Laxmaiah Manchikanti, MD

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Laxmaiah Manchikanti, MD Specialty
Interventional Pain Management (09)
Practicing in Paducah, KY since 1980 Medical
Director Pain Management Center of Paducah,
Paducah, KY Ambulatory Surgery Center, Paducah,
KY Pain Care Surgery, Marion, IL Associate
Clinical Professor Anesthesiology and
Perioperative Medicine, University of Louisville,
Kentucky C.E.O. American Society of
Interventional Pain Physicians Kentucky Society
of Interventional Pain Physicians Society of
Interventional Pain Management Surgery Centers
Member Kentucky CAC Board of Regents,
Murray State University, Murray, KY Past
Appointments Kentucky Board of Medical
Licensure Medicare Carrier Advisory
Committee Publications Over 200 peer-reviewed
journal articles 4 Books and one book in
press Over 95 Book chapters, and other
publications Peer reviewer for 10 journals
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SB 170 Goals
To achieve A Accountability B Balance C
Comprehensiveness D Diversity E
Excellence F Fairness G Gentleness I
Integrity Kinder, Gentler, Accessible,
Accountable, Empathic organization with
Integrity.
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Present State of Affairs
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KBMLQualifications

• Present Status
• No basic qualification
• Proposed
• Best qualified
• Licensed to practice medicine in the Commonwealth
• have been actively practicing medicine in the
  state for a period of not less than five (5)
  years immediately prior to the appointment
• Board-certified in their area of practice

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KBMLTerm Limits

• Present Status
• No term limits of membership
• Some members have served over 20 years
• 36 states have term limits
• 4 10 years
• Same members serve as board chair and panel
  chairs forever (yearly election!)
• Proposed
• Four year term
• The commissioner of public health and the deans
  of the medical schools shall hold office only
  while holding their respective positions.
• No member shall serve more than two (2)
  consecutive terms.
• Term limits for Officer
• Two terms of 2 years

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KBMLNomination Process

• Present Status
• Nominated by KMA an advocacy organization
• 3 names to Governor
• Controlled by 2 or 3 insiders at KMA
• Highly secretive
• No membership participation
• Members only
• Finally they prefer 1 of the 3
• Proposed
• Open process
• KMA
• Other societies
• Public
• Qualification is the only limitation
• Governor is free not a hostage to KMA

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Appointments

• Governor - 49 states
• Board of regents New York
• Occasionally shared by
• Assembly (1)
• Senate (1)
• Elections (1)

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Appointments

• Recommended by
• State Medical Association/Society (advice and
  recommendation) 7 states
• Arkansas, Colorado, Delaware, Oregon, North
  Carolina, Virginia, Washington
• Multiple societies 3 states
• Louisiana, Minnesota, Utah
• Mandated by State Medical Association 5 states
• Idaho, Kansas, Kentucky, New Mexico, Oklahoma
• Other mechanisms 35 states

continued
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Appointments

• Governor to member society
• Rhode Island
• Elections
• South Carolina
• Legislative (1) or Senate (17) consent
• Alaska, Florida, Georgia, Illinois, Iowa,
  Louisiana, Maryland, Mississippi, Missouri,
  Montana, Nebraska, New Hampshire, Oregon,
  Pennsylvania, Vermont, West Virginia, Wisconsin,
  Wyoming
• Special committee
• North Carolina

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KBMLMedical Monopoly

• To prevent medical monopoly, state disciplinary
  board should be composed of a significant
  proportion of non-physician members.
  Joseph A. Califano, Jr.
• Medicine has evolved into 24 specialties and 140
  subspecialties over the last 30 years.
• Along with advances in medicine, treatments have
  expanded, but the methodology of protecting the
  citizens of the Commonwealth has not changed.

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KBMLMedical Monopoly

• The mission of the Kentucky Board of Medical
  Licensure is to protect the public by ensuring
  that licensure qualifications and standards of
  medical and osteopathic physicians are met and
  that appropriate disciplinary action is taken in
  a timely manner when violations of the Medical
  Practice Act occur.

