Spillin Tea LIVE Show: Oklahoma

[00:00:00] Welcome back to Credentialing Chronicles, where we spill the tea on the doctors you see. And we're spilling it baby all across America. Okay, so I do want to say we do have a lot to talk about. Before we get into any tea, we have to do our disclaimer.

[00:00:29] Yes. Okay, because we've not credentials and you have these physicians and all this information is based on publicly reported information that y'all can find on your own. We're just here compiling it for you and reading the board reports because they're so much fun to read. All the tea. If we read all the different tea outlets and then put it all together and give you a good story. Yeah. So do you know what's funny though, Shannen? Because administration loves to say things like, can we fast track this?

[00:00:58] Yeah, like, credentialing is the drive-by Chick-fil-A. My pleasure. I'm not bad practice history, but here you go. No. Ready of this before. Oh my goodness. Alright, so, administration comes to me dead serious and says, We really need this provider credentials in 30 days. Okay. Okay? So we all know. We know that.

[00:01:27] So I said, okay, do they also want me to summon their residency program from 1997 out of the spiritual realm? Because that hospital doesn't even exist anymore. Exactly. Right? So, but the provider says, I don't have any gaps in employment. And we love a bold lie. We do. We do. We do love a bold lie. So, suddenly we teleport from 2016 to 2020. Okay. He teleported. Okay. Those years just, they didn't exist. No gaps? No. It was a disappearance act.

[00:01:58] So I asked about it. Okay. And what was he doing? Paternity leave. Paternity leave. Paternity leave. Paternity leave. For four years. I've been eating fruit ball. No. No. He said he was consulting. Thank you. Consulting himself in New York. Are they something cute? I don't know. I don't know.

[00:02:27] You are so funny. I know. Those are my little jokes for the day. Okay. I have a couple. Okay. So, you know how providers always say, I sent it to you through email. I uploaded it in a portal. Yeah. You know, I have it. I'm getting it to you. I'm going to put it in a day or a day. Okay. And then you say, well, where did you upload it? The cloud, Google Drive, the credentialing software.

[00:02:54] And then they say, you know, it's not in my system. So I don't see it anywhere. And they say, you know, I'm expecting something like, I uploaded it to NASA. Right? Because I am consulting there. So I don't see it. Okay. Got it. Got it. That was a good answer. Yeah, yeah, yeah. That's probably what he should have said. That's what he should have said. Because I'm like, at this point, honey, you know how it always is with that.

[00:03:24] Okay. So let's talk about Oklahoma, baby. Okay. Okay. Okay. Okay. So I got some legislative. I got some boring stuff. I know. I was thinking, I mean, you should start with that. So you got to give them some CE's here. Right? No, yeah. Y'all need to get your education certificate. And Eileen has about 102 certifications right now. No.

[00:03:53] So she's very good at making sure we're up to date with our legislation. Well, you know, that's what the compliance officer is all about. No, I love it. Okay. So y'all need to know legislative updates that are going to affect you. Or affect... Oh my goodness. Somebody don't want to hear legislation. They want confessions. They want confessions. They want confessions. They want confessions. They want confessions. They want confessions.

[00:04:23] They want confessions. Nobody wants to listen about the law. Okay. Okay. So we ready? Oh my God. Well, I'm going to give this one. This one came in from Oklahoma. Hot off the press. You want to read it or shine? Well, you're going to do the legislation. I'm going to do it. Yeah, yeah. I'm an MSP in Oklahoma. And I swear, this is something that I would only say to my friend. Dot, dot, dot. Credentially chronicles. Yes. Because we are friends. Yeah.

[00:04:52] There was this one provider file that just didn't sit right with me. Nothing you could do, flat out deny. But enough little things that I kept flagging it, documenting it, and trying to slow it down. But every time it came back, it met requirements. We need them. Push it through. And truthfully, it was because he was doing procedures and bringing in money. So it only got approved. So it got approved anyway. Just based on leadership's final work.

[00:05:22] After that, everything shifted. I went from being thorough to being difficult. I wasn't included the same way. My input didn't carry enough weight anymore. And you just could really feel that the tone changed in every conversation. All because I wouldn't just take quiet and pass it through like nothing was off. And here's the craziest part. I know I wasn't wrong. I felt it then. And I still feel it now.

[00:05:52] But instead of being heard, I was basically pushed out for speaking up. So I left, not because I didn't care, but because I cared too much. To stay anywhere that wouldn't even trust the MSP doing their job. Especially when new leadership came in acting like cleaning things up meant silencing the people who were actually paying attention. Yeah. Oklahoma, y'all. It wasn't me.

[00:06:20] I want to ask me, did you write that? I'm like, no, but I've been there. I was once called, you're an obstructionist. Because I was speaking up and saying, well, we have got... Is that a new word? Obstructionist. Obstructionist. Oh my goodness. Yeah. That's great. Unfortunately, these are things that we have to go through and then you have to make moral decisions as far as what you're going to do. Well, what happened? Since we're on storytelling, you know what happened to me?

[00:06:50] Don't get her started. Listen, I was at the hospital, the community hospital. And the CEO decided we had six floors. Each floor had a wing. So we had 12 wings. He decided to close one of the wings so that only employed physicians could consult patients on that floor. So only employed hospitalists or employed group doctors could see patients on that floor.

[00:07:18] And it was a community hospital run by mainly concierge doctors. So the concierge doctors would see their own patients. So their patient ended up on that floor. They couldn't see their own patients. And these patients are paying, what, six grand a year to see the doctor? So long story short, the doctors rebelled and they got the entire C-suite fired, which then led to getting a new CMO. When the new CMO came, she was a pathologist. Oh, cool.

[00:07:46] So that, of course, sat so well with all of our, you know, doctors. But anyway, she came on and first thing she did was she fired the medical staff director. Subsequently, my one other employee, she decided that she wanted to do something else. Another one decided to be a stay-at-home mom. I went from a department of four with 1,400 providers to a me. Ooh. And they said, okay, we'll give you $2 to stay. I was like, you know, $2?

[00:08:19] $2! To do everything. And, and, take $2. And I had to take the CEO's secretary with me. And when she came to my office, she's like, well, I could do your job. And I was like, oh, great. Do you know what the MD&DO is? And she's like, no. Got it. Got it. EFFA. So I said, let's, let's start with what that means. Do you know what a PA is? No. Do you know what an APRN is? No. Great. This is what they gave me to work with.

[00:08:49] But long story short, has a nice ending. So fast forward eight years later. You know she's the medical services manager now at the hospital? Oh. And she was at my webinar last week and she put everybody, she like, I mean, train me. Oh my goodness. That is a good story. That is a good story. That is a good story. I still quit though. I trained her and I said, you know. I didn't know that. Take the problem. Take the problem. Exactly.

[00:09:17] I wonder if she's getting the $2 plus a little more or? I don't know. Yeah. Well, they've been through a lot of changes now. Oh my goodness. Anyway. But we understand. It's all we're saying. We do understand. And that's why we're really bringing stories like this out to MSPs all over. Because you know, if you get told that you're an obstructionist. Obstructionist. I just never had heard that word before. But obstructionist enough, you might actually start believing you are an obstructionist. But you're not, baby. No.

[00:09:47] You are the what protects the patients from some of the wild and crazy stories that we're about to tell you today. Yeah. For sure. Okay. So let's say this. Get your CEs ready. Okay. So, according to Oklahoma, the Oklahoma Healthcare Authority has reinstituted mandatory provider attestation for compliance to be completed via their portal by May 15, 2026. Y'all know that? Great. See, they have any on it. They don't need me. Okay.

[00:10:16] Confirm your enrollment compliance and operational information. So, that was update number one. Number two, medical marijuana. So, the most significant change for physician credentialing in medical marijuana. Do y'all know about medical marijuana? Yes? Oh, we know all about it. I'm sure. Yeah. Okay. Is that we have no cards here? Okay. Mango is everywhere. I see. Mango. Mango. I said, what is mango? Let's go get mango. It says cannabis mango. I'm not. I'm not. I'm not.

[00:10:47] If a physician recommends medical marijuana. Okay. Tell me. They have to register with the Oklahoma Medical Authority, OMA, annually. Okay. That as well. Yeah. Complete approved medical education courses. They cannot operate out of a dispensary. Okay. A little conflict of interest. So, that's. Yeah.

[00:11:11] And then this OMA will publish a list of the registered physicians in January. Mm. So, when we're credentialing, we can check that list to see if the doctors are complying with the OMA requirements. Yes. Yes. Awesome. Okay. I got another one for you. Okay. Did you guys hear about the independent APRN prescriptive authority change? Yes. Look at everybody. Good job. Yes.

[00:11:39] So, removes the requirement for APRNs to operate under supervision for prescription. So, how did you guys handle that on your privilege forms? I'm just curious. It didn't change anything. It didn't change anything. So, it doesn't matter. They still have to do everything the same. Anybody here working in private practice? Do they do whatever they want? Can I just say, your hats are amazing. Did we not get them at all that I see where you're at? Yeah. I would have worn a hat. I love your hats.

[00:12:09] I love it. I'm like, are we actually not even in the Kentucky Derby? I'm telling you. I love it. I have to do it. And they're all like together. I know what I'm saying. I'm not talking to you. I'm not talking to you. Are you guys working the same thing? I don't know. We're friends. That's amazing. So, you guys aren't even doing this with the nurses still making them have a thing. Okay. Well, the plans make you still have it. So, it really doesn't matter that the stage changes.

[00:12:37] The plans make you have a supervisor. So, I think that's the part that everybody forgets. You know, when it's like, oh, they can see anybody they want. They can see anything. Well, the plan says, can I get your collaborative agreement? Yeah. Yeah. Okay. This one is going through all 50 states. Um, slowly but surely. Um, it has passed in some states. And it is on the bill for docket in other states.

[00:13:05] So, we just came from Iowa and Nebraska. It's on their docket. It has not been approved. In Florida, it's already been approved. And in Oklahoma, um, it was approved, I believe, November 1st, 2025. What? Tell me how it was. The international foreign graduates. Oh, yes. So, you guys are aware of that. Okay. So, every state has different requirements, however.

[00:13:30] So, in the state of Oklahoma, the pathway is, and here's going to be our challenge is, how are we going to verify education? Because, this is going to be a big problem. And I'll tell you because I ran into this in Florida already. So, I'm a CBO. We know about it. Yeah. So, they have to have three years. They have to be a doctor in their country, first of all. They have to have a medical degree in their country, whatever country that is. It doesn't matter. But. But not verifiable. Right. Because it's, you know, whatever language.

[00:13:59] But anyway, key requirements include three years of postgraduate training, an ECFMG certification, and a three-year non-renewable job offer with an ACGME accredited system. So, it's not a residency. It's an employment. And that's the difference. They are not enrolled in a residency program. They are given clinical privileges. Okay. During these three years, they have, and this is just in Oklahoma.

[00:14:27] In Iowa, it was six years. So, Oklahoma is giving them three years of clinical practice. They do have to complete their USMLE exams, and they have to get a job offer. Now, they have to practice quote-unquote under supervision of the chair of the department. What does that mean? It doesn't say if it has to be direct or not. They have to speak English. I think that would be a requirement. That's pretty helpful. Yeah. They have to pass a background check.

[00:14:57] I don't know what passing a background check means. Does that mean you have a name and a social? Mm-hmm. But, I mean... Well, I guess that you have policies and the facilities are. Okay. Right. Policy, yes. And then the license is three years. Yes. And they have to pay $500. $500 fee applicable. That's not a lot. No. So, after three years of supervised practice and in good standing, then they can be eligible to move to an unrestricted license. Only three years. Iowa is six years.

