Sunday, October 8, 2017

Mandalay Bay in the Aftermath of Horror


Mandalay Bay in the Aftermath of Horror



      Horror came to a peaceful gathering of approximately 22,000 individuals as the sky rained down bullets on them from the 32nd floor of a very well-known casino in Las Vegas. Mandalay Bay played host to a country music festival on October 1st 2017. With a great lineup and tranquil weather patrons never would have thought the sounds music would be eclipsed by sounds of automatic gun fire. Stephen Paddock gained instant worldwide fame as he carried out his own personal holocaust. This day would be indelibly written on the psyches of millions.

     Unknown to those on Spirit flight 695 approaching McCarran Airport carnage was occurring less than a mile down the road. My fellow passengers and I received our first inkling of the events unfolding that evening when our cell phones finally caught signals on the ground. Thankfully Spirit and their great staff kept us on the tarmac for 90 minutes as the first responders finalized it was safe to disembark the plane. No one at the time knew how many shooters were participating in the slaughter. Courage and bravery abounded everywhere sometimes from the most unlikely sources.

     Once the extent of the evil was known a tide of emotion overwhelmed the faces of those you passed on the streets and vestibules in hotels. An astounding quiet pervaded the areas immediately around the death scene overshadowing the immense building in the background. First responders may have saved thousands. Left to his own devices Stephen Paddock would have continued his reign of terror to an nth point only God could conceive. Fortunately those who moved on this beast did it quickly and effectively.

     The death toll stands a 59 at this writing with more than 500 injured. Makeshift memorials have been established throughout the city. One of note, not far the death scene, displays a series of white crosses inscribed with the names of each victim and statements of regret. As we walked through this area a palpable sorrow and a state of mournfulness was ever present amongst the observers paying their respects. Sadly the media finds the killer more important than the victims.

      Extensive investigations are now underway to uncover the basis for this horror. Stephen Paddock was a misanthrope, no doubt. Yet his extreme actions take a leap no rational mind could envision. When the history of this event is finally penned let us pray no one tries to outdo this maniac. May God rest the souls of these individuals and settle the minds of those left behind.



Mark Davis MD


onandoffthehill.com

superbbookreviews.com

Monday, September 25, 2017

Maryland's Medical Marijuana Laws a Mine Field for Physicians


             Maryland’s Medical Marijuana Laws a Mine Field for Physicians





One question physicians should ask themselves is: What civil and criminal penalties may I incur in the event I prescribe Marijuana? Neither Maryland’s inept and corrupt Medical Board nor its self-serving Medical Society have issued any statements concerning potential penalties. House Bill 881 signed by Governor Martin O’Malley in April of 2014 required the Department of Health and Mental Hygiene and its Marijuana Commission to derive regulations governing the dispensing of medical Marijuana. Recently directives have been released concerning physician involvement in procuring Marijuana for potential patients. Physician liability was not addressed by these rules or prior statue. Worse, Marijuana is listed as a Schedule 1 substance along with Heroin, LSD and other potential abusive drugs. Under federal rules prescribing Marijuana is a felony unless given prior dispensation by authorities. In recent times federal prosecutors have turned away from charging physicians with Marijuana law incursions if their respective states legalized it. This could change at a moment’s notice. Maryland physicians who become involved in accommodating patients seeking “medical Marijuana” run many risks for few rewards.



Physicians will have to move through multi levels of paperwork to be allowed the privilege to certify individuals to obtain “medical Marijuana.” An unrestricted active medical license and a spotless record of compliance with state regulatory structure is a must. Being politically well connected, similar to those chosen to be dispensers of this drug, would not hurt either. Physicians contemplating being listed for medical Marijuana certification should review all available literature issued by state authorities with particular emphasis on any statements by the Attorney General’s Office and the Medical Board.



Maryland Board of Physicians has a habit of inventing rules and standards care after the fact. Never proactive this Board cherry picks which sections of its legal Title it will follow depending upon who is before it. With a lawyer as the Executive head of this administrative entity expectations were the Board would have created guidelines for implementing House Bill 881, since it had 3 years. Without protections from civil and criminal penalties lawyers will have a literal field day prosecuting cases. Worse incorrectly certifying a patient or a patient who crashes a vehicle, with this Schedule One drug in his or her system, the physician’s liability may be substantial. Point is prescribing Marijuana could be entrapment for physicians.



Lastly does malpractice insurance cover prescribing of Schedule One drugs and the resulting detriment this drug could cause to a patient? Approximately 23 states have legalized Marijuana in some form or manner. Each state manages the legalities and judicial responses to this psycho active drug differently. Maryland’s Board of Physicians is not managed as it should. Control has been given over to lawyers with minimal input from physicians. The unpredictability of this Board’s actions, lacking specific written guidelines and standards for physician involvement with this highly potent drug, may not be worth the risk for health care providers.