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KBMLMedical Monopoly

• The Kentucky Board of Medical Licensure is
  composed of a few insiders representing 2 or 3
  specialties for unlimited periods with no
  consistent representation for family practice,
  internal medicine, surgery, and interventional
  pain management.
• A Public Citizen report said boards need to do a
  better job of protecting the public. Some say the
  study is flawed.
• Public Citizen, a consumer advocacy organization,
  has ranked Alaska and Kentucky as the best state
  medical boards at disciplining doctors in the
  past 3 years and Mississippi as the worst.

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KBMLMedical Monopoly

• The rankings are not an accurate reflection of
  boards' effectiveness - James Thompson, MD,
  president and CEO of the FSMB
• Physicians and public say worst states to
  practice Alaska, Kentucky, Ohio, Oklahoma
• KBML one of the worst boards in the
  country.

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Why Interventional Pain Physician on the Board?

• Interventional Pain Management is the discipline
  of medicine devoted to the diagnosis and
  treatment of pain-related disorders principally
  with the application of interventional techniques
  in managing sub-acute, chronic, persistent, and
  intractable pain, independently or in conjunction
  with other modalities of treatment

NUCC Definition 2002/2003
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KBMLMedical Monopoly

• IPM A special Case
• ? Drug abuse (4.77 vs 6.03)
• ? Deaths (8 vs 13.2)
• ? Health care expenditure
• Malprescribing
• Lack of education
• Need for Interventional Pain Management physician
  
• Consultants have their own minds.
• The medical board issues one-sided judgments.
• Pain management issues comprise almost 60 of the
  issues in front of the Board.
• Half of the Board members may never prescribe
  many of the controlled substances.

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Case in Point

• Dinesh Shah, MD
• 61 years old, Indian-born IMG
• Practicing in rural Kentucky for over 20 years
• Loss of License
• No fair hearing process
• Biased consultant
• Suspension issued, before Judges order lifting
  stay
• No response to Sen. Winters and
• Congressman Ed Whitfield
  

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Small States with 6 or less Congressional
Districts Number of Positions (2-17) per district

• Alaska (1) 8 8
• Arkansas (4) 13 3
• Connecticut (5) 15 3
• Delaware (1) 16 16
• Hawaii (2) 11 6
• Idaho (2) 10 5
• Iowa (5) 10 2
• Kansas (4) 15 4
• Maine (2) 9 5
• Mississippi (4) 9 2
• Montana (1) 11 11

Same size or smaller than Kentucky with 6
Congressional Districts

• Nebraska (3) 17 6
• Nevada (3) 9 3
• New Hampshire (2) 9 5
• New Mexico (3) 9 3
• North Dakota (1) 12 12
• Oklahoma (5) 9 2
• Oregon (5) 12 2
• Rhode Island (2) 13 7
• South Dakota (1) 9 9
• Utah (3) 11 4
• Vermont (1) 17 17
• West Virginia (3) 15 5
• Wyoming (1) 8 8

66 or 16 of 24 have 4 or more members per
Congressional District with a Range 2 17 per
Congressional District. Kentucky Less than 2
(Present) Proposed Less than 3
( ) Number of Congressional Districts
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SB 170Moving Toward Transparency and Equity

• i) The commissioner of public health
• ii) The dean or designee of the University of
  Kentucky College of Medicine
• iii) The dean or designee of the University of
  Louisville School of Medicine
• iv) The dean or designee of the Pikeville
  College School of Osteopathic Medicine

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SB 170Moving Toward Transparency and Equity

• Four (4) mandated members appointed by the
  Governor.
• One (1) osteopathic physician
• One (1) African-American physician
• One (1) international medical graduate
• One (1) interventional pain physician

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SB 170Moving Toward Transparency and Equity

• Six (6) members Physicians
• One (1) from each congressional district
• Six (6) members Non-Physician citizens
• One (1) from each congressional district

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SB 170Moving Toward Transparency and Equity

• ? public representation
• ? public protection
• ? minority representation
• ? essential representation
• Overall good change for Commonwealth citizens

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Thank You
Laxmaiah Manchikanti, MD Pain Management Center
of Paducah 2831 Lone Oak Road Paducah, KY
42003 Phone [phone] ext 101 Phone
(ASIPP) [phone] E-mail drm_at_asipp.org
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