[00:15:27] Yeah. But Oklahoma made it only three years. So, you're going to have these doctors coming through your facilities that have a license to practice with no residency and no fellowship in the US. There's only two places they can work. Where? The two academic centers that we have in Oklahoma. The academic centers. Because they're doing... Yep. So... So, they can't just go straight to a hospital. No. Oh, good. So... That's good. But... I think so...

[00:15:57] I'm interested here, at least when I was working in Oklahoma, all the hospitals I've ever worked in, in your bylaws, it says you have to complete an ACGMA residency. So, they're automatically out even after... But the problem is they're trying to fill these gaps. And so, it's like... I need rural health. So, the case in Florida, I have an interventional pain doctor. He graduated from Iran, one of the universities in Iran.

[00:16:23] And the hospital that picked him up enrolled him in a fellowship. So, he never did a residency, but he had got into a one-year fellowship with this program in Miami. So, the only thing I could verify is that he was actively enrolled in a fellowship. And then he got an active license in Florida, but there's no residency ever to be found. So, is that a not accredited fellowship? No, no. This isn't an accredited pain medicine fellowship. But I thought you had to complete a residency. That's where you're told. They get into a community. That's the new, that's the new.

[00:16:52] And so, they have to create these alternative pathways because if the state is allowing you to get a license and not have to complete it, so these are all the changes that we have to be on top of because, agreed, yeah, it could be just the academic facilities now, right now, but if other hospitals say, we need the help, we'll be willing to provide a supervising. Because it doesn't say supervising doctor from a school, academic facility. It doesn't say that. It just says supervising doctor.

[00:17:21] So, if a rural hospital says we need these extra hands to cover our floor, how are we going to adjust for that in our DOPs? Yeah, and the beautiful thing is that as we bring it up right now, as it's still going through and hasn't been approved yet, you know, that's again, ways that you make yourself more valuable is where you think of every obstacle this could be, every place this is going to touch.

[00:17:46] If you prepare your CEO, because what's going to happen is your CEO, the board members, somebody, baby, they're going to be in a meeting somewhere, they'll be like, oh, you know you can just hire foreign doctors now. Let's get them in there and get them in there. And that CEO is going to come to you or your CMO and say, hey, get these doctors in here and you're going to have to have, prove yourself valuable and have all of this documentation and say, okay, we can get them in here, but here are all of our obstacles that we have right now, here's solutions to, you know, things that we do as MSPs.

[00:18:16] But, you know, again, these are the things that, you know, build your brand as a person, as an MSP because you're already aware of things, you're already thinking of obstacles, and you're already thinking of solutions or barriers of like, we have to change our bylaws in order to make this work, baby. And so that's, you know, again, building yourself to be that knowledgeable. Okay, I got another one. Okay. Because we've got to talk for a long time. Yeah. Okay, what about social workers? I don't know. Should we talk about social workers?

[00:18:46] Oh, the good old behavioral health. So social workers, Oklahoma House Bill 2261 enables Oklahoma to join the social work licensure compacts. So licensure compacts are now not only nurses, there exist some physician ones, yep. And so now with social worker, they're going to create a multi-state license allowing social workers to practice across state lines in member states reducing the red tape.

[00:19:12] Full implementation is slated by the end of 2027. So they'll be able to have a licensing mobility, they'll be eligible for Oklahoma social workers so they can practice in other compact states without applying for a new license and vice versa. They're going to allow life help or telemedicine. Telemedicine.

[00:19:52] Telemedicine. Telemedicine. Telemedicine. So apparently you guys are only at 67%. Okay. Now they say that this is going to reduce the administrative burden because they only have to pass one exam or deal with lengthy licensing procedures. I love how they say they just put an adjective that it's lengthy. Not necessary. Not necessary. Because the light, it just takes too long, too much paper. No, no, too much. Okay.

[00:20:21] And then it's going to, like I said, it's going to be good through 2027, effective by 2027. Do we know which states is joining with that? No. They did not. Okay. Give me that detail. Is Oklahoma joining? Yes. Oh, okay. Is y'all thinking about it? We all think about it. Yeah. So it's called the Social Work Licensure Compact. Okay. Okay. So look up that. Y'all credential social workers or work and behavioral health. CME requirements are something you need to think about if that's something that's coming down the line. Mm-hmm.

[00:20:50] You know, supervision. Mm-hmm. Okay. So before we start spilling some tea and getting into my story. I'd like to talk about really quick the future of credentialing. Who has heard just in like the last six months about AI? Right? No. Thank y'all. So do y'all have a card that looks like this? Like one of our Rikki Lay cards? Yeah, I've seen it. Okay. So we're going to ask a question.

[00:21:20] And if the answer is use sparingly because you know chat TTP be lying, you're going to flash pink. Yeah. Yeah. But if it's like I'm all in baby, I want a solution. Give it to me. Give it to me. You flash in white. Okay? So where do you, I want to know where do you stand? Do you use it sparingly because you know it makes mistakes and you just a verifying bug? Pink.

[00:21:49] Or are you all in because you need a solution? You are overbearing. You are tired. You got things to do. Why? No, no. I'm a pink girl. You're a white girl? Where are you at? So are you white and pink? We got to do it too. I have got to do it too. Yes, thank you. I flip. Sometimes I'm like. I'm like pink and then I'm like white and then I'm like no, no, no, wait.

[00:22:19] I got to do pink again. Then I got to like double check out what they said. Yeah, yeah, yeah. They said. But we do want solutions. Well, we do need solutions. We need solutions. And so I just want us to think like a little bit outside of the area of, you know, will AI replace medical staff professionals? You know? No. Never. Okay. And so when we think about it and you know, I know everybody mostly has some type of credentialing software in your facility.

[00:22:49] And I know that the software people talk to you because you know, they always just want you to sign a new contract. And so when you're ever talking to them, you should talk to them about things that would make their software better. You know? So maybe something like, you know, now that the plans own CAQH, like once a provider becomes affected, maybe that should think back over the CAQH and you can kind of see where all the providers are affected.

[00:23:14] But again, your voices are the voices that get them to move in different ways. And so if they think that you need a solution so bad that you're willing to just throw all the cards on the table, you know, then they're just going to throw anything at you. And so I just want everybody to kind of look and think about how can we use AI to have the systems talking to each other accurately, having mapping new, oh Blue Cross Blue Shield sent

[00:23:43] out a new application. Oh, my system automatically has it, automatically maps it, automatically ready. Those are the things that you have to talk to your software companies about. Well, I sit in the bathtub and write a list, baby. Yes. Well, but can I tell you some are listening? Some are listening. So, y'all know, I mean, if y'all follow me, you know, I'm kind of out there a lot and I do a lot of things and I'm... Everywhere.

[00:24:10] Enjoying my change in life that's occurred. But anyway... Not that change. Not that change. Other changes. Not that change. Anyway, life situations. But anyway, so I had the opportunity to be reached out by many software companies and a lot of them want to say, can you vet our program? Tell us what you like. Yes. So what is actually out there? So there is a program out there and it's unfortunately, it's from the UK. It really hasn't been adopted. My feedback to them was you're not ready for the US market.

[00:24:41] But one of the things that they do is when a nurse in this case, it's an HR more used platform, but they, you put in the license, it reads the license and it automatically fills that in. So instead of us having to type it in, it types it in for you. So that's when. And then one of the platforms I do use for my surgery centers, she, girl. I can't say that platform. We're all saying they didn't pay it. They did not pay it.

[00:25:10] I'm not going to give you that name. There's no sponsorship. But this woman, she did, she, I don't know how she did it, which means if she did it, there's no reason why any of the other companies can't do it. Why she did it? You send out an application to the doctor. Okay. It goes out with an automatic release, right? That once the doctor creates the username, he'll get a, or she will get an alert. The alert will say, do you authorize us to query the AMA on your behalf? They say yes.

[00:25:39] It imports the information from the AMA and it types in their whole application for them. And they say yes. Oh, that's what I mean. Right? That's the biggest complaint. They don't even worry so much about job history, but it's a stupid education that they have to enter 20 times. It's a data entry. It irritates them. So I told her, once that launches, I said you have literally changed the game across platforms. So they're using AI. So that's how I think we should use AI.

[00:26:06] One of the things I will tell you for cautionary tale of AI is anything we put in AI is discoverable. So anything, if we're working on any cases on NBC, anything that has to be reported to the database, you should not be using MPDB for that. Throwing your minutes in there. Or throwing your minutes. Yeah, don't do that. Because all of that becomes discoverable, is not protected. So just be very careful how we use them.

[00:26:33] There's one thing to write a letter and all this other stuff, but not to use it or put ... But there are companies that say, oh, we have robots that call the plans. And you're like, well, what happens if they have a question? And you say, oh, well, then you have to call back. And you're like, well, that's not kind of helpful. So there's just so many ideas, which I understand. But I'm just saying, use your voice in things that you need. Write them down. And when you get the opportunity to talk to your software company, you give them your wish list.

[00:27:01] And make them make the software that you like. Take that idea. Put that on your list when you take your bath tonight. And just put ... Oh my God! Alright, confession session. There's other confession sessions. Okay, sure. Mine's are short. But mine's are short. Oh, do you ... Honey, I got one of these long ones over here. She wrote pages. This is the one of the pages I have. Okay, read it. Because she's so good at equations. Oh my God. I'm going to try and ... No, no, no.

[00:27:31] It's a good one. Okay, so when I first began my role as a credentialing specialist, I was trying hard to learn our bylaws. We all do that, right? We all do that. Oh, by the way, I just came from the AORN and I've talked to a bunch of nurses and I looked at them and I'm like, I know y'all have read your bylaws and they looked at me like I had like mud all over my face. They're like, what are those? I was just saying, oh. Okay, so anyway, okay. So, she will be the surgery's voice of the board. I'm going for her to take a look. Yes.

[00:28:01] They will get it together. They will. I know. I'm afraid it's the last thing I do. Okay, so she was trying hard to learn her bylaws, understand the various regulatory bodies and oversee the medical staff, becoming familiar with the self-government medical staff structure, all the things. And she had a doctor help her. Aw, she said a provider gave her a crash course. Okay, give me a hand. Okay, early one morning, we received a report that stopped everything. A provider had allegedly struck a patient the night before.

[00:28:31] Don't beat him up. Staff had whispered to the incident. He did it in front of somebody else. Oh, and we said that he was spirit of now. Given the seriousness of the allegation, there was no gray area. We immediately notified the department of health, triggering a full abuse investigation. Oh, not the whole health department. The patient in question had been brought in by the police. Oh, so that was how we were feeling that. It was how we were feeling all aggressive.

[00:28:59] And after a violent public incident had a head laceration that needed evaluation. Paramedics were involved, but due to the patient being aggressive. You know, just saying. Sometimes you gotta back down. The patient was being aggressive, verbal, and physically abusive. The patient arrived in a cop car in handcuffs with a gash in his head.

[00:29:28] It's not sanitary. It's not sanitary in the back of the police car. Woo! Okay, so law enforcement briefs medical staff ahead of time, and safety precautions were clearly a priority. The patient was also restrained at the ankles to prevent from kicking. Oh, fine. Okay. Once inside the exam room, the patient remained restrained with handcuffs. Oh, y'all can be putting the details in the story! I am there!

[00:29:54] A police officer, a paramedic, and a nurse remained present in the room to help manage to manage those three rooms. Okay, okay. Oh, I got a story about that too, okay. But nursing staff attempted multiple times to obtain vital signs, during which the patient continued to be verbally aggressive. When the provider first entered the room to assess the patient, it was determined that the patient needed time to calm down. Before the provider's asleep. He was fine. His heart is beating. Yeah. It's okay. Obviously. Let him cool down.

