ARIZONA MEDICAL BOARD

FISCAL YEAR 2008-2009
ANNUAL REPORT

9545 East Doubletree Ranch Road
Scottsdale, Arizona 85258
(480) 551-2700 or toll-free (877) 255-2212
www.azmd.gov

TABLE OF CONTENTS
Letter to the Governor, Jan Brewer…………………………………………..………..

Page 2

.
ARIZONA MEDICAL BOARD
Board Membership ………………………………………………………………………….. Pages 3-6
Board Accomplishments…….………………………………………………………………

Page 7

Licensing ……………………………………………………………………………...……… Page 8
Regulation ………….………………………………………………………………………… Pages 9-10

Page 1

LETTER TO THE GOVERNOR
JAN BREWER

Governor
Jan Brewer

Members of the Arizona Medical Board
Douglas D. Lee, M.D.
Chair/Physician Member
Paul M. Petelin, Sr., M.D., F.A.C.S.
Vice-Chair/Physician Member
Amy J. Schneider, M.D., F.A.C.O.G.
Secretary/Physician Member
Patricia R. J. Griffen
Executive Committee Member At Large
Public Member
Andrea Ibañez
Public Member
Ram R. Krishna, M.D.
Physician Member
Todd A. Lefkowitz, M.D.
Physician Member
Lorraine L. Mackstaller, M.D.
Physician Member
William R. Martin, III, M.D.
Physician Member
Dona Pardo, Ph.D., R.N.
Public Member/R.N.
Germaine Proulx
Public Member

Executive Staff
Lisa Wynn
Executive Director
Amanda J. Diehl, M.P.A., C.P.M.
Deputy Executive Director
Roger Downey
Media Relations Officer

D

ear Governor Brewer:
On behalf of the Arizona Medical Board, I
submit to you our 2009 Annual Report.

This has been a challenging year for the Board, but
I’m proud to tell you that our Board Members and Staff have
helped the agency trim costs and expenditures while still providing
the same level of protection and service to the community.
The agency’s internal operations have been “paperless” for
seven years, and this year the Board took a major step in making it
more so by enhancing our on-line license renewal processes. Our
licensees, by and large, have welcomed this innovation. At the
same time, the Board has moved to make our database and Web
site more secure from the possibility of outside threats. Our dedicated IT team continues to look for ways to improve internal security.
Working with the Attorney General’s Office, we have eliminated a backlog of cases at the Office of Administrative Hearings,
reducing the Board’s legal expenses.
Staff renewed their efforts to recruit physicians willing to
serve as medical consultants on complaints filed with the Board,
and the response has been phenomenal. These physician volunteers provide valuable insight and ensure fair case adjudication.
Despite the economic situation and the uncertainty of
health care, new physicians continue to apply for Arizona medical
licenses. The successful class of applicants during FY 2008-2009
helped the total number of doctors with active licenses climb above
20,000.
Even with all the distractions, the Board remains focused
on its primary goal: protection of public health and safety.
Sincerely,

Lisa Wynn
Executive Director
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ARIZONA MEDICAL BOARD MEMBERSHIP
Douglas D. Lee, M.D., the Board’s
Chair, is a Board-certified Anesthesiologist practicing in Flagstaff, Arizona.
He graduated from the University of Arizona School of
Medicine, completed an internship at the National Naval
Medical Center in Bethesda,
Maryland and a residency at
the Naval Regional Medical
Center in San Diego, California. From 1980 to 1981, Dr. Lee was a United
States Marine General Medical Officer in Okinawa, Japan, and he was also a reservist called to
serve in the Desert Shield/Desert Storm 1st Marine Division from 1990 to 1991.
In addition to his professional experience, Dr.
Lee is a member of the Arizona Society of Anesthesiologists and a member of the American
Board of Anesthesiologists. He previously served
as the Chairman of Anesthesia for the Flagstaff
Medical Center (FMC), President of the FMC
Medical Staff, and President of the Arizona Society of Anesthesiologists. He currently serves as a
Staff Anesthesiologist at FMC and Managing
Partner of Forest County Anesthesia, PC. He is
also a Board Member of the FMC Ambulatory
Surgery Center and a member of the FMC Credentials Committee.

Paul M. Petelin, Sr., M.D., the Board’s
Vice-Chair, is a Board-certified Surgeon in private
practice in Phoenix. He
received his medical degree from Creighton University School of Medicine in Omaha, Nebraska,
and has a Bachelor’s Degree in Chemistry from
Gonzaga University in
Spokane, Washington.
Dr. Petelin completed his internship and residency at St. Joseph’s Hospital and Maricopa

Medical Center in Phoenix.
From 1984 to 1988 and again from 2000 to 2004,
Dr. Petelin was Chief of Surgery at St. Joseph’s
Hospital. He is in his second term as governor of
the State of Arizona American College of Surgeons. He is a member of the Board of Directors
of the Phoenix Surgical Society, and is a past
president of that organization. He also serves on
the Board of Directors of the Arizona Medical
Association.

