How does guam's licensing boards handle complaints?

 THE COMPLAINT AGAINST ETHAN SNIDER WAS ORIGINALLY FILED ON DECEMBER 26 2018. THE ALLIED BOARD DID NOTHING FOR TEN MONTHS UNTIL WE WENT PUBLIC  ABOUT IT AND THEN THEY ASKED FOR MORE INFO. IMAGINE, THE DEATH OF A 5 YEAR OLD AND THIS BOARD SITS ON THEIR HANDS FOR 10 MONTHS WITH NO APPARENT INTEREST.  THIS WAS OUR FIRST WARNING SIGN THAT THEY MAY  NOT BE IMPARTIAL OR EVEN PROFESSIONAL . The Board HAS NOT FOLLOWED THE LAW IN THE PAST PER MEDIA REPORTS. 

 https://www.postguam.com/news/local/health-licensing-boards-noncompliant-with-parts-of-law/article_3431e1e4-1547-11e9-8129-7faa3d66e535.html 

THE COMPLAINT FOLLOWS...

October 9, 2019

Ms. Mamie Balajadia, Ed.D.

Chair, Guam Board of Allied Health Examiners

Allied Health Professional Licensing Office

Government of Guam

Department of Public and Health and Social Services

Dear Dr. Balajadia,

Thank you for the letter dated October 4, 2019.

I typed the original complaint (attached) which was received by your office on December 26, 2018 to make it clearer. The handwritten notes were by me on the SDA record in reference to the complaint and our issues with Physician Assistant Ethan Snider. I have explained the issues one by one in the attached document.

Please note, we are requesting, in the investigation process, to be interviewed and be able to discuss the experience with your investigator first hand so there are no misunderstandings. I will be off island from Oct. 12 to November 3rd for my son Asher’s, one year Anniversary.

Each Issue is outlined in the attached document in detail. We are particularly concerned about supervision or lack thereof among the other issues we have outlined.

As an example, again of the many issues. Guam standards based in law.

GUAM CODE ANNOTATED,

10 GCA HEALTH AND SAFETY

§ 121601. Definitions.

(b) Physician assistant means a Board-licensed person, qualified by academic and practical training, who provides patient services under the indirect supervision of a licensed physician. A physician assistant is not an independent practitioner.

121603 SCOPE OF PRACTICE A PA may provide any medical services when such services are within his skills, form a usual component of the PA scope of practice under the supervision of a supervising physician.

.121607 SUPERVISION REQUIRED: Tasks performed by the PA must be under the supervision of a registered supervising physician. (WHO WAS THE SUPERVISING DOCTOR OCT. 30, 2018?)

National Standard with the VIOLATIONS OF ETHICS… Ethan S. Snider is currently certified by NCCPA and holds identification number 1135579 Per the Guidelines for Ethical Conduct for the PA Profession (Adopted 2000, amended 2004, 2006, 2007, 2008, reaffirmed 2013) PA–Physician Relationship Supervision should include ongoing communication between the physician and the PA regarding patient care. The PA should consult the supervising physician whenever it will safeguard or advance the welfare of the patient. *This includes seeking assistance in situations of conflict with a patient or another health care professional.*

BY HIS OWN WORDS, HE ADMITTED CONFLICT WITH THE PATIENT, ASHERS DAD, ME, AND THUS VIOLATED THIS ETHICAL AND LEGAL TENENT AMONG OTHERS. THERE WAS NO SUPERVISION, EVEN THOUGH WE ASKED ALSO.

As a public record, we are requesting to know the name of the registered supervisor of Ethan S. Snider.

Thank you again,

David Lubofsky

Name of Person Complaint filed against:

Ethan Snider, Physician Assistant, SDA Clinic

3. COMPLAINT IN YOUR OWN WORDS:

Asher Dean Lubofsky, DOB June 15, 2013, age 5, passed away Oct. 31st at approximately 7am at the Guam Memorial Hosp.

We were for the second time in two days at SDA, October 30th with my 5 year old son Asher Dean S. Lubofsky. My 6 year old son was with us as well. We were sent to the SDA urgent care where PA SNIDER was working. We also had been at the SDA the day before on Oct. 29th and saw Dr. Miyagi for a physical yearly wellness exam for Asher, who was also very sick coincidentally that day. Physician Assistant (PA) Ethan Snider told me that they cannot assess Asher and he needed to go to the GMH. He never told me how sick Asher was. I asked him, did you check his records from yesterday when he saw Miyagi. Snider, with crossed arms, aggressively repeated over and over when I asked him to check the records, “YOU DID NOT SEE ME, YOU DID NOT SEE ME.”

