology culture.

3. Inform TJC that you would like to know if Truman Medical Center Hospital Hill laboratory or pathology departments violated any standards in 2011 or 2012. Then you can ask whether a Dr. Snodgrass reported any of those standard violations to them. [Instead of addressing the unethical and unsafe conduct – the state medical board filed Dr. Lankachandra’s April 2014 deposition in court against Dr. Snodgrass – on July 3, 2014 – creating the false impression that Dr. Snodgrass lied to TJC. The SBRHA should apologize for their unethical actions of: (1) failing to protect the public by not addressing TJC standards violations and (2) making Dr. Snodgrass appear as a liar for his veritable reports to TJC.

III. The SBRHA should acknowledge that the UMKC Pathology Chair and Program Director, Dr. Kamani Lankachandra made several false claims about Dr. Snodgrass’s training at UMKC.
A. Dr. KL falsely informed the Georgia Composite Medical Board in 2013 that Dr. Snodgrass was on probation. 

Ethics Complaint Details 

B. The SBRHA should acknowledge that Dr. KL made a significant false claim on the postgraduate training form that she sent to the Georgia Composite Medical Board. She informed them that Dr. Snodgrass was previously on probation at UMKC, and this dishonest act caused Dr. Snodgrass to report her lies to future employers in Massachusetts who then rescinded an internship at St. Elizabeth’s hospital because Dr. Snodgrass was – according to the change in assessment by the UMKC Pathology Chair – on probation while at UMKC.

C. Dr. Kamani Lankachandra (KL) made a false claim in court via telepresence and under oath on about July 2nd or 3rd, 2014, when she claimed that probation and remediation are the same. The DIO Dr. Moormeier testified immediately after her in live court and when she was asked by the Honorable Commissioner Karen Winn whether probation and remediation are the same she replied ~ “Ooh no. They are not the same. Only one is reported to state medical boards. Only probation is reported to state medical boards, remediation is not.” Dr. Lankachandra had been the pathology chair (evaluator of other doctors) and program director (evaluator of residents) by then for four years, but she claimed they were the same. It was unethical for Frank Meyers to witness this additional dishonesty and then continue, without concern that she also lied about patient care in her April 2014 deposition, to file Dr. KL’s lies in court against Dr. Snodgrass.

IV. Acknowledge that Dr. KL made false or misleading claims in writing to the SBRHA in 2013 when she wrote that she could not assess his competency because he left the program even though she already documented nearly identical information in the letter of ACGME Core Competencies.

A. The SBRHA should acknowledge that Dr. Snodgrass completed 44 months of ACGME training – including 12 months of general surgery at Carolina’s Medical Center followed by 34 months of ACGME-accredited training at the UMKC Pathology Department.

B. The SBRHA should acknowledge the training certificate from Carolina’s Medical Center. Connie Clarkston and the SBRHA should apologize for asserting that a quadruply signed document is invalid because a physician that Dr. Snodgrass never met made a negative comment about his performance during his surgical internship. 

Executive Director Connie Clarkston lied to the NPDB and Courts
It was egregiously unethical and deceitful of the Missouri State Board of Registration for the Healing Arts’ Executive Director Connie Clarkston to sign a letter stating that Dr. Snodgrass’s training certificate – which she had – was invalid

 

C. The SBRHA should acknowledge the letter of ACGME Core Competencies signed by Dr. Kamani Lankachandra.

D. The SBRHA should acknowledge that Dr. Snodgrass left the UMKC Pathology Department on June 27, 2011, and that he completed most of his June pediatric surgical pathology rotation – which moves him closer to 45 months of ACGME-accredited training.

E. The SBRHA should acknowledge that lying about patient care and physician competency does not protect the public.

F. The SBRHA should acknowledge that they have failed to evaluate Dr. Snodgrass and other licensees in a competent and equitable manner and that they will establish processes and procedures to prevent similar types of regulatory misconduct in the future.

G. The SBRHA should take steps to ensure that Dr. KL will not continue to make false claims to future state medical boards as she has done once to Georgia and several times to Missouri.

Dishonesty was rewarded by Ms. Clakrston and the Missouri Board of Healing Arts
The state medical board of Missouri enabled Dr. Lankachandra’s lies to be propagated indefinitely and the board did nothing to improve the integrity of physicians.