Amy J. Schneider, M.D., FACOG, is a
Board-certified Obstetrician-Gynecologist in Tucson where she is the Medical Director and Partner in
Grace Maternity &
Women’s Health. She has
held an Arizona medical
license since 2001.
Dr. Schneider received her
medical degree from Tulane
University School of Medicine in New Orleans in
1997. She did her internship and residency at the
Department of Obstetrics and Gynecology at the
University of Arizona Health Sciences Center in
Tucson. She earned her Bachelor of Science Degree from the University of Oregon.
Dr. Schneider is a member of the Physicians
Leadership Group at Northwest Hospital in Tucson and a member of the Tucson Society of
Women Physicians.

Page 3

ARIZONA MEDICAL BOARD MEMBERSHIP
Patricia R. J. Griffen, a public member,
is the first Board Member elected to the newly
created position of
“Executive Committee
Member at Large.” She is
the founding Executive Director of Against Abuse,
Inc., established in October
1981 to provide domestic
violence and child abuse
shelter services to the citizens of Pinal County. In
2008, she received the Sunshine Peace Award, a
national honor recognizing her work against domestic violence. She has a Bachelor of Science
Degree in Social Administration.
Ms. Griffen has more than 35 years experience in
the field of private, non-profit management and is
a founding member of Arizona Coalition Against
Domestic Violence and formerly serving as a
member of the organization’s Board of Directors.
Ms. Griffen is the secretary of the Pinal County
Victim Compensation Program, the Chair of the
City of Casa Grande Personnel Advisory Board,
and the Chair of the Desert Pavilion Advisory
Board.

Andrea Ibañez, a public member, is the
Deputy Director of the Department of Neighborhood Resources for the
City of Tucson and supervises the daily work of the
Neighborhoods and Administration Division.
Before taking that post,
Ms. Ibañez served as a
Project Manager in the
Tucson City Manager’s
Office.
She has also
worked as an Interim Tucson Court Commissioner and as a Youth and Family Coordinator for
the City.

Ms. Ibañez is a member of the University of Arizona Hispanic Alumni Association, the Pima
County Children’s Action Alliance Advisory
Board, the Hispanic Professional Action Committee, and the Arizona City County Managers Association.
Ms. Ibañez has a masters degree from Syracuse
University and a Certificate in Public Policy and
Management from the Eller College of Management at the University of Arizona.

Ram R. Krishna, M.D., is an Orthopedic Surgeon in private practice in Yuma. He is a
newly elected member of the
Board of Directors of the
Federation of State Medical
Boards, the first Arizonan
named to that national panel.
He also serves as a federation
representative on the Board
of Directors for the Educational Commission for Foreign Medical Graduates.
In Arizona, Dr. Krishna has served as chief of
surgery and as chair of the Board of Trustees at
Yuma Regional Medical Center and as president
of the Yuma County Medical Society. Currently,
he is a member of the Arizona Orthopedic Society and the Arizona Medical Association. Dr.
Krishna was awarded the Arizona Medical Association’s Distinguished Service Award in 2000 for
his exceptional work in the community.
He obtained his medical degree from Bangalore
University Medical College in Bangalore, India.
He did his internship, a one-year residency in general surgery and a four-year residency in orthopedics at the University of Massachusetts Medical
Center.

Page 4

ARIZONA MEDICAL BOARD MEMBERSHIP
Todd A. Lefkowitz, M.D., is a Boardcertified Ophthalmologist and the Medical and
Surgical Director of the Sonoran Desert Vision Center in
Phoenix. He has had an Arizona medical license since 1983
when he became Chief of
Ophthalmology at Luke Air
Force Base.

Medicine/Family Practice Advisory Board, the
Hilton Head Health Institute, and the Arizona
Commission on Women’s Health.

Dr. Lefkowitz is a Fellow of
the American Academy of
Ophthalmology and a member of the Arizona
Medical Association and the Arizona Ophthalmological Society, as well as both the American
and European Societies of Cataract and Refractive Surgeons. Prior to his appointment to a fiveyear term on the Medical Board, he reviewed
cases as one of the Board’s Outside Medical Consultants.

William R. Martin, III, M.D., is a

Dr. Lefkowitz is a former Executive Committee
member of Physicians for the Phoenix Symphony. He has written two books and in 1991
was a three-time “Jeopardy” champion on the
long-running TV quiz show.

Lorraine Mackstaller, M.D., is Board
certified in Internal Medicine and is an internist in
the section of cardiology.. She
began her medical career as a
Registered Nurse at St. Joseph’s Hospital in Phoenix,
and then thirty years later
earned her M.D. at the University of Arizona in Tucson. She
performed her residency in
internal medicine at the University of Arizona and is currently on staff at the Sarver Heart Center in Tucson.

