K. DEAN REEVES, M.D., FAAPMQR SEP 0 8 2016 PHYSICAL MEDICINE AND REHABILITATION KS State Board of Healing Arts ROELAND PARK, KS 66205 HM '74 (913) 362-1600 FAX: (913) 362-4452 September 2, 2016 Joshana Offenbach Associate Disciplinary Council Kansas State Board of Healing Arts 800 SW Jackson, Lower Level -Suite A Topeka, KS 66612 Re: Request for termination of consent order Dear Ms. Offenbach: I received noti?cation of the consent order on December 3, 2010 which addressed 3 areas: 1. Patient care documentation: A documentation upgrade was clearly needed. I attended the CPEP seminar on March 11, 2011, at the first available date, pro?ted from my interactions from their fine staff, carried over their recommendations, and made additional refinements along the way. This has prepared me to be a more effective instructor for resident and graduate physicians and I much appreciate it. 2. Office based surgery quality assurance issues/documentation: ceased utilization of conscious sedation on December 4, 2010, the day after noti?cation by the board. I then progressively incorporated local anesthesia and components of tumescent anesthesia, keeping lidocaine amounts well below guidelines. This allowed me to use small doses of analgesics or anxiolytics orally that have no significant risk of impairing the patient?s ability to maintain adequate cardiorespiratory function, independently and continuously maintain an open airway, a regular breathing pattern, protective re?exes, and the ability to respond purposefully to tactile stimulation and verbal commands. am functioning in full compliance with minor surgery as defined by K.A.R. 110?25-1 using local anesthesia as defined by K.A.R. 110-25-1 This change has been excellent for many reasons such as reducing sedation effects post treatment and facilitating advances in technique. 3. Research concerns: KSBHA was under the mistaken assumption that have performed research in my office without human subject committee approval. I have never performed research without human subject committee approval, and shifted away from any research in the office as of 2003 in favor of research design and facilitation for other researchers. function as part of a research team including faculty representatives from the University of Wisconsin and the Chinese University of Hong Kong. As examples, I included PubMed citations of our 2016 publications (to date). "5 Since official entry of the consent order have received three office visits: The first was on April 26, 2012, the second on October 26, 2013, and the third on July 17, 2014. Feedback during each of these visits was quite positive with complementary comments on our organization and thoroughness of record keeping. The third visit was prompted due to a medical error on my part on May 9, 2014, in which two patients were inadvertently given an incorrect (hypotonic) IV solution with a resultant hemolytic effect reflected in a change in urine appearance. I directed the patients to a local emergency room for prompt evaluation, called to notify the examining physician of my error, and there were no untoward outcomes. have received two letters from the board (via the associate disciplinary council) since official entry of the consent order. The first was a letter of March 30, 2013, with an accompanying series of comments from an anonymous consultant. was hoping for some constructive feedback. Unfortunately, the reviewer?s comments were based on outdated medical literature, did not evidence a knowledge base in the area of pain management (were not practice-area-specific), or were erroneous based on an inaccurate reading of the records, as indicated in general and then explained in detail in Appendix A, B, and of my August 20, 2013, response. I concluded my letter by indicating that anyone who reviews my records for quality of care cannot do so competently unless they practice prolotherapy and perineural dextrose injections and are capable of treating complex patients with multiple pain conditions simultaneously. I received a second letter from KSBHA on February 12, 2015, requesting competency testing by CPEP. CPEP, unlike KSBHA, conducted a 3?day evaluation using both inpatient and outpatient records, during which I was interviewed by or general medicine physicians, half of whom had a working knowledge of prolotherapy. Their extensive report was received by KSBHA on July 22, 2015. The CPEP conclusion was that was competent and there was no indication for formal remedial training. In summary, I made prompt and effective changes in record keeping and in methods of analgesia for procedures in response to the consent order. The board?s comments about research concerns were groundless, since my patients are not involved in any research. Since 2003 I continue to publish high quality research but only in cooperation with other properly licensed physicians, whose patients are fully informed and have properly consented to be included in studies and those studies are fully compliant with the standards of medical studies in the locations where the cooperating physicians practice. Follow-up office visits by your investigators have established my record-keeping consistency including record keeping for the use of low levels of analgesics and proper use of local anesthesia for the evidence?based procedures I provide in my office. The fact that have made an oversight error in my practice is consistent with well- established and abundant medical literature indicating that all physicians do so. Our ethical obligation as physicians is to reveal our errors quickly upon discovery to avoid untoward effects that can be prevented, and to learn from such errors. I immediately stopped using IV drips for hydration and have coached my patients on proper fluid intake before their appointments. Also, given that I am the primary designer and writer for most of the publications referenced herein, my mental competency should be self- evident. This has been further confirmed through a 3-day review of records and knowledge base by like?specialty reviewers with no formal reed ucation recommendations. This process, presented as involving two yearly office visits, has now extended five and one half years from my original notification. respectively request termination of my consent order. Sincerely, K. Dean Reeves, MD. 1. Maniquis-Smigel L, Reeves KD, Rosen JH, Rabago PD. Vertical Small-Needle Caudal Epidural injection Technique. Anesth Pain Med 2016:e35340. 2. Sit RWS, Chung VCH, Reeves KD, et al. Hypertonic dextrose injections (prolotherapy) in the treatment of knee osteoarthritis: A systematic review and meta-analysis. Scientific Reports 2016;6225247. 3. Topol GA, Podesta LA, Reeves KD, et al. The Chondrogenic Effect of Intra- articular Hypertonic-dextrose (prolotherapy) in Severe Knee Osteoarthritis. 2016;doi: 10.1016/j.pmrj.2016.03.008. 4. Bertrand H, Reeves KD, Bennett CJ, Bicknell 8, Cheng AL. Dextrose Prolotherapy Versus Control Injections in Painful Rotator Cuff Tendinopathy. Arch Med Rehabil 5. Reeves KD, Sit RWS, Rabago D. A narrative review of basic science and clinical research, and best treatment recommendations. Med Rehabil Clin Am 2016;27zln press.