V. The SBRHA should acknowledge that it was unethical of them to file Dr. KL’s 2014 deposition in court against Dr. Snodgrass without addressing the dishonesty about patient care or the medical misinformation. Dr. KL’s April 2014 deposition appears unethical or incompetent because she claimed that neck dissections are massive procedures and then she said, “I did not cause that.” First, neck dissections are not all massive procedures.11 It was unethical for the SBRHA to witness such a lack of medical knowledge, or incompetence and then file it in court. There are many types of neck dissections, and they are not all “radical neck dissections.” Indeed, Dr. KL’s misdiagnosis of a benign pleomorphic adenoma as a malignant “carcinoma ex-pleomorphic adenoma” resulted, per the surgical pathology log, in a level 2-4 unilateral neck dissection – to check lymph nodes for the spread of the “malignant carcinoma.” The SBRHA acted unethically in this additional instance in several ways. First, the SBRHA did not address Dr. KL’s false claim about the “massive” nature of neck dissections. Second, the SBRHA did not address the dishonesty related to causing a minor neck dissection – the patient did fine regardless, but she lied about it and then referred to Dr. Snodgrass as a liar, another act of perjury.

The state medical board should address physicians who either lie about or do not understand the care that they rendered – a characteristic that Dr. KL demonstrated in her April 2014 deposition. The care occurred on about June 20-22, 2010 and was related to an intraoperative misdiagnosis.

Ms. Clarkston and the Board Members acted lofty, dismissive and were dishonest
Ms. Connie Clarkston of the Missouri Board of Healing Arts was lofty and dismissive. Ms. Clarkston enabled her attorney to file myriad lies about patient care into court.

The SBRHA should review surgical pathology report S-10-003342 from Truman Medical Center Hospital Hill – as well as the associated operative report, and they should consider the operative note, whether the surgeon performed a level 2-4 unilateral neck dissection, and whether Dr. KL’s intraoperative misdiagnosis played a role in causing the patient to receive unnecessary surgery. The SBRHA should evaluate whether Dr. KL’s April 2014 claims of not causing an unnecessary neck dissection and stating, under oath that Dr. Snodgrass lied are consistent with (1) the surgeon’s operative note and (2) the surgical pathology report.

dishonesty is rewarded in Missouri
Did Ms. Clarkston investigate the reports of dishonesty or patient harm in an equitable manner?

The SBRHA should establish means to prevent them from filing false claims about medical information in court in the future. For example, the SBRHA should not propagate misinformation from a senior physician regarding what constitutes a neck dissection.

The SBRHA may have acted unethically by not addressing the lack of competent medical knowledge demonstrated by Dr. KL, in spite of her being the physician who assesses the competency and professionalism of resident physicians.

The SBRHA acted unethically by filing a doctor’s misinformation in court against Dr. Snodgrass while concomitantly asserting that Dr. Snodgrass lacked sufficient training and skills to be licensed as a physician.

VI. The SBRHA should acknowledge that it was unethical for them to instruct Dr. Snodgrass to obtain a multidisciplinary evaluation without specifying why. This $10,000 test was ordered without a reasonable rationale on November 20, 2013.

A. The Missouri State Board of Registration for the Healing Arts instructed Dr. Brett Snodgrass to obtain a multidisciplinary evaluation without specifying the purpose of such an exam – an unfathomable, reckless, unethical, incompetent, and deceptive regulatory practice nearly akin to rectal feedings of patients by CIA Physicians and staff.12 These were acts that allegedly were for safety and security – yet no reasonable person would think that ordering a $10,000 drug evaluation for no stated reason would make sense or that giving food rectally to prisoners would have any benefit of security. This egregious conduct is unethical and illustrates a state medical board that may not be fit to regulate – at least not as they presently are, a deceptive agency that conceals months of patient harm and enables doctors to commit perjury about the care that they provided. Multidisciplinary evaluations are typically used to evaluate drug addictions, and Dr. Snodgrass had already met with the hospital wellness committee in October 2010, where he met with a multidisciplinary panel consisting of the former chair of the UMKC Family Medicine Program, a psychiatrist, and a psychologist. They made no allegation of drug abuse or drug problems and returned Dr. Snodgrass to work in the pathology department with only monthly counseling meetings. The SBRHA should not use state authority to harass people with instructions to obtain bizarre and expensive tests without providing any rationale. This was unethical for the board to do, and it was unethical for Connie Clarkson to write the letter, which can be found on the Board’s website or at the shortened URL http://bit.ly/BoardReform. As the SBRHA’s executive director, Ms. Clarkston should have sufficient experience in the medical field to understand that when physicians instruct patients to get tests or evaluations, there should be a reason. However, she provided no basis for the instruction but nonetheless told Dr. Snodgrass to obtain an expensive, multi-day, in-hospital, multidisciplinary drug evaluation.