[00:30:21] When the doctor returned later to look at his head maceration, the patient spit in the doctor's face. Oh! What did that happen? At that point, the situation escalated. I said it did! I said it did! I said it did! Witness accounts buried and details became unclear. Staff reported... Girl, I wonder who wrote this? I'm not telling you! All right, the staff reported that the provider struck the patient with a fist. A fist!

[00:30:49] Body camera footage showed the provider's fist raised, but the footage was obscured by movement and confusion as personnel attempted to deescalate the situation. Now hold him back! So they told me he didn't make contact. Didn't make contact. Oh my goodness, that's what I'm wondering. Okay. Part of the investigation, a comprehensive review of the provider... Oh, this is coming to y'all medical staff, honey! What y'all doing? I know it! As part of the investigation, a comprehensive review of the provider's credentialing file was conducted, including verification of mandatory reporter training. Has he hit other people? Correct.

[00:31:19] Today, as a direct result, proof of mandatory reporter training became standard requirement on file. Multiple credential committee meetings followed as we balanced internal due process on the ongoing state investigation. The provider was placed on the absence fewer than 30 days. If you know, you know. During that time, the committee determined the provider would need to appear before the NEC to walk through the incident with their perspective, which is true.

[00:31:48] After careful review, the decision was made to allow the provider to return to work. How many of you would allow him to go back to work? Or advocated. Yep. Yeah, for sure. I'm not... I had to punch the back in. Okay, no. Sorry. I'm going to have to go up in front of NEC now. Alright. The enrollment... He had to enroll in a rehab behavior program, consistent attendance to classes, regular check-ins with an in-house peer mentor. Wow. It was corrective, structured, closely monitored, and of course well documented.

[00:32:18] The program spanned six months, and during the time the provider came up for reappointment. With the state investigation still unresolved, privileges were extended to allow the process to continue. Each extension was accompanied by a formal update on the provider's progress. By the time the program concluded, the provider's reports were positive, compliant, strong, and no further incidents occurred. On that basis, the committee approved a one-year reappointment. Nearly two years later, the state medical board finally held a hearing.

[00:32:45] Even now, we remain in limbo, awaiting a decision regarding the provider's license. In the meantime, the provider continues to work actively in the facility. For me, this case was an unforgettable introduction to credentialing. It's taught me how policy, behavior, regulation, or real-world chaos intersect, and how one incident like this changes your whole credentialing process. Isn't that a beautiful one? That is beautiful. I got this stuff, I got this stuff, I got this stuff. I got this stuff.

[00:33:11] Well, that transitions me into, this is actually a really good transition, into my, I think this is my last one, about the legislative update in the law. We are still on the list. I told you I got it on, we have to go. We got to talk to these people for a long time. Okay, so, speaking of that, now that the board heard about it. They're very solid in their papers. Oh, wow. So they say no, but okay, so, now that the board heard about this doctor in Oklahoma, Oklahoma

[00:33:40] State Board Medical License has adopted a significantly stricter zero tolerance of parole. Mmmmmmm. See? Two, the licensee misconduct, emphasizing patient safety over rehabilitation. Mmmmmmm. In cases of moral turpitude and criminal behavior. So, would that be considered moral turpitude? I would say. Okay, how about a physician, so this is, true story, I'm going through this right now.

[00:34:12] A physician who locked up his wife in a closet and was arrested for, um, uh, battery, not battery, but, uh, no. In that case? No. So, false imprisonment. False imprisonment, that's how I could go on. That's how I, that, I was going to go on. Is that moral turpitude? Okay. Yes! I would think so. Yes! That is a thing! But I could also see on the boards, I mean, you have to, you could see it the other side of it too, right?

[00:34:42] It's like, you're the provider, if you've felt yourself escalating, you should have left the room. You should have left the room. And, uh, delivered a fist to the face. So, I mean, I can see both sides of that. But, in an instant, humanly, yeah. Because if you spit in the face of a police officer, that is assault and then you're That's assault. That's assault. That's assault. That's assault against you. That is a doctor. And the doctors are standing out. And in a major reaction, I think you're going to, he didn't actually knock the guy out. Right. But, uh, so he did refrain. Correct.

[00:35:12] Yeah. But he didn't jump on top and start wailing. And there, see, there is an MSP perspective. Cause like, hello, it's still not even up. Exactly. So, the Oklahoma board has refined the definition of unprofessional conduct and tightened its authority to immediately revoke licenses for specific criminal acts, even if those acts did not happen in an exam room. Well, I have a story that might contradict that. Well, this just happened. Oh, okay. Okay.

[00:35:41] They're updating their laws. Okay. They need to. Cool. Right. So maybe because as a result of all this tea spilling and all the stories we got, they decided, cause if I'll tell you who y'all still have practicing around. Yeah. I'm just saying. Woo. We have some license verifications. So, we gotta. Okay. So, the board now places immediate action on the following. You ready? Fraud. The. Sexual misconduct. Violence.

[00:36:11] And drugs. Those sound like all the things we talk about. I know. Moral turpitude is a conduct that violates community sentiment regarding honesty, justice, or good morals, which is now a primary target. Abuse of trust. This board strictly enforces penalties for an abuse of trust, or coercion, or manipulation using the doctor-patient relationship. Falsification. No second chances for lying.

[00:36:40] So, if you lied on your application. Falsification in clinical settings or in license application documents is handled as a zero tolerance issue. I'm okay with that. Well, one of the stories I got. He done lied on his license application a couple of times. Okay. So then. The no go zone. If a licensee has been found guilty of a felony, sexual misconduct, or drug abuse. It's automatic. I'll go with that. I'll go with that. Y'all good with that? Yes. I'm good with that, too. And then.

[00:37:09] I love it. I'm going to go with the board. Oh my God. Wait. Y'all must be talking to some people. Yes. That's our MSP is doing their job. Okay. Humanity action. The board has accelerated its ability to take action, revocation, suspension against licenses who exhibit a risk to patient safety. So that's just like exhibiting a risk. I mean, how many times do we talk about patterns of behavior? Every time. It's 20 times that they already. Every single time.

[00:37:37] And really, I mean, if Oklahoma could do all those board changing, honey, people need to come over here and learn from Oklahoma. Yeah. Because we have states that are not doing that at all. They are letting things dry. There is still a doctor in Helena Monskina killing people. 11 people dead under his watch, y'all. He's still active on restricted licenses. Now, here are the two that I really love. So get this. A licensee can no longer easily surrender their license to avoid prosecution unless they

[00:38:07] explicitly admit to the misconduct in the sworn statement. Oh, hello. Eww. Yeah. That's a real... Can the hospitals again as well? Right? Y'all got that. The state is setting... The state medical board is setting the precedent. Washington, our hospitals. The hospitals can. Yes. Write it on your list. You cannot falsify your application and you cannot surrender in the middle of an investigation. Yes. Okay. Cost recovery, if a licensee is found guilty, they have to pay the board's investigation legal

[00:38:36] costs in addition to the funding. And it's just getting free. It ain't free to look this good. Don't open Oklahoma. Don't open Oklahoma. Good job. This one's good. You finished good on the list. You started more than you was... Eww. Is there more? Do I see? I get honest criticism. Right? It's okay. I was trying to be like all serious. I'm ready now. I'm like, yeah. I will say, I will say, and since there's only a few of you guys here, y'all can be honest with us.

[00:39:03] One of the other reasons that we did the podcast is we wanted to bring credentialing to the mainstream and just be like, it'd be okay. To patience. To patience. And to let them know we are doing something. There are good people who are here to keep them safe if they don't see, number one. But number two, that we can talk about it. Even though we can't talk about it, we can talk about it. We can talk about it. And so, I don't know. Do you guys feel that? Do you guys feel that? What do you guys think? Is it a good idea?

[00:39:33] Was this a good idea to do? Yes. We're going to do it. Yes. Okay, period. They said baby, we're here. We're here. And they like it. Great. Now you may need the love on. We got love on for tonight, y'all. Somebody get her a lot of weird. So, okay. Alright, so I got my stories. But we got time, so. Yeah, yeah, yeah. Well, I have one legislative thing. Look now, look. Well, you put it in my notes. Oh, good.

[00:40:05] Alright, so I'm like, but let me tell you real quick. You guys know that. So, she told me that I should really touch on the nerves of the nursing background check changes. Oh, yes. Have you guys heard about all of that going down? No. No? Okay, well, see you. Okay, so. Here's still you and baby. Give you a lesson on this one. So, now the nursing schools are going to be required. Well, the Board of Nursing in Oklahoma, which I'm so in love with all the boards here.

[00:40:35] And I'm in love with the weather. And I'm standing on a little peninsula with my little RV. And I'm just like, oh, it's so beautiful here. Oh, it's so green. Okay, but anyway, I love Oklahoma. So, the Board of Nursing is saying that the schools here, the nursing schools are going to have to start reporting the completion rates. Number one. Okay. They're going to have to start reporting the enrollment data.

[00:41:03] So, who was enrolled as versus how many people are completing these programs. And the student outcomes. So, are they going out and actually getting jobs as nurses? LPNs, Auburn, okay. I love the nursing school. And so, really what they're saying is, you know, Oklahoma, the Board of Nursing is saying prove that you're teaching people and that they're actually graduating now. And that what you're teaching them is viable in the workforce, which is incredible.

[00:41:32] And so, when you look at that, if the school falls below 70% of graduation levels and outcomes, the Board actually now has the right to step into the nursing school, do site visits, do recommendations, do audits, and really is governing the schools. Which, what do you guys think about that? Dunza? Of course. Pink, you love it. White, you hate it. Yeah.

[00:42:01] Pink, you love it. Yeah, I love it too. I love it too. I love it too. And I'm so proud of Oklahoma doing that. You know why? Did y'all hear what happened in Florida? Yeah. Because y'all know it's Florida. I know right now. And the nurses have been far and wide. Well, if you want. Yeah, we have an episode about it, actually. But did y'all hear about what happened in Florida? No. When? So, they're still arresting nurses across the US. Two schools, fraudulent schools opened up. And they were just printing diplomas. They graduated over 6,000 nurses.

[00:42:32] Yeah. With fake diplomas. With fake diplomas. And then those diplomas went to all the different states. See, y'all didn't listen to the credentials. Yeah, I didn't listen to the credentials. Yeah. I mean, yeah. And so there are people in states, MSPs in states far and wide. I mean, all the way into Maine, you guys. That are literally catching these fraudulent nurses, you know, when they're going back and actually verifying the school. What was your question? Have you guys heard anything about the changes in the NCLEX? Is that what it's called?

[00:43:01] The NCLEX? The NCLEX? The NCLEX, they're on an exam? Yeah. Which I guess they're loosening the restrictions and the environment that you have to take in, which is going to be wide open for potential fraud. Oh. On passing that exam? No. Have you heard about that? Well, at least Oklahoma is trying to make sure they graduate from an actual school, you know. But I do have a real testing exam, so I can see that. Like, if I could, you know, if we could just make it relaxed in the lights, have some tea.

[00:43:31] I could talk to somebody real good. Ace it. No, you know, the hardest exam I took. I don't know how you do it. No, no, but the hardest exam I took was my open book exams. Oh, God. You know why? So, it was my CPCO exam, which is the Certified Compliance Officer. And they're like, oh, it's an open book exam. I'm like, what? It's a study I did. This is so great. And then I'm sweating. Oh, I forgot my camera. The guy waited at me and then 15 minutes, I went to Staples. It was the whole thing. Come back sweating. I'm like, okay, I got my camera. I got it set up.