This attitude and while with a very sick child irritated me. I explained to him, that I know that we did not see him, but check his records for what Miyagi said. Snider refused to do it. He told me that Asher needs to go to the ER. I asked for a referral to take him, but Snider denied the request saying that we do not do that. He also never called the hospital ER as he stated he would do before we got there. I asked him to speak to his supervisor or any doctor; he responded that they were busy. You want my son to go to the hospital by ambulance, as he had said, but the doctor is too busy to see us, you won’t check his records from yesterday and will not give me a referral?

PA SNIDER said that we are leaving the clinic against advice and made us sign a form. How can I stay there when he told me an ambulance may take 30 minutes to get to SDA and a drive is only 3 minutes? Why would I stay there after the day before Miyagi literally refused to exam my boy who was sick and later died? Why would I follow what the PA said, when he refused to check my sons records, refused to give us a referral, refused to get a doctor to talk to me and see ASHER? To make matters worse, he was argumentative in the middle of the Urgent care room with me. He told me that he will call the police, loudly if we didn’t go the hospital, which I was trying to do and leave. He said it loudly and scared my dying 5 year old, who asked me why he will call the police. Those words were the last words my son heard from anyone besides me and the last question he asked before going into the hospital where he died the following morning. Do you need a witness? To this day my 6 year still asks why they want to call the police on Asher.

ISSUE: The form stating that we were leaving against medical advice that the PA made me sign, in order to get medical care and to see a doctor at GMH, was stated to be against medical advice of a doctor or admin of SDA per the form (see attached), which I asked to see a doctor again when he wanted the form signed. The PA is not a doctor. He was a bully that day. The form now noted a witness signature. There were no witnesses signing any forms while I was there and no one came to talk to us besides SNIDER. This means he took the form to someone who did NOT witness my signature and had them sign that they saw me sign. People not involved in my sons care and not present during the problems in Urgent Care with SNIDER should not be signing they witnessed anything.

ISSUE Isn’t a PA supposed to be supervised, at least indirectly? With a child who was seen the day before and is back with serious symptoms or dying (PA SNIDER never told me how sick he was and refused us to see a doctor) why would PA SNIDER not call a doctor? I requested a doctor, he said they are busy, but he was clearly over his head and as his records indicate, I was irate and freaking out with two small kids, one dying. Where is the required supervision? NO DOCTORS. SNIDER, overstepped his level of skills, especially since the situation required a doctor and I requested one. We did not need a bully. Even if he lies and denies that I asked for a doctor, the situation called for one for sure. PLEASE REFER TO NATIONAL STANDARDS. PA–Physician Relationship Supervision should include ongoing communication between the physician and the PA regarding patient care. The PA should consult the supervising physician whenever it will safeguard or advance the welfare of the patient. *This includes seeking assistance in situations of conflict with a patient or another health care professional.*

**PA ETHICS CLEARLY STATE: PA–Physician Relationship Supervision should include ongoing communication between the physician and the PA regarding patient care. The PA should consult the supervising physician whenever it will safeguard or advance the welfare of the patient. This includes seeking assistance in situations of conflict with a patient or another health care professional

THIS IS A STANDARD OF THE PA PROFESSION AND THERE IS NO GETTING AROUND THAT HE VIOLATED THIS.

ISSUE We were at the clinic the day before, why would PA SNIDER refuse to check my son’s records, and instead argue with me. I TOLD HIM HE NEEDS TO CHECK TO SEE IF MIYAGI NOTED ANYTHING.. Scope of care would call for this He didn’t do it and arrogantly repeated ” YOU DID NOT SEE ME, YOU DID NOT SEE ME,” looking like he wanted to hit me or something. How can you make decision without checking medical records from the day before?