B. On November 20, 2013, the SBRHA instructed Dr. Snodgrass to obtain a multidisciplinary evaluation through standard mail only. They did not specify why, and this is an example of poor communication – a dangerous practice for physicians, especially when ordering tests or exams. It is unethical for medical boards to order $10,000 drug evaluations, a type of study where a person goes to live in a hospital for several days while being evaluated for drug issues.
C. Connie Clarkston is significantly responsible for overseeing this unethical conduct. Acknowledge that it was unethical for the board members to have Connie Clarkston, the SBRHA’s Executive Director, instruct Dr. Snodgrass via a formal letter in the mail only, to obtain a $10,000 multidisciplinary clinical drug evaluation without specifying why, other than the bizarre claim of it could be “very insightful.” It was unethical or incompetent for the SBRHA to believe that such an evaluation could be “very insightful,” without specifying how or why any reasonable person would arrive at that conclusion. It was also unethical for the SBRHA’s Executive Director, Connie Clarkston, to write the letter to Dr. Snodgrass with full knowledge that she was not providing a reasonable explanation to establish why Dr. Snodgrass should obtain such an evaluation. Ms. Clarkston, as the executive director of the SBRHA, should understand the importance of there being a clinical rationale for the ordering of clinical evaluations. Furthermore, as the SBRHA’s executive director, she should know that communication is critical to obtaining accurate information from consultants, such as those providers who perform multidisciplinary evaluations.

Paid for incompetence is the status quo in Missouri
The state medical board of Missouri is unnecessarily slow. They are paid to be incompetent, paid to lie, and they are paid to be slow

D. Connie Clarkston’s conduct was, by the professional standards that she probably is familiar with, unethical as well as evidence of negligence or incompetence.

E. If lives are at stake, then Missouri probably needs medical regulators who demonstrate far higher standards than the current SBRHA. If the safety of the public is at stake as the state medical board has argued, then we probably should have a medical board director who is not grossly negligent when they document why they want a particular clinical evaluation. Whether the move to establish safe and competent medical regulators occurs through retraining, firing, or simply apologizing and admitting wrongdoing, the grossly unethical and incompetent regulation should stop.

VII. The SBRHA should acknowledge it was unethical for their agency to commit fraud or gross misrepresentation against the Cardiologist Dr. Antoine Adem and the SBRHA should implement a plan to prevent fraudulent regulation from occurring again in the future.

a. The SBRHA should acknowledge that fraud and misrepresentation do not protect patients, but that it creates an unnecessary burden on physicians who provided excellent patient care. Dr. Adem is one of those doctors, and there is robust evidence that he provided excellent patient care.
b. Please see the enclosed article – which is also found at
i. URL – http://www.esciencecentral.org/journals/novel-insight-into-the-quality-of-assessment-of-physicians-2375-4273-1000155.php?aid=66342

ii. PDF – http://www.esciencecentral.org/journals/novel-insight-into-the-quality-of-assessment-of-physicians-2375-4273-1000155.pdf

VIII. The SBRHA should acknowledge it was unethical of their agency to try to discipline Dr. Surendra Chaganti for providing – “by the books,” “U.S. Food and Drug Administration-approved” excellent patient care. The SBRHA should take measures to ensure that they and their staff know how to read FDA-drug labels. Many physicians would probably take measures to prevent their attorneys from filing blatantly false claims about FDA approved medications in court. Once the SBRHA has established a policy to ensure that the doctors on the SBRHA know how to read FDA drug labels, they should train their staff how to read them including how to identify a drug’s contraindications. Please see attached manuscript describing the SBRHA’s unethical regulatory conduct.