[00:44:00] Okay, get the camera set up. Go to go smart. Okay, open book. Yeah, it was just the 1,400 pages of the laws. How helpful was that? So, it was literally, I had a Stark law open and the Anti-Caveback Statute. Law open and they're like, that's your open book. Oh, yeah. But you passed, right? I did pass. Yes. See, she's feeling good. I cannot. And that's why I told her. She said, why do you have me to start writing? I'm not. I'm just not a good text maker, you know, which some people aren't.

[00:44:29] Okay, so anyway, let's talk really quick. Finish it above the horse. The nursing boards now can put a progressive program into place. They didn't, you know, lower the bar for people. What they really did is they set it to where the bar is. So, everybody knows where the bar is now. The bar is very transparent. And everybody that can reach it, it's there for you to reach, you know. So, that's really great because, you know.

[00:44:55] And then with that, mandatory fingerprints are now for anybody that wants to be a nurse in the state of Oklahoma. They have to be fingerprinted on the state level and the federal level. There's no gaps in screening, so they have to have, you know, all of their history laid out. So, really, Oklahoma says they want to know who you are, your history, your risk level. And they're verifying that before that nurse ever touches a patient.

[00:45:22] And so, again, it's just like all of the information that we discovered and learned coming out of your boards, I was just, again, another thing for you to love about Oklahoma. Yeah, I know, I know. I have never been to Oklahoma. And I have never been to Oklahoma. And I'm just, okay. Oh, I'm sorry.

[00:45:52] We have personalities. Am I going to provide you, too? Yes, just at the beginning. Okay, so provider two. The provider shortage has stopped feeling theoretical and started feeling personal, y'all. Wow. We saw it firsthand with our anesthesiology group. With more providers retiring than actually graduating, we had to lean on a locum's agency to keep our OR actually running.

[00:46:20] The agreement was to bring in four nurse anesthesives. In reality, we only needed one. But contracts are contracts and the locum company required us to credential all four. Ever have that happen? Okay, okay, because I see the head shaking. The anesthesiology group was hoping for a start date within four weeks and asked that at least one CRN be credentialed quickly to help bridge this gap. Not ideal, but doable.

[00:46:49] The file was clean, references actually checked out, and there was actually no red flags. So we granted temporary privileges to allow the provider to start before the board officially met. It gave the anesthesiologist. It gave the anesthesiologist some peace of mind. The intent privileges were only needed for a few days, and everything went really smoothly. Honey, then came the remaining three. Two of them were exactly what you hoped for with locum providers. Responsive, transparent, and easy to credential.

[00:47:23] The third one though, fell off. The locum company started getting evasive in small but noticeable ways. We repeatedly requested procedure logs from the past 24 months, a standard requirement I need, especially for local tenant providers. Each time the request was deflected or answered with an alternative suggestion. Would appear letter attesting to competency work?

[00:47:49] Would a letter of recommendation from a current employer work? Short answer, no and no. Eventually, we were told that the logs couldn't be provided because the provider hadn't been working consistently due to a job transition and some issues with a previous employer. That explanation raised more questions than it ever answered. The locum company vaguely referenced false claims made by a prior employer.

[00:48:17] Very much a carefully worded, lawyer-approved statement. Without providing documentation or meaningful context that I could use. A quick Google search filled in the gaps. The provider had left following an investigation into drug diversion allegation. A nurse anesthetist, you all, drug diversion.

[00:48:41] While no formal charges were filed and both the provider and the locum company emphasized that the diversion actually couldn't be proven, the situation was still deeply conserving. Combined with the missing procedure logs, it painted a picture that we couldn't ignore. We strongly suggested that the locum company would draw the application. In the end, no harm was done. It made us especially grateful for a credentialing committee that stayed focused on the details and held the line.

[00:49:10] Even when peer pressures from the anesthesiology group was strong, they cared enough to do it right and that made all the difference. No patients were ever put at risk and no credentials were granted. And it felt, truly felt like a bullet dodge. More importantly, the situation reinforced her critical lesson. Even when staffing shortages create pressure to move quickly, thorough credentialing still matters.

[00:49:37] It was a good one. That was a good one. That was so nice. I love them. I love them. They're so smart. I love them and I love them. I love them. Now I need all you guys to get on it and get on surgery centers, please. I want to get on it and send in you guys to surgery centers so bad. Okay. They don't want to pay enough. No, naturally. Every single person in here can be a CEO of a surgery center. I bet. And quadruple your salaries. I bet. I'm not kidding.

[00:50:08] You want the secret? I'll tell you the secret. Yes. Yes. Just apply. So listen, the last orientation I went to my last job as a CEO, they had hired a lady who worked in a nursing home. Like, what do they know about MEC, about a governing body, about policies, about procedures, about compliance? Nothing.

[00:50:32] You guys have, the thing is, is sometimes I feel that we, when I tell you guys, you guys are the smartest people in the room, 99% in the hospital, 99% of the time. Yes. I can tell you what we do, and going into the surgery center world, literally, the only gap in knowledge I would say y'all or I had, we would have as MSPs, is understanding surgery. Right?

[00:50:59] But guys, go into the operating room for like, I don't know, a day. You'll know, you'll have to have, you know, what the requirements are, which is, you know, your time outs, your signing, your site checking, your infection prevention, all that stuff. If you take one day with your clinical director, y'all can rule any, oh my goodness, any surgery center. Because the number one deficiency in every accreditor for surgery centers is credentialing and privilege. They do not credential. Yeah, yeah. They do not. Yeah.

[00:51:29] And so it's really, really, really scary. Some do. Some do. By you, but that's because it's you. Yeah, yeah, yeah, yeah. That's because it's you. Yeah, they outsource it. That's because it's you. Right. Okay, one other thing that I wanted to know if you guys have heard about, because I've never heard about it, but it is called an AUA. Have y'all heard about that? Yes. Yes? Yes? Oh, I've never heard of that. That is called an advanced unlicensed assistant.

[00:51:55] And so really, Oklahoma again, honey, Oklahoma, go play about their patients. They say you can be a patient care technician, but you need to come and get this AUA training so that you can actually be documented, be trained up, know exactly what you're supposed to be doing, and we can be tracking you. And I just, again, was another reason to fall in love with Oklahoma because I've never

[00:52:23] heard that in any of the states that we've been going through. And so I'm just saying, if other states are listening and watching, look at Oklahoma, baby. Because they're doing it right. Yeah. Okay, this was my last, that was my last. That was your last.

[00:52:46] But what I would like to do now really quick is if we, let's say, had a mock award ceremony right now, period. I don't care what you have on. Three of the women got hats. They might have been a star, but I don't know. Okay. I'm so mad. You should have told them because I got a nice pink one. I know. We would have worn a hat. Okay. Just shout it out. Most dysfunctional payer in Oklahoma? Medicaid.

[00:53:16] Okay. Okay. Medicaid's a winner. Medicaid's a winner. Okay. Ready? Ready for the next one? Community care. I knew y'all were going to say that. Don't make my MSPs. I said, oh, I thought we had a community care person here. Okay.

[00:53:47] So, community care y'all? Okay. Okay. They won. They won. I'm sorry. They won it. Next one. Last one. Alright. Who's the MSP hero in Oklahoma? Who y'all know about? Who's the person? So, everybody knows that. Don. Don. He is the... He's our MSP hero.

[00:54:16] We're going to call him he's our Oklahoma MSP hero. Thank you. And I don't know Don very well, but I do know that when we started Production Chronicles and from very today, he has been here to support us and I love you for that. Thank you so much. Thank you. Oh, okay. Did y'all like that? Yeah. We just got to get it out, right? We just got to shout it out. Okay. Your turn. Oh, I'm ready to spill some tea. I'm ready too, girl. You guys ready to get some tea? Oh, yeah.

[00:54:46] Okay. All right. So. All of the stories. I know stories. Okay. I'm going to do mine first. She gave me all the bad stories. I did. Why is it me? It was bad. I was researching. Oh, okay. Go ahead. Okay. So this doctor will bring up our age-old question that none of us have been able to answer yet, which is what do we do with the aging physician? We don't even have an answer for that. One of the needed topics all the time. Right?

[00:55:16] So what do we do about them? Well, this is what happens when we don't do about them. Hopefully we love all that. Well, we just, you know. Okay. So we've got 1989, he graduated medical school. He was issued an Oklahoma license in 1996 and he's a neurosurgeon. Oh. He's a neurosurgeon. Yeah.

[00:55:43] So there were malpractice allegations, board scrutiny, practice restrictions, and then eventually ended up with a license surrender. But again, look at the timeline. Issued a license in 1996. His first board action was in 2000. Well, he made a letter to malpractice in 2008. So how many years is that? Y'all who are good at math? 18 years? Yes. 18. 18, right? It's now 2026. Right.

[00:56:11] So he hasn't been practicing since then. 18 years. So, okay. I don't know. So according to the November 2009 complaint and citation, the Oklahoma State Board said he had, get this, over 30 medical negligence lawsuits filed in a period of nine years. But seven cases were in 2008 alone. So something happened to this guy in 2008.

[00:56:41] But then in 2009, he said seven wasn't enough. Seven more by 2009. And nobody's checking. Well, it was laid out patient by patient. So I'm going to give you some of these errors, okay? In neurosurgery. 55 year olds failed to recognize a non-union complication after surgery. So the patient required repeat surgery. Okay?

[00:57:11] 15 patients. Then in June 2009, 15 patients of deceased individuals tried to get their financial settlements from this doctor. Some of these had died. 48 year old man. Okay? So according to this, it was a transramural approach on the L3. So L3, L4, L5. So just so you guys know, it's right here. It's right there. Okay? Right here. All right.

[00:57:42] So this guy had post, he performed the surgery without indication, without giving the patient the option of conservative care, which means therapy, right? He just said, we're going to do surgery on you. Mm-hmm. Post-operative complications with a severe injury. That was a 48 year old. 71 year old. Girl, he was doing craniotomies. Oh, my God.

[00:58:09] Crania, temporal, parietal, right. There's a temporal, parietal, craniotomy. With an evacuation of a hematoma. He died. My bad. 55 year old, who had a plating in his back, required another surgery, left unable to work. 27 year old, to work or wrong? To work, work, work.

[00:58:39] 27 year old. He used the wrong size rods in his lumbar fusion. And he required revision surgeries. He coerced the patient into having a wrong surgery that he didn't even need. Oh, my goodness. Led to permanent injury, severe pain, depression and disfigurement. I guess the guy couldn't even walk anymore. 61 year old. Again, with the plating in the back. Didn't do it right.

[00:59:08] He was left with back pain. A 75 year old. The electrodes were not placed in the appropriate location, causing intracranial bleeding. With permanent neurological impairment. Then a 37 year old. Oh, my God. All ages. A laminectomy with a decompression. Left them paralyzed. 69 year old. Cervical discectomy. Okay? Post-operative complications. 75 year old.

[00:59:36] Deep brain stimulator implant. Severely incapacitated after surgery. Another female. Peripheral nerve damage. 57 year old female. With failed back syndrome. Ended up on a morphine pump for life. 37 year old. With another discectomy in the neck. Permanent nerve damage in the left arm. 50 year old male. With a neurological injury due to a disc replacement.

[01:00:06] I feel like we in court. We didn't have verdict. Girl. 52 year old. This is... Everything that was presented to Oklahoma before they did anything. 52 year old. Well, they would have come up. Because it wouldn't last. Necrosis of brain tissue. Oh my goodness. 16 year old. Oh, death. External ventricular drain for hydrocephalus.