Dr. Mackstaller has taught classes at the University of Arizona College of Medicine, lectured on
women’s health and heart issues, and authored
numerous medical journal articles. In 2003, Dr.
Mackstaller received the Patients’ Choice Award
from the University Medical Center in Tucson.
Board-certified, fellowship trained Orthopedic
Surgeon at Copper State
Orthopedics, Ltd., Phoenix,
Arizona. In addition to his
busy private practice, he
helps to provide Orthopedic
services for Children’s Rehabilitative Services (CRS), and
for the poor and the medically indigent populations
both in the inner city and on Native American
Indian Reservations. Dr. Martin is also the medical director of Urgent Care+, LLC, Phoenix, Arizona.
Dr. Martin is a member of the American Academy of Orthopaedic Surgeons (AAOS) and has a
dual appointment on the Academy’s Diversity
Advisory Board and on the Council on Advocacy.
Dr. Martin is a lifetime member of the National
Association for the Advancement of Colored
People. He is a member of the American Medical
Association, the Arizona Medical Association,
and the Arizona Orthopaedic Association. Dr.
Martin received his medical degree from Loyola
University of Chicago in Maywood, Illinois.

Dr. Mackstaller has served on the Board of the
American Heart Association, the Sarver Heart
Center Advisory Board, the University Heart
Center Board, the National Scientific Internal
Page 5

ARIZONA MEDICAL BOARD MEMBERSHIP
Dona Pardo, R.N., Ph.D., is a public
member and a registered nurse. Dr. Pardo has
over 30 years experience in
nursing education and has
taught in diploma, associate
degree, baccalaureate degree
and continuing education programs. She retired from the
University of Arizona after 21
years of service during which
she taught baccalaureate nursing students, headed the Continuing Education
program in the College of Nursing, and just prior
to retirement was the Administrator, Continuing
Education for the Arizona Health Sciences Center. In that post, she was responsible for Continuing Education for physicians and nurses.
Dr. Pardo is 2nd Vice-President of the Board of
Directors for Compass Healthcare, and founding
Foundation Director and current Treasurer for
Tucson Nurses Week Foundation.

She has been a member of the Parish Council at
St. John Vianney Catholic Church where she is on
the Finance Committee. She has also served on
the Joint Legislative Committee on Hunger.
Mrs. Proulx is a graduate of Scottsdale High
School and attended Northern Arizona University
in Flagstaff.

Robert P. Goldfarb, M.D., F.A.C.S.,
departed from the Arizona Medical Board in
April, 2009 after serving as a
member for seven years.
During his tenure on the
Board, he was elected Chairman in 2006. He is the Chairman of the Carondelet Neurological Institute at St. Joseph’s Hospital in Tucson.

Dr. Pardo earned her master’s degree in nursing
from the University of Texas Health Sciences
Center at San Antonio and holds a doctorate in
higher education from the University of Arizona.

Germaine Proulx, a public member, is a
certified Pharmacy Technician who lives in Sedona with her family. She
has been very involved in
her community since she
and her husband moved
there in 1977.
Mrs. Proulx has served on
the Board of Directors for
the Sedona Adult Community Center and helped establish the Meals on
Wheels program. She has served as President of
the West Sedona PTA and as a Girl Scout leader.
Page 6

BOARD ACCOMPLISHMENTS
The Arizona Medical Board became an even more responsive, secure and
productive agency in a challenging financial climate.
The Board adopted a number of suggestions
from Board Members and Staff that produced
significant cost savings during the fiscal year.
Diligent work by Staff enabled the Board to
begin scheduling one-day meetings, rather
than the usual two-day sessions, offering additional savings in expenditures. The Attorney General’s Office assisted in reaching
Consent Agreements with physicians in cases
that were destined for Formal Hearings at the
Office of Administrative Hearings, reducing
the Board’s legal expenses.
The Board now offers on its Web site, at no
charge, an alphabetical directory of active licensees that contains a physician’s practice
address, phone number and specialty or area
of interest.
The Web site continues to be one of the
more popular and user-friendly consumer
portals for information about physicians. For
years it has offered citizens the option of filing a complaint online. The Board now affords doctors the ability to renew their licenses online, while still respecting that fact
that some physicians prefer to use the traditional paper form. Additionally, the Web site
has been an important conduit of information
regarding the H1N1 virus, commonly known
as Swine Flu. Staff has provided physicians
and the public with the latest information
from the Centers for Disease Control and the
Arizona Department of Health Services.