IX. The SBRHA should acknowledge that it is unethical to show partiality to senior physicians in their same profession solely because of one’s academic title. The SBRHA should acknowledge that it was unwise of them to trust the April 2014 deposition of a pathologist, Dr. KL, who lied under oath in court in July 2014. The SBRHA should acknowledge that enabling a doctor who committed perjury to be the main assessor of the professionalism of future physicians is grossly unethical – at least without first acknowledging and correcting the dishonest physician behavior.
A. The SBRHA may have a conflict of interest between their doctors who work at universities and the protection of the public. The SBRHA has previously written on page four of their newsletter that their plan is to work with medical school deans to increase the number of primary care physicians in Missouri.

A Conflict of interest is found in the SBRHA’s April 01, 2015 newsletter http://pr.mo.gov/boards/healingarts/newsletters/2015-04-01.pdf
Facilitating and overlooking repeated dishonesty about patient care by a senior faculty member at a university may be done to strengthen the relationship between the state medical board and the dean of the medical school, something that would be beneficial to the SBRHA’s plans as described on page four of their April 1, 2015, newsletter.13

They permitted a university pathologist to claim she could not evaluate my academic performance in 2013 even though she had already documented nearly identical information on the letter of ACGME Core Competencies from 2011. It is hard to win a court case when the SBRHA repeatedly empowers a dishonest physician to make false claims -even about patient care under oath.

According to the American Medical Association Council on Ethical and Judicial Affairs (AMA-CEJA), physicians should not be silent about the SBRHA’s repeatedly egregious and unethical conduct that is akin to corruptions. Doctors who witness the SBRHA’s numerous instances of unethical actions have a fiduciary duty to speak out against it.14

According to Scutchfield and Benjamin (18th US Surgeon General),
…in the case of physicians’ responsibility to consider the character of their colleagues, the Council (AMA-CEJA) has called on the profession to abandon the “conspiracy of silence” surrounding unprofessional behavior, and has noted, “Incompetence, corruption, or dishonest or unethical conduct on the part of members of the medical profession is reprehensible.”
Furthermore, in dealing with knowledge of a colleague’s misconduct, “A physician should expose, without fear or loss of favor, incompetent or corrupt, dishonest or unethical conduct on the part of members of the profession.”
Enhancing professionalism and addressing physician misconduct should remain major agenda items for organized medicine, with particular focus on strengthening the medical profession’s responsibility and accountability.15

The SBRHA’s enabling of the Dr. KL to lie multiple times to our medical regulators – even about patient care – is probably considered corruption and is in stark contrast to the recommendations by the previous US Surgeon General. Furthermore, it is the fiduciary duty of physicians such as this author to report and try to stop the unethical conduct of the SBRHA.14

B. The SBRHA should not show partiality to doctors who lie about patient care regardless of academic title, and they should take means to prevent this from occurring again in the future.

X. The SBRHA should acknowledge that lying about months of breast cancer care does not protect the public.
A. The SBRHA should acknowledge that using the phrase, “lives are at stake,” does not grant them a pass to place more lives at stake through reckless and dishonest regulation.

B. Acknowledge that using the phrase “lives are at risk,” does not mean it is okay for regulators of medicine to lie or to be incompetent. Lies about patient care do not protect patients, and the SBRHA should no longer withhold relevant medical records from the courts. The SBRHA should acknowledge that they are not above the law, and they should be held to the same standards as other physicians. The SBRHA members and staff should acknowledge that they are not above the law, and they should establish plans to prevent the egregious regulatory misconduct in the future.

C. The SBRHA should make plans to keep themselves from appearing grossly incompetent or negligent in the future with regard to matters related to patient care and medical knowledge. SBRHA members should acknowledge that evidence-based medicine plays a role in their job. Physicians are appointed to the SBRHA so that they may use their expertise to evaluate the care provided by licensees, but many of the present and all of those that were on the SBRHA from 2010-2014 have repeatedly failed to assess licensees in a competent manner. In contrast, a physician whom they claimed to be incompetent – Dr. Snodgrass – published an article illustrating the SBRHA’s profound lack of medical knowledge and explaining how a competent medical regulator would go about assessing the appropriateness of the coronary artery stent procedures performed by their licensee Dr. Adem.16

D. The SBRHA should acknowledge that it is not appropriate for them to use state resources to discipline doctors that are more competent and knowledgeable than themselves – doctors such as the interventional cardiologist Dr. Antoine Adem and the psychiatrist Dr. Surendra Chaganti.16

Dishonest regulation may be facilitated by assumptions
Making assumptions about important matters of patient care has been Connie Clarkston’s modus operandi.

