I am speechless

This is an article that appeared in today's newspaper. Unfortunately, there are a couple of errors in the report:

Saipan Tribune, Friday, December 19, 2008

EXCEPT FOR LIFE-OR-DEATH SITUATIONS
Tinian clinic turning away patients

By Kristi EatonReporter

Without a doctor and its physician assistants not authorized to prescribe drugs, the Tinian Health Center is now forced to treat only those patients in life-or-death situations and is turning away all other patients.

This came about after the Medical Licensing Board failed to come to an agreement with Tinian Health Center's physician assistant Terri Clawson on a system relating to the prescription of drugs, including narcotics, to treat the island's patients.

*[This statement is inaccurate. Terri has no control over who is chosen as a doctor for Tinian Health Center! Both supervising MDs (Dr. Brown and Dr. Balachandra) were selected by the Medical Board. As noted later in this article, it was not Terri, but Dr. Balachandra, who was unable to reach a compromise with the Medical Board as to how the Tinian Health Center should be run.]*

The situation, according to the THC acting director, has forced the medical providers to act under the Good Samaritan law in order to give patients the necessary treatment. This means that the clinic can only treat patients with life-or-death problems. All other patients will be turned away until a solution can be found.

Since July, when Dr. Ronaldo Toledo left the center, the Medical Licensing Board has issued emergency orders allowing THC physician assistant Terri Clawson to prescribe drugs, including narcotics, with remote supervision by a Saipan doctor.

On Tuesday, members of the board met with Clawson and Clawson's new supervising physician, Dr. Shirish Balachandra of the Commonwealth Health Center, to discuss concerns about remote supervision. The board had expressed concern about the high volume of narcotic drugs Clawson had prescribed under the supervision of Dr. Christine Brown.

The board created a new order with strict guidelines for Clawson and Balachandra to follow.

But, according to THC acting director Freddy Hofschneider, the order was not seen as workable.

“[The order] was not a workable order to Dr. Balachandra as a supervising physician, as well as the PAs [physician assistants] on Tinian,” he said. “And that's because it was so restrictive to the point that Dr. Balachandra might as well just pack his bag and sit here at Tinian Health Center.”

Balachandra could not be reached for comment yesterday.

The order included the agreement that Clawson would send daily e-mails to Balachandra about controlled substances; Balachandra must review monthly a database of chronic or long-term medicated patients; Balachandra must review and sign chart notes; and Balachandra must closely monitor pain contracts.

The order stated that Clawson was not to prescribe schedule II drugs-drugs with a high potential for abuse such as morphine or oxycodone-unless it was a “bona fide medical emergency,” and in such situations, Balachandra was to countersign the chart within 24 hours. A practice agreement was to define “bona fide medical emergency.”

For schedule III through V medications, which have less potential for abuse, Clawson was to exchange daily e-mails with Balachandra and seek approval before starting chronic or long-term medication.

Clawson also was to provide the board with her Drug Enforcement Agency number and certificate. Physician assistants who prescribe controlled substances are required to have a DEA number.

Clawson, at Tuesday's meeting, said the chronic and long-term patients she was treating were all inherited cases.

For now, Clawson and medic Juan Pangelinan are working under the Good Samaritan law to treat patients in life-or-death situations, Hofschneider said. On Wednesday night, two patients were sent to the THC in an ambulance. The first did not require any medications, he said, but the second was in an automobile accident.

“The second patient, about 45 minutes later, a victim of an auto accident [came in] and fortunately, there were no injuries to the body, but there was some treatment required and that's when PA Clawson declared a Good Samaritan law and she treated the patient,”

Hofschneider said. Hofschneider said he has communicated with the Secretary of Public Health and the Governor about the situation and the effort to find a workable solution.

The situation has been tiring, he said.

“I'm not just stressed now. I'm drained,” Hofschneider said, but added that he understands where the board members are coming from.

“We have to respect the Health Care Professional Licensing Board,” he said. “Remember they also have to protect their own integrity and their own license. They have to exercise the necessary steps to protect themselves.”

The Medical Licensing Board is doing their best to look after the well-being of the people of the Commonwealth, a member of the board said yesterday.

In October, 1,176 patients sought treatment at the Tinian Health Center.

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The entire situation simply leaves me speechless!