[01:00:35] Seven year old. Oh. Underwent removal of a brain stem tumor. Caused hydrocephalus hemorrhage. Lack of improper consent. Improper surgery performed with permanent neurological injury. Whew. So what did Oklahoma decide to do? Yeah. In 2009, after these bajillion lawsuits and people dying, they sent him to a neuropsychological evaluation.

[01:01:04] And on the report, it stated that he needed to hold off reopening his office because there were other matters. Concerns that he wasn't... He didn't have professional judgment and he had inability of fitness to return. So it was just filling out everywhere. But then, girl, it said he had unprofessional conduct because he would deceive, defraud and harm the public misrepresenting the condition that they had in order to justify their surgery

[01:01:30] that they didn't actually need or should have tried other things before. So, therefore, they determined that his behavior showed the incapacity or incompetence to continue treating patients. I mean, I think we started, what, on old age and left off malice? Because by that time, how old was he? He graduated medical school in the 80s. Is he 60? Yeah, right? Where's the math people at? Where's the math people at?

[01:01:59] That's not really old. I'm kidding. It's not really old. No, that's not old. There's 60-year-old doctors practicing. Every day. Surgeon. Neurosurgeons. I pray to be 60 one day. Please. So he ceased all patient care December of 2008. Then they forwarded him to a mandatory outside evaluation. So the state of Oklahoma did their thing. Then they told him to go to an outside evaluation. He did agree to go through the assessments. And these are two things called the Professional Renewal Center. Do y'all know about that?

[01:02:28] Have you heard about that? No. And the CPEP, the Center for Personalized Education for Physicians. Do y'all know about that in Oklahoma? See, Oklahoma got it down. Oklahoma has it down? Yeah. Oklahoma has it down? Yeah. And they recommended that he stopped. But he's not practicing right now. 2012. Well, no. But you know what he is doing? What? Consulting.

[01:02:55] In your facility. No. See, these are good guesses though. They're really good guesses. Yeah, really good. No, but he found Jesus. He is now living a public life in the Yukon in civic and church-related roles. He is the priest head of the Czech parade in the Yukon.

[01:03:24] Where is this Yukon? Yukon. Yukon. It's a town. It's a town. Oh, here. In Oklahoma still. Oh, he is here, y'all. What? What? What? What? What? What? What? What? So, he's the head of that. So, if y'all wanna be known. He's the pastor down there. He the pastor.

[01:03:54] He's leading the parade. I was on company before that. Come up here, girl. I got more information. She has more information than she takes down on the team. I knew. You knew it. Oh, yeah. So, wait a minute. Say it again. He stopped being a physician, started a lawn company? Yes, for a short period of time. It was hot, though, right? Does it get hotter here? I don't know.

[01:04:24] Don't touch the weather on this week. Okay, okay, okay. So he was out there cutting grass until us. Until he found Jesus. Until he found Jesus. Oh. So is he an RV con or the U con? The power. So you're going to go to the festival and you're going to try to create this. You're going to plan it. He might be there. You're going to be like, thank you for serving your license right now. I'm just kidding. Just, I'm just saying. Oh, my goodness. Oh, my goodness.

[01:04:53] Great story. Okay. Oh, I love you. Okay. Oh, my story's so sad. Does anybody need a bathroom break? Oh, it's a commission session. Yeah. Okay. Wait a minute. We're supposed to get it together. Come back here. Okay. So this doctor was already credentialed when they started working there. So when they first came to the hospital, they were practicing as an ENT.

[01:05:21] But their privileges, staff category as an ENT were temporary while they completed cosmetic surgery. Okay. Because they can do that. They haven't done the plastic space yet. A review of the file showed that the credentials committee had clearly done due diligence. Education, privileges. Got it. Everything was checked. Yes. The provider was thriving when they got there. New privileges patients were happy. Outcomes good work. It always starts like that, right? Catch-only procedures like liposuction, breast augmentation, butt lifts were in high demand.

[01:05:49] Oh, y'all like some plastic surgery up in here. Oh, my. I don't have any. Do you have any? And I don't see not a butt lift. So I'm not very good at that. Do you have any plastic surgery? No. Me neither. I'm scared. I've heard too many here to mention a chronicle story. So as their success grew, so did their ambition. The provider opened their own standalone practice. New shiny building with their own equipment. Coached hospital staff.

[01:06:19] Once the new facility was operational, they stopped using the hospital, of course. And preferred operating exclusively at their own suite. Still, they wanted to maintain active hospital privileges, of course, in case the patients required an admission and a transfer. That makes sense. When readmission, when reappointment time came, I sent out the usual paperwork, and it came back a little slower than usual. While reviewing the application, I noticed something new. The attestation questions. We got a couple of yeses. Okay.

[01:06:49] They appropriately disclosed that they had a couple of findings on the NPDB. That was good. After follow-ups about the missing procedure logs and peer references that weren't coming, the provider informed us they actually no longer would wish to continue their reappointment. Great. Because this is going to be a hard conversation with the provisions committee. But now we can just say, oh, they're not coming anymore. Great. Not my problem. What eventually emerged publicly was quite serious.

[01:07:16] Two known cases were only a small fraction of many lawsuits being filed against the provider. Hundreds of patients alleged negligence for outcomes related to cosmetic procedures performed at the facility. And reports included infection, significant complications, and patient death. We were aware of the death case and had expected it to be thoroughly reviewed during reappointment, but the provider's decision to step away meant it never reached that point.

[01:07:43] As more details surfaced, the situation became even more troubling. Allegations included failure to follow standard safety practices, inappropriate filming of surgeries. Which we see more and more. That just happened in Georgia. That just happened. The doctor, the Georgia board, the guy from the board that came to present at GAMS, he put her, he brought her case up on and he said that the board was,

[01:08:12] they were not playing with her at all. They said, you're out. We're recording herself doing surgery. And she ended up killing somebody. Anyway, an inadequate post-operative care leading to widespread infections. The practice ultimately shut down. Providers no longer practicing. Because this all unfolded so close to home, literally it prompted us to take a hard look inward, especially at what was happening in our own ORs. During the self-review, great.

[01:08:39] This was a great opportunity for a performance improvement plan. We discovered scenarios where a nurse, first assist, and even an athletic trainer were closing surgical sites. Which, let's talk about that for a minute. Iowa just approved that. So, Iowa expanded the scope of care. Athletic trainers can close. Just so you all know. That was in Iowa. So, they're expanding their scope of practice. So, look at your scopes of practice every year. Annually.

[01:09:08] The trend is, just like they did with your nurse practitioners, they are increasing the scopes, particularly of these first assist and athletic trainers. So, athletic trainers are being allowed to go into the operating rooms. And service first assist. You keep saying that, girl. You're taking it out of the facility. Okay. So, this led to a policy change. Any first assist who are not PAs or nurse practitioners

[01:09:38] must now be credentialed through the medical staff office, which includes alignment with CMS and DMV. We were fortunate. Nothing happened at our place. Patients operated at our hospital with this provider. We're good. And they didn't have any issues. Still, it's a sobering experience. The connection was close enough to make us stop and ask, are we doing everything we should to be safe at our OR? Hearing stories from community members who weren't as fortunate, who didn't know what to look for when seeking cosmetic procedures has been difficult. Another reason why I need all of you to help me and just take over a surgery center.

[01:10:09] None of this would have happened if an MSP was at a surgery. If an MSP were at a surgery center, I'm telling you, we would research every single policy, every single timeout, every single site, everything that has to do, not only are we have the tools, right? We have the tools to know how to navigate the policy and procedure system to make sure that we execute everything that we have to execute. Anyway, that was a sobering story. That was a professional session.

[01:10:39] Those are from our MSPs in Oklahoma. Yes. They are bringing in honey. And I'm telling you, these stories are what? Real-life reminders of what's happening every day in your facilities. And I know, look at all the heads shaking, so we just know. Okay, are you ready for my story? My story is so sad. And they probably heard about it. I know y'all have heard of this. This is national headlines. This is a huge story. Okay. All right. So June. I don't want to know if any of them knew her.

[01:11:09] Oklahoma Children's Hospital. I don't know. I don't know. I don't know y'all as a children. I saw the people. No. Oh, okay. Okay. Good. But do y'all know the doctor? Did y'all know the doctor? It's us. It's us. It's us. Do you know the doctor? Oh my God. Okay. Did you know her? Did you know her? Not personally. Okay. What a sad story. It's so sad.

[01:11:38] And you know, I have four daughters. So I wanted to have a son, but I just never had a son. So I have. No, I don't. I lied. Yeah. I have six daughters. Six daughters. I'm going to tell from the other. So what happened was I have four originally, and now I got two more. And I just want to put them all together and equal it. Okay. But there's six of them now. And they're so cute.

[01:12:06] But four of them are, you know, 22 and up. And then there's a seven year old, a little cute two year old. They're just so cute. But when I was speaking this story, you know, how did you not? It's just so sad. But here we go. Okay. June 2025 on the 27th day. This doctor, we try not to say doctor's name. So if you know the doctor, that's fine. You guys can say it. But we just try not to because we don't ever want to be looked at as physician batch. But we.

[01:12:36] Or state bashing. Or state bashing. No, we're not bashing anybody. We're just exposing you. But we talk about, as you can see, the good, the bad, the ugly. You know, we just try to talk about it all. Okay. So this doctor was 36 years old. She was an Oklahoma pediatric working out of Oklahoma Children's Hospital. And she went on vacation to Florida with her daughter.

[01:13:00] And they, and in the course of this, her daughter is in the bottom of the pool dead. And so what happens is they're at this short-term rental, like an Airbnb. And the doctor, you know, calls 911. She's talking to the 911 person.

[01:13:26] And she's saying that her daughter must have gotten up in the middle of the night and gotten outside and gotten into this pool. Is she performing CPR while she's calling 911? Well, she's telling the people. Or is she not ACLS certified? Pals. Pals. Pals. Pals. Pals. Pals. That's right. But, yeah, because she's pediatric. But anyway, so she is saying, she's saying that she tried CPR. And, yeah, we're going to talk about that even further.

[01:13:55] And so, but it doesn't seem right. Like the investigators, you know, even the 911 dispatch, they're just saying it doesn't feel right. The whole situation doesn't feel right. And then the baby is pulled from the water. And they're investigating. And guess what? There's no water in the baby's lungs. There's no water in the baby's stomach.

[01:14:15] And so now it has turned from the baby left in the middle of the night with her mother, a pediatrician, and drowned to her mother must have done something, right? And, oh, I just get goosebumps. So it didn't match up. And they're talking to this, you know, the pediatrician. And the pediatrician is saying, like, I tried to perform CPR. I was trying everything.

[01:14:42] And so as they were examining the body, they said that there were injuries internally to the mouth that didn't correlate with CPR. It correlated more with smothering. Yeah.

[01:15:03] And so the police, you know, literally, I mean, before they went anywhere, it's just such a severe story, you know, about, I mean, the police themselves could not believe that she was a pediatrician from Oklahoma while all of this was going on. So that was just something that was being reported out in Florida that was just saying, like, how did this happen? And then as it keeps coming out, and it doesn't look what it's supposed to look like.

[01:15:32] So they ended up accusing her of, you know, the death of her daughter. That has happened. So the thing about this that I looked at is allegedly is that her, I went ahead and verified her license because it's just something we do. And her status class under the Oklahoma Medical Board is listed as expired. So they actually let her license expire. So it doesn't say anything like her license was taken away or anything.