References

1. Missouri State Board of Registration for the Healing Arts website. Available at: http://pr.mo.gov/healingarts.asp. Accessed March 1, 2016.

2. The Joint Commission. Accreditation, Health Care, Certification. Available at: http://www.jointcommission.org/. Accessed March 1, 2016.

3. Photographs of Dr. Snodgrass’s certificates and documentation of 44 months of ACGME-accredited postgraduate training- every month denied by the SBRHA. Available at: https://twitter.com/BrettSnodgrass1/status/703386555071639553. Accessed March 1, 2016.

4. Brett Snodgrass, MD v. Missouri State Board of Registration for the Healing Arts – entire case exhibits were not uploaded. 2013 – 2014. Available at https://archive.org/stream/Snodgrass-v-SBRHA/Snodgrass%20v%20SBRHA%202013%202014#page/n0/mode/1up. Also available at: http://bit.ly/BoardReform. Accessed March 1, 2016.

5. Johnson D, Chaudhry H. Medical Licensing and Discipline in America. Lanham, MD: Lexington Books; 2012. Avialable at: http://www.amazon.com/Medical-Licensing-Discipline-America-Federation/dp/0739174398. Accessed March 1, 2016.

6. Snodgrass v. Missouri State Board of Registration for the Healing Arts – Verdict from Honorable Karen A. Winn, Commissioner on October 30, 2014. http://archive.org/details/Snodgrass-v-SBRHA. Accessed March 1, 2016.

7. TMC – Truman Medical Centers. Available at: http://www.trumed.org/. Accessed March 1, 2016.

8. Qiu J, Kulkarni S, Chandrasekhar R, et al. Effect of delayed formalin fixation on estrogen and progesterone receptors in breast cancer: a study of three different clones. Am J Clin Pathol. 2010;134(5):813-819. Available at: http://ajcp.oxfordjournals.org/content/ajcpath/134/5/813.full.pdf. Accessed March 1, 2016.

9. Hammond ME, Hayes DF, Dowsett M, et al. American Society of Clinical Oncology/College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol. 2010;28(16):2784-2795. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881855/pdf/zlj2784.pdf. Accessed March 1, 2016.

10. Snodgrass, BT. Breast Cancer Scandal. 2015. Available at: http://drsocial.org/forums/topic/1057/breast-cancer-scandal. Accessed March 1, 2016.

11. Iype EM, Sebastian P, Mathew A, Balagopal PG, Varghese BT, Thomas S. The role of selective neck dissection (I-III) in the treatment of node negative (N0) neck in oral cancer. Oral Oncol. 2008;44(12):1134-1138. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18486527. Accessed March 1, 2016.

12. Annas GJ, Crosby SS. Post-9/11 Torture at CIA “Black Sites” — Physicians and Lawyers Working Together. N Engl J Med. 2015;372(24):2279-2281. Available at: http://www.nejm.org/doi/full/10.1056/NEJMp1503428. Accessed March 1, 2016.

13. Arts MBoRftH. Healing Arts News, (Apr. 1, 2015);29(1):1-20. Available at: http://pr.mo.gov/boards/healingarts/newsletters/2015-04-01.pdf Accessed March 1, 2016.

14. Margolis JD. Professionalism, fiduciary duty, and health-related business leadership. JAMA. 2015;313(18):1819-1820. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25965224. Accessed March 1, 2016.

15. Scutchfield FD, Benjamin R. The role of the medical profession in physician discipline. JAMA. 1998;279(23):1915-1916. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18486527. Accessed March 1, 2016.

16. Snodgrass B. Novel insight into the quality of assessment of physicians. Health Care: Current Reviews. 2016;4(155):1-4. Available at: http://www.esciencecentral.org/journals/novel-insight-into-the-quality-of-assessment-of-physicians-2375-4273-1000155.pdf. Accessed March 1, 2016.

Supplementary material – enclosed
I. Reference #16 – regarding the SBRHA’s harassment of the interventional cardiologist Dr. Antoine Adem. See lines 749 and 832-835 above. This describes the SBRHA’s unethical conduct over a period of more than two years related to the interventional cardiologist Dr. Antoine Adem.