Aware that there are those who don’t respect
barriers protecting Web sites and confidential information, the Board’s IT staff has put
in place new equipment and procedures and
continues to look for ways to improve internal security.
Members of the public and licensees often
seek information from the Board via email.
During the fiscal year, the average response
time to nearly 2,000 queries was less than
half a day.
An important aspect of any complaint investigation is the opinion from a medical consultant who reviews the case. Besides the
handful of physicians who work directly for
the Board, the agency relies on hundreds of
other physicians in the community in a variety of specialties. To attract new specialists,
Board Staff initiated a campaign to find additional consultants by reaching out to various
specialty medical societies, by placing recruiting announcements in initial license and renewal packets, and by directly contacting
physicians who have been recommended to
serve. As a result, the Board now has a list
of more than 1,200 consultants in specialties
ranging from family practice and internal
medicine to endocrinology and vascular surgery. Their involvement provides valuable
insight into physician practices and has ensured a fair and complete adjudication process.

Page 7

LICENSING
The Arizona Medical Board now has more than 20,300 physicians licensed
to practice medicine; approximately 12,240 have Arizona practice addresses.
Another 1,100 physicians have Arizona
mailing addresses, but no practice addresses.
The Board issued more new licenses during FY 2009 than in the previous year. The total
number of initial licenses issued was 11% higher
than FY 2008.
National studies indicate the average age
of the physician workforce continues to rise, but
the Board has not seen any significant increase in
license expirations. And the number of PostGraduate Training Permits issued by the Licensing Division remained steady, indicating a continued interest in Arizona residency and fellowship
programs.

The Board awarded 55 more miscellaneous medical licenses during FY2009, representing
a 77% increase, and issued 10% more Dispensing
Certificates than a year earlier.
The Board conducts primary source verifications on educational and training programs in
initial license applications and performs national
queries to determine if a physician has any professional conduct issues in other states. Board Staff
help physicians with the verification process to
reduce the overall timeframe for licensure.
Not funded by tax dollars, the Board relies on the $500 biennial licensure fees to pay for
its licensing, investigative and administrative functions.

Licenses Issued
FY 08

FY09

Licenses Issued

1,328

1,481

Post Graduate Training Permits Issued

1,260

1,254

Miscellaneous Licenses Issued

71

126

Dispensing Certificates Issued

512

564

2

2

95%

95%

Average Number of Days to Issue a License (Date of receipt of fully
completed application to final approval)

Customer Satisfaction Rating

Page 8

REGULATION
The Arizona Medical Board regulates the allopathic medical profession,
those physicians who are MDs. The complaint process is structured to ensure
a fair and impartial investigation to resolve cases in a timely fashion.
When an investigation substantiates a
violation of the Medical Practice Act, the Arizona Medical Board uses its authority to discipline a licensee.
Disciplinary actions taken against a licensee
are public. Since the effect these actions can
have on a physician are long-lasting, the Board
takes all complaints against physicians seriously.
Its decisions to issue disciplinary orders in quality of care cases are based on a review of the

community standard of care.
In the end, the Board is bound by its charge
to protect Arizona citizens from the unlawful and
incompetent practice of medicine. The actions the
Board takes are reflective of that mission.
Overall, the Board took disciplinary action in
128 cases (see chart below) during FY 09. Additionally, the Board issued non-disciplinary Advisory Letters in 229 cases.

FY 09 Board Disciplinary Actions
80
67

70
60
50
40
30

27
22

20
10

6

4

2

0
Loss of License

Practice
Restriction

Decree of Censure

Letter of
Reprimand

Probation

License Denial

Page 9

REGULATION
The Arizona Medical Board’s regulatory activity most often begins when
a complaint is received and an investigation is opened.
The Board opens an investigation only when
a complaint meets two criteria: it involves an allopathic physician and the allegation—if true—
would be a violation of the Medical Practice Act.

ing the average was that the agency had three vacant investigator positions due to the budget hiring freeze. However, the FY2009 average was
still below the benchmark of 180 days.

The average caseload of open investigations
on a daily basis was about 330 cases during FY
2009, down from the previous year.

PHP Monitoring

Investigations Remaining Open at
Fiscal Year End
Year

Number

2008

489

2009

299

Board Staff kept pace with the caseload while
improving the quality of the investigation. This
led to a larger number of Consent Agreements
with physicians in lieu of a formal interview before the Board.
Conversion of the data to the Board’s new
database system is believed to be one reason for
the increase in the average number of days to
complete an investigation. Another factor affect-

Type

Cases Monitored

MAP

95

Other PHP

26

Licensees in the Board’s Physician Health
Program (PHP) may be in either the Monitored
Aftercare Program (MAP) for substance abuse
rehabilitation or monitored separately for medical,
psychiatric, psychological or behavioral health
issues. PHP coordinators ensure that physicians
comply with the program’s requirements and are
safe to practice medicine. Findings of noncompliance are immediately brought to the
agency’s attention.

Average Days to Complete an Investigation
Year

Days

2008

115

2009

154

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