[01:16:02] And under the disciplinary action portion of it, it's listed as there are no pending or active investigations. And so when you're thinking of that, you think, how does something, you know, like this that is national news, that is, you know, how would you ever know? You know, cases like this is why we talk all over the United States because things like this actually have ripple effects, right? I mean, people went and seen this doctor in the Children's Hospital.

[01:16:29] People knew about this doctor and then they see this on national news. And so what does it, you know, correlate to the organization, right? It correlates to the organization that, you know, initially there is a bond. There's a provider that we can trust. And that's the core essentials of health care is that we can go and see a provider and have trust. And it kind of tore that all apart, right?

[01:16:53] Because it's like this pediatrician that has dedicated their lives to protecting children has now went and hurt their own child. And, you know, granted, there's probably a lot of mental health issues as we've already kind of talked about that were going on. But ultimately, when we're thinking about it, it hurts the trust of the community when things like this happen. And it hurts the hospital's reputation when people hear things of this happening.

[01:17:20] And then it creates, you know, privileging and credentialing concerns. And it's like how does the off-duty conduct, how do we monitor that? Can you monitor that? You know, like Nylee said, you know, we have a doctor that put his wife in a closet and there's false arrest charges. Well, is that something that affects the medical staff?

[01:17:45] You know, I mean, you know, so you just, we're really thinking there's things like on the back of a background check that you first see on the provider that's really not kind of monitoring the behavior of that person. And we really want to look at, you know, what triggers those kind of incidences, those events. And you guys are always, you know, looking at ways to assist and to provide support.

[01:18:11] We did an episode on PBI education and they provide a lot of support for physicians and medical staff offices. But it's just, you know your medical staff. Look for triggers. Look for patterns. You know, look for behaviors. Listen to patient complaints. And all of those things are really the holistic approach of that provider. Would we still catch something like this? Probably not.

[01:18:38] But ultimately, right, I mean, it kind of starts to build like a pattern because like we always say, these things don't just kind of happen spontaneously. There are patterns and behaviors that kind of lead up to this when, you know, if you question something and you question something and you question something and you question something, but you never get together and say, hey, we were all questioning the same thing, then how do people know? Well, and how many of your hospitals have a physician wellness committee? Yeah. Oh, okay. You guys, you have one? Two. That's good.

[01:19:08] That is good. Three? Yeah, that's good. That's good. So the hospital like that I came from, we had 1,400 doctors. We had three doctors commit suicide in the period of two years. One was a neurosurgeon who slit his wrists in his parents' house. Another one was a hospitalist who jumped off to a bridge in Miami. And another one I think on himself.

[01:19:34] So, I mean, these are like severe issues that doctors are dealing with and that's why there are foundations like she mentioned about PBI education to if someone is going through a mental health crisis, regardless of their status in the community, they should seek help. We should seek help. Yeah. They don't sponsor us. I mean, but we just could have said, we figure that they are just a great resource and that not all MSPs know about it. They should. Please email them and ask them to sponsor us.

[01:19:58] But, you know, it's just a great resource because really you all, I mean, it's an uncomfortable realization, right? When we look at it and we say, okay, a clean license, a prestigious title. Right. You know, an elite training, but it still doesn't let you know who that person is, what they're dealing with, what they can, what they're capable of not doing and what they're capable of doing.

[01:20:22] And so, but you guys are the person, the defense, the line, the person, and you are supposed to know how to do all of that stuff. And so anything that we can provide to help you with that, you know, is just something that we would love to do. So, all your beautiful handy dandy, pink and, yes, you got it. I trust the partner. Exactly. No, I trust.

[01:20:52] Okay. So on the pink, that's the file. On the white side, they have the file. That's our game that we're making. So we're going to go ahead and put it up. You're going to ask the question. You're going to choose. We'll look. If you want to talk about it, we'll talk about it. If not, we'll move on to the next one, okay? It's your show. We're just here to support. Yeah. Yeah. It's your show. Sorry. It's the name of it. She's just so ready for credit.

[01:21:22] Obviously, you guys are signing for credit. Me? Yeah. Okay. Here we go. A provider submits their application claiming an OGA. You start verifying and you find your discrepancy. When you run to the audit, they casually say, oh, yeah, I was consulting. So it will be some little documentation that's fine. Are you going to pass the file? Stop.

[01:21:51] Oh, everybody stop at that file. Okay. You finally reach a listed reference after multiple attempts. We all love this. You ask if they would recommend the provider. There's a very long loss, dot, dot, dot. Followed by, I mean, if you really need someone. I don't know. I don't know. I don't know. I don't know. What would you do? You don't know. That would be exactly. That's hilarious. Okay. Do y'all want to have cards?

[01:22:21] Oh, pass? Okay. The application is submitted quickly, but it's too quickly. Everything is filled out. This perfect milk actually was almost like it was brushed or copied. Your insings are tabulating. You know the MSP, you know the MSP, you know the MSP. You're going to pass it by.

[01:22:56] Your eye is on that provider, right? Your eye is on that provider. Okay. My turn. The provider checks no malpractice history. But during verifications, what do we uncover? A subtle case they get up to close. When asked, they say, oh, I didn't think that was counted. And they passed it. That's why I got it. Do we get new disclosure credits?

[01:23:26] Yes. Yes. Okay. But remember, the state of Oklahoma said if you fly in your application, you're done. You're done. So. You're going to make a provider short of the whole numbers. Okay. Yeah. All right. A provider's license is sent to expire in two weeks. They assure you the renal authority in progress, but they're proof. Meanwhile, leadership wants them onboarded. But the license is active right now. Yeah.

[01:24:02] Yeah. Yeah. Okay. And the provider is asking to perform perfectly. When questioned, they say, I've seen it now a lot. Mm-hmm. Sweetie. I love it.

[01:24:37] What are you getting? Say in the picture. Say in the picture. Say in the picture. Okay. Okay. The administration goes to a side and says, we're short-stacked, we just need providers. Can you move things along? The file still has missing verifications and unanswered questions. Why are you passing the file through?

[01:25:08] She's passing the file through. I can just get it done. Oh! That's what we're saying. That's what period. Two days ago. Okay. Who's me? They said, get it done and granted temporary privileges. Unanswered questions. Did you have a plan to start? Start from the afternoon because they were taking a call that night. She made it. Wow.

[01:25:38] And you pushed it through. I lost it up. Okay. I didn't want anything to do that. Tell me. That happened to me also. And I made an email from this. If they wanted to prove that I'm very best and it is not completed, you can sign up. Did y'all hear her? No. Okay. Because that's exactly what you do in that situation. Is it? Give me some. This, this, this, this. They sign off the virtual committee. Yep. It's our army. Exactly. But you're documenting. Yes.

[01:26:08] Okay. See you. You open the MPB report. And it's not just one issue. What do you mean? That's like our favorite city. It's not my name. The rest of that. It's like a sitcom. It's multiple entries across different facilities. Each one has a slightly different identity. What? Like this? Yeah. Yeah. Let's say. It depends on how many people are involved.

[01:26:37] Because if there's maybe 15 people and they're part of it because they can do anything with it. Then. Just a name. So maybe that we played that nobody answered on LinkedIn. But that's okay. You guys are not. What's the longest MPB report you've had? 36 days. Oh wow. 50? We got 50. We got 50. We got 36. We got 50. How much? Oh. 90. Yeah. 90. 90.

[01:27:06] So it had to be you to get that. I know. You always think with the problem. But you're going to document, right? The whole way through. Exactly. Exactly. So mine was 110. I know. Mine was 110. Yeah. Okay. You've sent multiple follow-ups requesting documents. But the providers have responded in over three weeks.

[01:27:34] Suddenly they email saying, can you rush this? I need privileges next week. Hello? Schedule. No. No. What do you all say back? I was just like. Keep on. I'll tell them. Keep your hand. Yeah. Yeah. You can't get some back. Please tell them they get a contract. Yeah. You're going to miss it.

[01:28:04] And get the term lost. Exactly. Okay. How about that? You're going to miss it. They don't have a DEA. Can I just do it for them? No. Do what? Fill up the application for them? No. Can I just prescribe them? Subscribe for them? Yeah. I'll have my dad one before, too. And now I will tell you. I'm going to add a caveat to that. I'm going to add a caveat to that. Because there's a lot of specialties that don't have DEAs.

[01:28:34] So what I do at my facilities is I have a DEA waiver, which says if this patient needs a prescription and I don't have a DEA, I'm going to send them back to their primary care or refer them to this partner or some kind of arrangement that they can get that care or get that prescription. So it's not necessarily off. We just need a documentation to support that.

[01:29:02] But do you have the other providers saying that they will provide an DEA if they... Right. Right. Technically, yeah. You should have that back up. I have a agreement. Yeah. With that agreement kind of... You should get it. Okay. Okay. Okay. Yeah. Yeah. Yeah. Yeah. Gotcha. Okay. These are short ones.

[01:29:32] These are the short ones. Oh, no. We have this one here. Yes. Okay. Family practice. Family practice OB arrested in 2008. For... For child molestation and a sonomy. Samarily suspended by the hospital. Was acquitted.

[01:30:04] According to LinkedIn, now owns a healthcare recruitment company. This is another one? Yes. You know what the reference is? Yes. But... So when I looked up his name, because Sean also wears his provider. He founded on LinkedIn, and now he owns a high-quality healthcare recruitment company. I'm sure it's extremely high-quality. High-quality.

[01:30:34] Yes. High-quality. He's still with... Oh, no. I'm going to... I'm going to... I'm going to... The second one? Okay. Oh. No. He had previous disciplinary action during residency for inappropriate interactions between locations that require a job. I'm going to... The next day, he's a very good reason. Because they asked for an explanation, he gave a plausible explanation, and they said, oh, okay, that seems reasonable. And then this came out of time.

[01:31:04] Adults have been taken. They always have an allowance. That's what we always see. That's what we always see. You contact with a student reference, and they say, I don't think comfortable speaking on their clinical ability. That's it. No elaboration. No. What inferno. So let me tell you a story that came out of Iowa while we were there. I just found this to be so incredible.

[01:31:31] One of the providers, one of the MSPs was credentialing, was trying to call this reference, the last reference, trying to call the reference, trying to call the reference. They said it was 17 times, calls and emails trying to call the reference. Got with the provider, the providers in the office, and you call and, you know, this reference isn't working. Right? Thinks up the cell phone, calls the reference, and the reference says, he says, hey, my medical staff is trying to call you for a reference.

[01:32:01] The guy says, I've already answered 17 references in the last three months. I don't want to answer any more references. He says, look, I'll send you a $50 gift card. Just answer the reference. Oh my gosh. Amazon. Woo! I said, well, did you take the reference? She said, yeah, but I heard it on the line. Can I have another magic trick? Right. That's kind of crazy. But just thanks, I mean, with it, you know, I, I, I, I, I, I, I think that they said you hear.

[01:32:32] Yeah. Here. Things across the application, CV, and verification documents don't really line up. When we pointed out the provider says, oh, it's probably a typo. Mm. My assistant. Mm. My assistant. Yeah. Yeah. Yeah. Yeah. It's a good one. Yeah. Mm. Mm. For the CBO, so a lot of the times we send stuff back, you know, so you gotta do it. It's gotta match. It's all gotta do across the board.

[01:33:00] Because by the time you send it to the, or one of the things that APC tries to do is make sure that when the client gets the Bible back, it's ready for committing. There's nothing that people have to do on it. And so it's constant like, oh, we need to do so many questions. Oh, we need it. You know? So it's like, this ain't feeling right. We can't set it on. Right. During privilege review, the provider states that they are comfortable performing a high-risk procedure, but cannot provide miscadely laws or supporting documents. We already know that when everybody's stopping that one. We just talked about it. Okay.