The author of this article cautions physicians to be wary of signing on to prescribing Marijuana until such time as the civil and criminal liabilities have been “totally clarified.” Maryland’s Board of Physicians and its attack dog the Attorney General’s Office will quickly blame doctors, not themselves, for prescribing mishaps related to Marijuana, even though they have promulgated no rules as of this writing. In the event you want to learn how corrupt your medical board is read a few of the articles at: medicalboardusa.com.



Mark Davis MD


medicalboardusa.com

onandoffthehill.com

Friday, September 22, 2017

SPEX: SPECIAL PURPOSE EXAMINATION OUTLINE MARK DAVIS MD SPEX TUTOR


                SPEX: SPECIALPURPOSE EXAMINATION OUTLINE


                                  Mark Davis MD SPEX TUTOR AND MENTOR

                                                  platomd@gmail.com 

                             

                                      

Special Purpose Examination, commonly called SPEX, is a test unlike any you have taken before. Created by the minds at the Federation of State Medical Boards it attempts to test a physician on a wide range of subjects. Federation officials claim in their literature that every physician, regardless of specialty, should have knowledge of the subject matters contained within the structure of the SPEX. Their claim further notes that participants in this exam who stayed current with general medical literature should not find the questions on this test “totally unfamiliar.” Reading the Federation’s literature many candidates for the SPEX,  who took this exam, would contest the Federation’s description that common medical knowledge is sufficient to obtain a passing grade. The high rate of failure speaks for itself.

Medical Boards send their SPEX candidates into this exam literally blind. They provide no guidelines, literature or other information to enable a potential examinee to know what they will be confronting.  Most candidates I have come in contact with were given a phone number of a faceless bureaucrat at the Federation of State Medical Boards to call. The voice on the other end is more interested in collecting the enormous exam fee than guiding the examinee on how to study for this very broad based test. It is to the benefit of this Federation for you to fail because they can collect additional test fees. Obtaining an edge up on the questions and subject matters of this exam is extremely important. Why? Because it can make the difference between passing or failing. It will only take a few questions marked the wrong way to fail this extensive exam. Hence SPEX tutoring came into being.  As a tutor I come into contact with many who have moved through this exam. Their feedback is enormously helpful for future test takers. Reviewing books on the market, many of them antiquated for this test, have not been very helpful to the multitude of examinees who could not make it through this exam the first time. Physicians taking this exam two, three and even four times are not uncommon. Since there are no legitimate live courses available the tutor, Mark Davis MD, can provide help to overcome the hurdles of a test designed to fail. The content of this e-book provides a glimpse how a tutor can be of great assistance to a potential examinee.



Given by computer over a one day period this test is a challenge to fully complete in the allotted time. There is a total of 336 questions divided into 7 segments each containing 48 clinical presentations. Each segment is given 64 minutes to complete. This provides 1.3 minutes per question. Many of these presentations are a full page long with paragraphs that contain 8-10 sentences or more not including the multiple answers to evaluate. Being well versed in the content of this exam and its layout is extremely important. The Federation of State Boards’ description of this exam is illusive at best. Listed subject matters on their website concerning this exam are incomplete. Therefore tutors, such as this author, are indispensable to help a potential examinee through the maze of literature necessary to succeed.



Versatility in many subject areas is a must to conquer this expansive exam. There is an array of radiographs one must be able to assess quickly. These x-rays do not always have the clarity one would expect on an exam yet you are expected to know the answer to the problem presented. When x-rays are displayed the written clinical presentation may not always be clear exactly what the author of the question is looking for. There have been a number of x-rays which have been repeated over the years and a tutor can clue you in to those he or she has come across. Certain types of fractures, dislocations and injuries show up more often than others. In the pulmonary category there is a focus on certain disease states. Both pediatric and adult equivalents must be known by the test taker as well.



Reported that EKGs are not of the best quality is also a fact. The clinical presentation may request a treatment based on your diagnostic capability therefore analyzing the cardiogram appropriately is a must. SPEX designers may have purposely introduced artifact into their EKGs to confuse the test taker into thinking they are viewing a rhythm other than it really is. Certain patterns have shown up more frequently in recent years which your tutor would be able to reveal to you.



Though clinical genetics is a class we took in our medical school days it is ever present on current SPEX tests. The Federation’s foray into genetics encompasses inheritance, chromosomal anomalies and phenotypic expression. The test participant should be aware of both pediatric and adult presentations of genetic anomalies. Emphasized most recently is the percent of genetic expression for specific diseases. Your tutor can enlighten you on which diseases were most frequently represented on the test.



Orthopedics is showing up more frequently on current exams. Many of the presentations are purposely misleading which diminishes the amount of time you have for evaluation.  Fractures, dislocations and tumors in both the pediatric and adult age ranges have been displayed. Knowing which have shown up more frequently could save you much time. Many of these presentations are not common bone diseases therefore a tutor who has communicated with prior examinees is someone you should seek out. 