ISSUE We, for sure agreed to go to the hospital, but when he said we can’t see a doctor at SDA, that was the last straw, faster to drive. Snider said ambulance may take 30 minutes to get to SDA. My son can’t see a doctor; Snider refuses to check records and will not give us a referral, not to mention Miyagi the day before did not exam my son who was very sick then. I had enough with how he was treating or not treating my son and left. It would be negligent as a parent to stay there any longer; they obviously were not caring about Asher. DOCTOR TOO BUSY to treat a dying child. PA SNIDER, not getting a supervisor and obviously he wasn’t being supervised. Even if the supervisor was busy, SDA is full of pediatricians that I know very well as I have been going there for 30 years. We were obviously in crises at URGENT CARE and no one came in to assist SNIDER or no one was called. THIS IS PA SNIDERS job to get

supervision. … DOCTOR TOO BUSY to treat a dying child..If you heard those words with your dying child, would you trust them, would you stay or get upset? IF a Pediatrician came in and spoke to us, things may have been different. I still can’t believe, that with all the commotion, PA bad attitude, arguing with us and the sickness of my son and me wanting to leave in essence due to PA SNIDERS attitude and apparent apathy that no supervisor showed up. Actually, even doctors that I know said it’s not protocol and that someone should have come back to talk to the parent. You do not let parents leave without a doctor coming in. NO SUPERVISION.

ISSUE PA Snider would not let us leave SDA unless we signed a form, stating leaving against medical advice. I asked him again to see a doctor and showed him on the form that he wanted me to sign that it says against medical advice by a doctor or SDA admin, not a PA. He should have given us, especially with an irate father and dying 5 year old time to see a doctor or call one to talk to us. THAT FORM IS NOT FOR HIM TO SIGN FOR SURE. WHERE IS THE SUPERVISOR? The form now has a witness signature. No one witnessed me signing the form and no one spoke to us. IS HE COVERING FOR HIMSELF? We didn’t leave against medical advice; we were in essence chased out due to incompetence and arrogance on his and SDA part. IMAGINE THAT FOR ONE MINUTE, MY SON IS TOLD, DOCTORS TOO BUSY. I WILL NEVER FORGET THOSE WORDS. EVEN IF HE DENIES IT OR LIES, he was already over his head and a supervisor or a doctor was needed, especially when I wanted to leave the clinic due to how he was treating us. Tell me when supervisory doctors or any doctor helps the PA’s, if not with a dying child? How difficult is it for PA SNIDER to call any doctor in the clinic and ask for help. It was clearly that it was needed. He isn’t a doctor, that day he was a bully. I was irate with him, he knew it but did not want to back off and preferred to challenge me rather than get help. He even states it in the records that I was irate with him.

ISSUE PA Snider refused to give me a referral when I first asked for it to the ER and refused to give me a referral for the ER when I told him we were leaving. He said he would call. Well, when I got to ER they had not received any calls from the PA SNIDER. I had to explain everything all over again and start from scratch. There is no excuse and even if he called after we got there, he violated a basic tenet of patient care and broke his word to call the ER FOR CONTINUATION OF CARE. That means before we get there not an hour later or even 15 minutes later. IF he gave us a referral, all would be okay when we got there. He could also have called. Once we said we are leaving; he should have given us a referral AS WE WERE LEAVING ANYWAY so a referral would be needed. You can check our arrival time at the hospital and any records of him calling. Shame on Snider.

ISSUE Why would a PA threaten a family in distress, with a dying 5 year old child, and his brother a 6 year old, and an irate father, SNIDER wasn’t done arrogantly with us. Why loudly would he threaten that he will call the police, saying it loudly at Urgent Care for anyone in the room to hear? There is a witness to this. At the same time, I am trying to leave for the ER, which he knew but refused to give me a referral and never called the ER before we got there. He scared my kids and made things worse for my dying son. Is this the scope of care of a PA? He showed absolutely no patient care or concern. He said it loudly and scared my dying 5 year old, who asked me why he will call the police. Those words were the last words my son heard from

anyone besides me and the last question he asked before going into the hospital where he died the following morning. Do you need a witness? To this day my 6 year still asks why did they want to call the police on Asher.

ISSUE Does a PA have 2 days to sign his records as Snider took? Why is there no supervisor signature on his records, which is required?

ISSUE why does his medical record for Asher, signed after Asher passed away; appear that he is responding to my questions about how he treated us? He seems to be responding to my complaint to his medical director which I made as he writes his records. Was his records altered?