[01:33:30] Well wait, true story. Tell me. I have a true story. This doesn't really happen. You already know that. All this, like, that fact that we're stopping the file. So, I just went into, I'm not even kidding. I just went into a rural critical hospital. They have CRNAs doing pain management and then self-paying management. Oh! No people. No supervisor doctor. No.

[01:34:00] And then Montana, Montana Surgery Center reached out. And the CRNAs were like, well, yeah, we practice independently in Montana and we can do whatever you want. And I was like, oh, you can do whatever you want. So then I said to the medical director, I said, do you feel comfortable allowing a CRNA to do an advanced level of procedure at your facility when you have no physician oversight? She was like, no, not at all. And I said to the CRNA, I said, so it will not be on your privilege form. And then they were like, okay, fine, whatever. We can do it down the street.

[01:34:31] So, down the street, I got the CRNAs coming. And I said, I'm going to see you on some boards. Yeah. Because they can do whatever they want. According to that, it's on their trainees. It's on their boards. Well, there's a missing chapter of work history when asked the provider says, I took some time off of personal reasons, but the plans to get any further explanation for documentation. What are you thinking? Read an explanation, right? Yeah. Read an explanation for them. Definitely.

[01:35:02] You're letting me go through? Oh, sorry. Okay, okay. Not that. Not that. Let's see. The application is flawless. No gaps. Quick responses. But it feels unusually perfect compared to every other file you'll see almost too perfect. Sometimes they are. Sometimes they are. Oh my God. They're good. They're good. They're good. So, okay, true story. People are perfect.

[01:35:32] Okay, true story, true story. True story. We have a doctor. Everybody knows he has bad outcomes. Nurses don't want to work with him. Mm. But he has a clean file. We deferred him twice and after the second time I say, you guys can not, not grant me any privileges. You know, where's the security data? Where is the information? You don't have it.

[01:36:01] It's just all here to say, you can't do anything about it. And I think that's one of the things that is frustrating about us. That means we know that something's going to happen, but it's like, you can't do anything about it. And that's part of our talk. And I think that and then you overlay it. You guys have a couple times I get a combination of stuff. I'm going to finish this talk first because you know, I'm about to be 50. I'm like, I got a couple times going. But I think when you overlay it then with a confidentiality umbrella, you know, and then

[01:36:31] it's like, you don't know everything. So like we said, a person's doing something over here, a person's doing something over here. Nobody's able to talk about it. You know, you choose what your references are. And so things can fall through the cracks. So, you see, right? Yep. I started noticing something weird. At first it was small. One file, then another. I'm going through peer references, you know, the ones everyone kind of skims before they look fine on the surface. But something felt off. The wording.

[01:36:59] Every single reference had the same phrasing, the same structure, even the same little forks in how things were said. So I slowed down. I started lining them up side by side. And that's what it did me. Every peer reference had the exact same wording. No, not similar. Literally, I did. Same sentences, same tone, same everything. And I thought there's no way multiple providers from different places just have to them write exactly like this. So I dug deeper.

[01:37:29] Different names assigned them. Different emails. But the voice, the voice never changed. They were all written by the same person. And the craziest part, no one caught it. Not in one cycle. Not in two cycles. Not in years. These files went through committees, approvals, reappointments, clean, stamped, done. And it made me stop and think. If something this obvious can sit in a file that long without anyone questioning it, what else are we missing?

[01:37:57] Because this right here, this is exactly why we do what we do to catch things. How many office managers, right? You know, it appears it's three people at the same office and the office manager is filling all the beers out. The office manager at one case, actually the neurosurgeon that had come in, his practice, office manager, she would be all there for women's applications and stamp their applications.

[01:38:24] They had all had a $2 million lawsuit that she never disclosed and it was like all ten of the doctors out of the team. They had all these things. So some staff say, the doctor is still standing in front of the team. I mean, it's like this. If you cannot do that, you have to disclose. She's like, I didn't know they didn't tell me they'd have to move this. I said, cause it's not your most love of a plitty. So sign off on the app. It's there. Yeah, it's definitely a sign of your average. It's there. Okay, let's go some tear them in the spot. Okay. So this is a doctor. Okay.

[01:38:54] Long before medicine. Yeah. So he had a life before medicine. Yes. Between 1980 and then 2009. He had accumulated nine arrests. Many times, tied to alcohol related offenses like the wine, dragging while suspended, child endangerment because he had a nine year old son in the car. He had a driver with license suspensions and an additional more teaming violations.

[01:39:25] And some of this really stood out. That's the accident. Right? Yeah. So a DUI, he admitted to drinking four or five years. Another where officers were noted that he had slurred speech disorientation and inability to call him corrections. And then he refused to submit to some testing. Right? But then, that started in 1980.

[01:39:51] So then by 1998, he said, well, I'm going to be a doctor. So he's going to apply to Oklahoma for his medical license. So he goes, he says, but Oklahoma, I only have one DUI from 1998. But the board says, well, you actually failed to disclose multiple prior arrests and convictions, including some of those early DUIs, you know, like the driving while suspended.

[01:40:20] And the, the problem was that he had a physician evaluated for his application who attested and said to him, he doesn't have an alcohol dependency problem. Which is nice. Okay. Okay. However, because he did not disclose his full history, he answered, no. Check this out. The renewal. That's funny.

[01:40:49] So they applied for his license in 1998, right? 1998. The one DUI. Well, what happened was he actually went to his renewal application in 2003, 2004. So the board finally filed a formal complaint in 2011 after they noticed their mistake four times before. They said, okay, there's fraud through a constitution of a license, failure to disclose arrest, substance abuse, inability to practice safely, dishonorable and moral conduct, a grieving had violations.

[01:41:19] So the outcome, rather than fight the case, what does the doctor do? He goes voluntarily submitted to the board of church judge. He pled guilty. So the board ordered a license suspension for four months and five years of probation. Okay. But the five years of probation included intensive monitoring. So he had to do the recovery program. He had to go to the Oklahoma Health and Health and Federal Recovery Program.

[01:41:47] He had to submit to the random drug and alcohol testing. He had to go to four meetings a week. He had to go to therapy and psychiatric monitoring. He had to have a sponsor. He had to regularly report to the board. He couldn't prescribe medications for himself or his family. And he couldn't drink. No more drinking for you. You're cut off. In 2011. Right. So a lot of you have to visit every day. Right. I have to do this. But most importantly, he couldn't supervise allied health.

[01:42:16] Which I thought that was a really full restriction that the board placed on him. In 2014. In 2014. He didn't finish his probation. Because he was not allowed in. He was probation by years. But they only took all his lessons for four months. So in 2012, they reinstated him. After suspension, they reinstated him. And they said that he could be managed. So fast forward to 2026.

[01:42:45] Where did he sit in? Where? Where is he today? Where? Where is he today? In O.S. No. He is, has an active, unrestricted license in Oklahoma. He's actively practicing right here in Oklahoma City. And he's in a general surgeon. And he has a clear and active.

[01:43:14] Are you able to see all the previous boards? Yes. I got all of that. Those details from the board actually. He's on his license. So he keeps up. I'm very happy. Passing or failing? The file. Ah! I heard of you. Yellow ball, orange head. She don't let us know. She said, her CEO say, pass that file. Nobody else? Pass or fail? Only what are we doing? Eek. He said, I don't know why you said that. Totally.

[01:43:44] I think it was required of me. The question Frank is, were the probation firm successfully completed? Because they gave him back his license in 2012. Now obviously he still has an active license, but he must have. He must have completed the five years of probation. But like as an NSC, right? As a medical staff office, what things are we going to put in place to ensure that he's compliant? Now, something I learned in Georgia. Florida worked differently. Every state has a program. Your program is called the what?

[01:44:13] Oklahoma what? The recovery program. Do you guys get letters from there automatically? Or do you have to request them at reappointment? We have to request them. We have to request them at reappointment. We request them at reappointment. So... We request them at the mark-per-time. Or you request them every quarter? We request them every quarter. Every quarter. So the responsibility is on you. So Georgia, listen here's a recommendation. What about your list? Your master's list.

[01:44:43] So I... The conference last week, I just came the lady from the Georgia program, PHP program. As soon as the doctor decides to release to have their information sent back to a facility, that facility receives automatic updates every quarter. I thought that's what you said happened. But I'm going to break it. So... Because we got so many doctors to be worrying about. Is it a letter or email that you guys sent? Yeah. Yeah, with a special release. So...

[01:45:12] But Georgia doesn't want to imagine for us. So I thought that was really, really good. I thought that was really helpful for us. Put it on your list of things to help. And so... And then who needs to know? Right? Your risk manager, your quality manager, your CMO, your department chair. Those are really important things. But... That was a good story. That was a good story. Okay, what's your answer? Oh! Let me see. Mine has to do with a...

[01:45:40] Well, I was telling my story but then Heather said that she even had a... The editor's story. No? I didn't need something. She was supposed to tell me. Oh, I'll put it. Yeah, I'll put it. No, I didn't. Sorry. Oh, it's good. Okay, okay, okay. We got an email from the provider that said, we've registered online tomorrow and need it right now or close the OR. So I said, okay, who is it? What is it? What is it? What's their email? Getting their like, do they have a...

[01:46:10] Do they have a license in Oklahoma? Half the time we get no and I'm like, I'm not doing anything with it. So this one, we sent out the application. You know, we need it tomorrow. Well, she still hasn't filled it out so that was kind of weird. And then later, we get the same guy who said, Russia, I need it tomorrow. We're going to close the OR. And he says, never mind. We're just going to withdraw it. And I said, that's interesting.

[01:46:37] And about 20 minutes later, I get an alert from our narcotics division that he's been arrested for stealing drugs. I don't know. He's in jail. Still. Yes. That was a good confession session. That was a good confession session. She didn't even do it honestly. Okay, so this gentleman is a dental assistant.

[01:47:07] This is a story that I wanted to bring out because really it is an oral surgery center. And what we're really going to talk about is all the monitoring and everything that we put in place, but sometimes it's not the doctors or the APRNs or the PAs that would be the monitor. It's really everybody that kind of has an access to a patient, right?

[01:47:30] So this gentleman in 2021 had an allegation of sexually assaulting a sedated patient at an oral surgery center. The allegations then started to come forward all the way to 2024. Some of the allegations started to include that children were included, that they were

[01:47:54] waking up feeling uncomfortable, that everybody that had this problem was unconscious. And the setting of this was their oral surgery center. So I guess my first question was where are all the people? Because when I talk to you, it sounds to me there's about four or five people in the surgery. There is usually a many people.

[01:48:23] So I said, how does it help the dental assistant? So that was one of the questions. It was quick. It was quick. It was quick. Thank you. There are charges. I mean, yeah. So there is a core assumption again that, you know, safety is there. And this gentleman who was charged, they, when they found out, when they finally brought everything to him, they had his phone.

[01:48:50] He had over 10,000 images of children in a problem of my position. They, why did that bring in 30 charges against him? Sexually battering, forcible sodomy, children exploitation. And here's the 30 charges you all. And here's the thing. In 2026, he pled guilty, which is by what's called a blind plea, meaning that he admitted everything.

[01:49:19] I recall the comment he said that he admitted it all. Have you all heard of that story? Yes. Sometimes, you know, I mean, does it make you think about like non-licensed providers in situations and should we be credentialing them? I know, you know, as a CEO, we credential a lot for FQHCs. And under the HRSA, they credential everybody, whether you're CMA, everybody's credential.