II. Manuscript describing the SBRHA’s 5.1 years of unethical conduct related to the psychiatrist Dr. Surendra Chaganti.

III. Unethical letter written on November 20, 2013 by the SBRHA Executive Director Connie Clarkston to Dr. Snodgrass. See lines 92-100, 612-630 for information regarding the unethical nature of the letter. Furthermore, the letter states “please do not hesitate to contact us.” I did contact the SBRHA several times and they refused to provide any additional reason about why I should obtain a multidisciplinary evaluation. Our leaders should be able to articulate why they want someone to go live in a hospital for several days. Connie Clarkston was unable to do that, but she did help enable a pathologist, Dr. KL, to make numerous incompetent evaluations of a resident – such as December 29, 2010 where she wrote “he has not recovered to anyone’s satisfaction.” Dr. KL was asked by Dr. Snodgrass’s attorney on about July 2nd or 3rd 2016 what he was to recover from. Dr. KL had no reply. This is grossly incompetent documentation by Dr. KL, and Frank Meyers was in court when he saw Dr. KL fail to give a reply to the critical question about Dr. Snodgrass’s evaluation written by Dr. KL on 12 29 2010. According to Dr. KL, Dr. Snodgrass was to remain on probation because he has not recovered to anyone’s satisfaction. Instead of addressing the incompetent documentation, Connie Clarkston and Frank Meyers propagated the dishonest and incompetent evaluations and have refused to acknowledge that a physician who is a residency program director should have sufficient clinical insight to know that if she writes that a “resident has not recovered,” then something should be done. Dr. KL did nothing reasonable after 12 29 2010 and instead of addressing Dr. KL’s inability to competently communicate critical information, they apparently instructed Dr. Snodgrass to obtain a multidisciplinary evaluation. Similar to how the SBRHA and Frank Meyers enabled the Dr. KL to lie and then disciplined Dr. Snodgrass at the expense of patient safety, Connie Clarkston made bizarre and harassing efforts towards Dr. Snodgrass at the expense of ensure that Dr. KL could communicate critical information and assessments to those that she manages.

IV. A print-out of the letter that Dr. Snodgrass received where his job at St. Elizabeth’s hospital was rescinded after he informed them – about what Dr. KL informed the Georgia Composite Medical Board – that Dr. Snodgrass was on probation when he was at UMKC. According to Dr. Thomas Nasca, CEO of the ACGME and Dr. Jill Moormeier, Dr. Snodgrass was never on probation at UMKC. In spite of this blatant dishonesty and extensive harm caused by false claims filed with the GCMB, Connie Clarkston refused to address the dishonesty and punished Dr. Snodgrass. This is unfathomable perversion of the role of a Medical Board Executive Director, and Connie Clarkston should, at the very minimum, acknowledge the dishonesty made by Dr. KL multiple time to the Missouri SBRHA. However, Connie Clarkston has actually enabled and empowered Dr. KL to propagate her lies, and this is an egregious violation of basic ethical principles.

lying about breast cancer care
Lying about patient care matters

Comments and Suggestions are Welcome.

What do you think can be done to ensure that physicians in Missouri stop lying?

 

 

Missouri State Board of Healing Arts Ethics Complaint

How to File a Complaint With the Missouri State Board of Healing Arts

FAQ:

How can I file a complaint with my state medical board?

Board of Registration for the Healing Arts

3605 Missouri Boulevard
P.O. Box 4
Jefferson City, MO  65102
573.751.0098 Telephone
573.751.3166 Fax
800.735.2966 TTY
800.735.2466 Voice Relay
healingarts@pr.mo.gov

 

Answer:

Electronically via a PDF, or, in writing.

If you complete the PDF, you can email it to the Board at their above email address. If you choose to send it in writing, you can send it via standard mail to their above address.

It is important to note that the Board’s physical location is different than their mailing address. The address of the Missouri Division of Professional Registration

Address: 3605 Mo Blvd, Jefferson City, MO 65109

 

Leadership in Communication

I went to their office and attended their teleconference in April 2012, but they did not permit me to speak about anything other than their listed topics. This is a problem because I had critical information about patient care that they had repeatedly ignored. One is better off talking to a wall, than trying to communicate or share information with any of the medical board members or their staff. In contrast, the North Carolina Medical Board’s staff has been helpful and professional during my interactions with them. Apparently some state medical boards value other people, and some, such as Missouri, live in a culture of collective narcissism.

Comments and suggestions are welcome,

-Brett Snodgrass, MD

 

 

 

How to File a Complaint With the Missouri State Board of Healing Arts