ISSUE If he is supervised at all, why is it that he discharged us to go home, not to the ER per his records? TAKE A LOOK AT HIS RECORD. His records reporting are a mess and indicate that no one reads them. He states my son’s condition, vital signs etc were stable, and wanted to discharge him home. My gosh, anything but. His records are full of errors. Also, he never spoke to us about anything, and refusing my son access to a doctor at SDA. PA record keeping is of vital importance. It’s a medical record; there is no room for mistakes as PA SNIDER makes. He uses a template and does not change data fully from one patient to another, Sorry; you cannot justify mistakes in records when they are supposed to be doubled checked and read by a supervisor. THIS IS A CLEAR VIOLATION and another example of lack of supervision and lack of professionalism by PA SNIDER as well as an ethical concern. ..

ISSUE Information that I provided to PA SNIDER was left out of the medical records, why is that? My son had been vomiting off and on for days by the time we got to SNIDER. My son had a total hoarse voice, barely could speak but none of that is mentioned.

ISSUE PA SNIDER was argumentative, threatening, uninformed of Asher’s history at SDA, incorrect in his reporting, refused to let us see a doctor, refused to give us a referral and did NOT call GMH as he stated he would.

ISSUE I contend that there was no supervision that morning for SNIDER and per the PA Guam regulations, he is NOT supposed to see patients with no supervision. If supervision, why none during a crises showed up? WHO SUPERVISED SNIDER THAT DAY???

ISSUE I also question that Shishin Miyagi may have been supervising Urgent Care and SNIDER OR IS THE REGISTERED PHYSICIANS ASSISTANTS SUPERVISION and if so, PA SNIDER wanted to keep Miyagi away from us as he knew there was a problem from the day before with MIYAGI. If this is true, then he prevented my son access to medical care at SDA to protect a doctor. THIS VIOLATION HAS TO BE CLEARLY DECIDED. What other reason that no doctor came to see ASHER?

I ALSO CONTEND THAT PA SNIDER WAS IN VIOLATION OF THE FOLLOWING.

PA RULES BASED IN GUAM LAW….

GUAM CODE ANNOTATED,

10 GCA HEALTH AND SAFETY

§ 121601. Definitions.

(b) Physician assistant means a Board-licensed person, qualified by academic and practical training, who provides patient services under the indirect supervision of a licensed physician. A physician assistant is not an independent practitioner.

121603 SCOPE OF PRACTICE A PA may provide any medical services when such services are within his skills, form a usual component of the PA scope of practice under the supervision of a supervising physician.

.121607 SUPERVISION REQUIRED: (a)Tasks performed by the PA must be under the supervision of a registered supervising physician. (WHO WAS THE SUPERVISING DOCTOR OCT. 30, 2018?)

(b)All medical records must be reviewed and cosigned by the approved supervising physician within seven 7 days. (WAS IT DONE, ERRORS AND ALL.)

(E)If no registered supervising physician is available to supervise the PA, the PA must NOT perform patient care activities.. (WHICH HE DID, ESPECIALLY SINCE HE HAD A CONFLICT WITH US.)

121603 SCOPE OF PRACTICE A PA may provide any medical services when such services are within his skills, form a usual component of the PA scope of practice under the supervision of a supervising physician. (DENIED US TO SEE A DOCTOR AND SHOULD HAVE GOT ONE WITHOUT US EVEN ASKING.)

REGISTRATION OF PHYSICIANS ASSISTANTS SUPERVISION.

(THIS IS A PUBLIC RECORD, WHO IS THAT PERSON SUPERVISING HIM?)

VIOLATIONS OF ETHICS AND THE LAW BY SNIDER…..

Guidelines for Ethical Conduct for the PA Profession (Adopted 2000, amended 2004, 2006, 2007, 2008, reaffirmed 2013) PA–Physician Relationship Supervision should include ongoing communication between the physician and the PA regarding patient care. The PA should consult the supervising physician whenever it will safeguard or advance the welfare of the patient. This includes seeking assistance in situations of conflict with a patient or another health care professional.

(BY HIS OWN WORDS, SEE RECORDS, HE ADMITTED CONFLICT WITH THE PATIENTS FATHER AND THUS VIOLATED THIS ETHICAL TENETS AMONG OTHERS.

Ethan S. Snider is currently certified by NCCPA and holds identification number 1135579

*THANK YOU, WE REQUEST TO BE INTERVIEWED BY THE ALLIED BOARD MEMBER WHO INVESTIGATES SUCH CASES.*

DAVID LUBOFSKY