[01:49:47] I mean, but is that something, does any of your facilities credential everybody that have a station contact or is it only the NPI? We're done doing dental assistance right now, actually. I think they're doing it now. Yeah, that's awesome. I mean, right? And so when you're looking at that, you know, it's like you're monitoring them, you're doing their background checks, you know, that is a tool that we use for monitoring.

[01:50:14] And when you're saying, you know, that we're looking for patterns, you're thinking that, you know, people have come out and made complaints, made allegations before. And so those are some of those patterns that you're looking for in the background checks. But really, you know, there has to be some sense of continuing monitoring when we're looking at that in the form of camera policies, right? In the form of chaperones.

[01:50:38] I mean, you know, again, you're not talking about PBI, but PBI now has a chaperone program that any facility can get anybody chaperoned. And they're told, you know, when things are becoming inappropriate, what things, what to look for. And so again, that is just when they told me that is that that is just such a great program, because it's like where you even start to be a chaperone. You don't even realize that it's this objective position that the person has in the room.

[01:51:07] And so many times there are over 50 to 100 incidences that happen before a person actually gets caught. You know? And so when you're looking at that, 2021 to 2024, this is three years of exposure.

[01:51:31] And this is when the patients actually started to come up, you know, get the ring, the list of the 30 charges that he actually completed to all 30 of them. But you think about that and how many patients were before the 2020 that didn't feel comfortable about it, that didn't even know that something had happened. And that is, you know, something that kind of hinders the detection process because the patients don't talk about it,

[01:51:58] aren't being able to voice that they are uncomfortable. They don't know where to go. So, one of the places that we went in January in PodFest is a forum where it just kind of taught us how to be podcast people. And we, you know, they have the happy hour. Everybody, you know, conferences. And so we went to the happy hour with our cameras, with our hyper calls. And, you know, we were talking and these are people that have no idea what we all do.

[01:52:28] And, you know, we're asking them, you know, hey, what is a credentialing committee? And they're like, what is a credentialing committee? You know, what is OPPE? And they're like, yeah, we're down with OPPE. And, you know, we're telling people, you know, patients. But the number of them. No, we did tell them. They thought it was the coolest thing ever. They're like, oh, no, no, no, we have the coolest job number.

[01:52:57] You do that ongoing? Yeah, there's a problem. We focus it down and figure it out. But when you look at it, the patient is just so not knowledgeable to the things that MCCs are. And so it's like if they have a problem, number one, what? All patients are taught, like, you know, that a doctor is pretty much close to God. And so you don't want to say nothing wrong. You don't want to feel bad.

[01:53:22] But when we talk to patients, like literally the number one thing, what do we hear? My mom. Yeah, exactly. My mom. When I took my grandfather, you know, and honey, they go into this long, vented 40-minute story sometimes. Or, you know, severe cases of like doctors just didn't know we're made of bad mistakes. And we all know that they are practicing. I had a case right now. We had a patient come in and we had a carpal tunnel surgery.

[01:53:52] And he came in and he kept saying that I had curled up three, six months ago. And my hand is still hurting. The doctor said, it's done everything for me. I came here for a second opinion because I work for a cancer patient. Well, long story short, the guy who lost his hand, he had developed an infection that let shrunk his pinky all the way to his elbow. It ended up being a huge surgery. And my doctor's like, all I had to do was one test and I knew that you were infected. And it was infected for over six months. And nobody knew.

[01:54:21] And the doctor kept saying that the patient was the problem. So when patients experience that, they just get... And they don't even know how to say it. And they don't even know how to say it yet. They go, who do I complain to? And it's like, you know, and what we're finding, what we're finding out every single time. And, you know, which we're very happy and fortunate that we get to talk about with Predictionary Progress is that the system cannot see itself. You know, it's just unfortunate that the system cannot see itself.

[01:54:48] And so there's all these systems that we all put out there and that organizations and through our policies and everybody. But it is you all, the MSPs, that see the system, see the practice of the system, see the patterns of the system. And then you all are able to advocate for the patient without ever meeting a patient. Right? I mean, it's not like you're advocating for Susie because you know Susie and you love Susie. No, you're advocating for Susie without ever knowing Susie.

[01:55:14] Because you're making sure that the provider, that you stop, that Heather stop because she knew, you know, that the application didn't come in. Those are the people that are preventing a patient from waking up and feeling touched, feeling violated, feeling because something is happening. And again, you know, I know that we're very close to closing this session out. But, you know, what we're going to talk about just kind of going into tomorrow. And again, you know, tonight, every night when you are in your NASA, wherever you do meditate, pray,

[01:55:44] whatever you are doing, get your book, write it down. You know, you are the voice of this industry. And the more that people hear from you and what you can use and how they can use it, the more that it gets the voice out there and it helps everybody else in all the other states that we're going to. Guys, I'm just letting you know, like, we did this and this is a truly, can I tell you, just a side note for prevention conference, this is truly a labor of love.

[01:56:08] We have put in our heart, our sweat, our tears, our anger, our screaming, our families, our everything, because we find it so important to get this message out here. We've truly done this completely on our time. Yes. On our time. And we've just now gotten, you know, we have two big sponsors. Two big sponsors. Two big sponsors for the top final items, two more big ones. Two of them, let's talk about.

[01:56:37] Let's talk about this. The top one is Baton Health, which we talk about on every episode. We talk about it on every episode. Baton helps our mom. They have been our number one supporters since the beginning. They sponsor every episode and it's a great, do you know what your name is Baton? Baton is a system, I would say it's comparable to MSNB. You know, I tried to give it that comparison.

[01:57:04] But what it is, is you put the provider's NPI number in there and it brings up the provider in every single state, all licenses. All their actions all around, and it puts on the end of the record to the source, to the source and all that. It's a little bit more. And it quite changes it for nurses as well. Yeah. And everything. So that's where it kind of differs from the MSNB where it's not just a provider to PAs. Because you know that is a very valuable resource when people don't just close all their licenses. Yes, it's all to be seen.

[01:57:33] So that is number one, Baton. They are a great, great company. We love Robert. We made our song. We made our song coming in. Are you saying Baton like a swirling baton? Yeah, we made T-O-N. That's my baby. The one. The one. The one. The one. The other one is HST Pathways. The HST Pathways is here and here to my heart.

[01:58:00] It's an EHR vendor company and also an RCN platform for practice management for surgery centers. And they have one of the biggest EHRs for surgery centers to make sure that they are compliant and up to date. They have a little potentially module. They kind of put a little thing in place where you can put the doctor's license and it will pop up the moment to schedule the case. So that's pretty cool. So that's another one of our sponsors, HST Pathways.

[01:58:28] I will say that he is our sole sponsor in Germany. Yes. Okay. And I don't know his title but he is housed in Germany. Yeah. So I'm not sure. I love it. She's like, oh that's great. I'm making sure that it's all. I don't know. I don't know. I don't know.

[01:58:56] So just so that you know, it starts from nothing. I mean we went last year to, you know, Nance was our first year there and I think to be honest I think a lot of people just, you know, the MSPs you guys have always loved us and supported us but I think a lot of the other vendors and stuff kind of they're like, what they do with them, they don't think it's bad. They get ecto.

[01:59:27] So we're going to have the podcast. We, the lady sent us all these podcasts. What do they call it? The cover art. Cover art. Oh yeah, we hired somebody to help us cover our branding and all this other stuff. And so she's like, well what is it? What do you love? What calls you? And I said none of this. And you know, she's a Pisces, I'm a Pisces. She's a March Pisces. I'm a February Pisces. But we are so like, if she says yeah, that's good.

[01:59:55] She already knows that I'm probably going to say yeah, that's good. And the same with her. And so she's like, yeah, I just really love Pink too. And then when we did it and we had the two girls on the mics, the lady's like, oh yeah, Pink is the only one that stands out on all the podcasts. And I'm like, yeah, that's how Emma's Beach should be, like standing out on all the other podcasts. So again, it's yours too. I mean, if you all want to do a podcast, I mean maybe not. You want to do stand up comedian. Maybe you want to talk about all of this.

[02:00:24] But again, whatever it is that you all want to do and however you want to express yourself as Emma's Beach, we want you to do that because it is a profession that every person that is involved in healthcare, which is everybody, your parents, our children, everybody needs to know that we exist. And that we are out there and that there are people that are literally protecting patients from bad actors. But can I just, I just want to say this story because like when we talk about the doctors,

[02:00:53] I'm like, oh, you know about bad patients? Mm-hmm. What can I tell y'all what happened the other day at our office? Okay, because I have to spill the tea. Yeah. Because I don't live in Oklahoma, so I'll have to spill some of my fever. So this is exactly what the story. Because like we saw in the stories earlier, the patients fit in the doctor's face. I think patients do need to be held accountable for their behavior in the life. So my clinic, my office, not my hospital, my orthopedic clinic that I have.

[02:01:22] She's in a couple of different things. I know that a couple of different things going on. I've got to make sure I keep my hands in everything. So we do hormone replacement therapy. Hopefully that patient isn't listening, but okay. Hopefully she will. Anyway, we do hormone replacement therapy. Do y'all know about hormone replacement therapy? Right? Okay. Pelot, do you know about Pelot? Yes? Anybody over 45? Okay, everybody over 45 start looking into it, whatever. Anyway. The point is that.

[02:01:52] We do it right here. We do it right here. I'm just telling you where we do it. We say we only know Pelot. No, yeah. No, you're homo girl. I heard that. So it's here, which means it's not down here. The Pelot's up here. So we normally, like the top of your booty, it's not the most, but like the very top, you know? So we have your area. So the doctor goes in and one of the things I love about my doctor is he's amazing. It's a little rock.

[02:02:22] It's a little Pelot. It looks like little food pellets. It's a building tree. It looks like little white stuff. Here. Like food pellets, like a bunny pellet. Yeah, that's what it looks like. So the patient comes in and he always, always, always, tells me, I never come in a room with female. Don't care. Always been rural. He's been married for 40 years and it's been rural. He's always had it.

[02:02:48] So he tells our medical assistant to go into the room with him. He tells her, okay, I'm going to numb you up. So he normally numbs them up for about 10 minutes and then make sure they don't have any pain when he inserts. Okay, fine. So he goes, okay, you can lay on the table and just, you know, scooch your pants on. Usually a patient will lay down and then MA will go and pull the pants down to the necessary area. Usually it's like right above the crack. You don't have to think of the other. No. She didn't do anything, girl.

[02:03:18] You know what she did? He said, I'm going to go numb you. She said, okay. She went, what am I going to do? She took off her old pants and she had no underwear on. She put them all the way down to the floor. She just got me up. She said, what am I going to do? She's going to go numb you up. She's going to go numb you up. She's going to go numb you up. She's going to go numb you up. I'm going to go numb you up. I'm going to go numb you up. What is your doctor?

[02:03:46] I'm going to go numb you up. My MA ran with a little chuckle. She was like, oh, maybe you can lay down now. She's like, she laid on the table. I just wiped down everything. I was like, ew.

[02:04:15] So we go to the doctor's room. It's like, just huge terror on my soul. Do you tell the patient like, hey, next time we're panties? My God. For real. Did you say that? I mean, I wasn't there. But she was actually saying that the policy is you must wear underwear. I don't want to wear a mask. Maybe I want to go. Maybe I want to go. I'm going to go. I'm sorry. I'm sorry. I'm sorry. I'm sorry. She just behaved. You know?

[02:04:45] I'm sorry. I'm sorry. Because the patients are just bad, man. Oh, Shannon. That was a lot of tea. Honey. But have they subscribed yet to hear it next week? On all of these platforms, please subscribe, like, and follow us.