Vaccines have been included in recent exams. An odd presentation of a very common disease showed up more than once in the most recent circuit of exams. The wording was straight forward yet those who studied for this exam overlooked this disease. It is not enough to know vaccine schedules. One must understand when to apply them in emergency settings and or not use them as a specific case is referenced. A tutor could be instrumental here.



There are thousands of variations of cardiac disease. Yet the Federation of State Boards appears to want their physicians to know certain disease states. Knowing Cardiology is not sufficient. Odd presentations of symptomatology are examined on SPEX.  Also tested is the examinees ability to elicit certain symptoms to arrive at a diagnosis. Physical diagnosis is tested in a number of ways. When to test and when to withhold testing of a patient is paramount. Which cardiac drug to select when a patient presentation is given is of utmost importance to know. As a tutor for SPEX those who have taken this exam several times reported back the recurring themes the Federation of State Boards has utilized in cardiology.







A wide range of pulmonary presentations have confronted recent examinees. The examiners have introduced an international flavor to the test. Diseases normally not seen frequently in the United States have challenged test takers. Remember you have approximately 1.3 minutes to evaluate an x-ray, graph or chart. In addition you must read and evaluate the clinical presentation before moving onto the 4-5 answers to select. Preparation is key. With few exceptions the flash cards offered for study of SPEX and other books sold were not very helpful in this section as reported to me. Variants of common pulmonary disease states both in the pediatric and adult categories were also amongst the offerings.  Several deceptive presentations of lung cancer and uncommon bacterial/viral diseases made their mark on examinees. Knowing where to emphasize your studies in this medical subject is paramount.



Psychiatry had a wide presence on recent exams. A series of symptoms describing a patient’s personality was frequently seen. The examinee was required either to make the correct diagnosis or chose the medication for that diagnosis. Some of these presentations were a full page in length.  One clever presentation gave a description of an infection which required a psychiatric diagnosis. There are several methods to cut down the time for evaluation of these types of questions.

Check with your tutor for the best approach. Parsing your time is one of the keys to passing SPEX.



Numerous questions in gastroenterology, both in the pediatric age group and adults have been given on recent exams. These questions frequently but not always have x-rays along with their extensive description of diseases. Knowing which age groups these diseases appear more frequently would substantially cut down the time in finding the answer. Remember many of these clinical presentations appear the same except for a few distinguishing characteristics.  Questions related to the liver and the various toxic encounters it incurs should not be overlooked.  A large number of errors are made in this area of the anatomy. Your tutor can cue you in on what has been seen most recently.



A wide ranging knowledge of infectious disease is a must to move into the passing grade zone. This subject overlaps with every other category of disease on the exam. Odd presentations of common diseases have been seen. Both domestic and foreign vermin are presented to challenge the examinee. In some questions a specific symptom or set of symptoms may be given and you have to know the disease presented in order to answer which treatment modality is needed. This is called a second level question. This type of question is seen frequently. A patient presents to a physician with several symptoms of severe neurological disease. On first glance at the question the examinee may not consider this is an infectious disease problem, yet it is. The Federation test writers do an excellent job with  infectious disease questions literally misleading the test candidate by adding vacuous information to the introductory paragraph of a given question.  Your challenge is to get beyond the confusing verbiage to quickly delineate the answer.  Tutors are helpful here because they can clarify the fine differences in questions to get to an answer sooner.



There are numerous questions on Oncology and Hematology. Many of the books on the market have physicians studying various slide presentations of cells or other extraneous lab data. If that makes the examinee comfortable then by all means study this material. Recent tests did not have microscopic slides for these specific subjects. Questions are definitely recycled.  Additionally a clinical setting may be given requesting the examinee to answer several questions based on its contents. This type of presentation was given throughout the test. On the Oncology side pulmonary, bone and skin cancers have been frequently seen.  These questions either ask the diagnosis and or the most common treatment mode.  Few may request the cause of the cancer which may not be as obvious as one would think. A vast array of hematology questions have been seen from bio-chemical deficiencies to blood born cancers. Your tutor can be very helpful here directing the examinee to emphasize certain areas of study.



Neurology and Neurosurgery questions are part of the repertoire of presentations. Symptomatology is similar for many of these diseases. Therefore questions can be quite confusing. With limited time available the examinee must get into the “meat” of the question quickly. Knowing the physical findings specific for compressing lesions and or vascular anomalies would be very helpful to the test candidate. Within these fields your ophthalmological knowledge will also be tested. Knowing the layout of specific nerve roots could help answer some of these complex questions. Your tutor can enlighten you on some of the more broad based approaches examinees should take to get beyond these types of questions.



Nephrology is represented by many key questions from urinary crystals to cancers. Vascular anomalies have been presented in creative ways to throw the examinees’ thinking for the proverbial loop. A multi-prong study approach should help the test candidate through these difficult questions. Let your tutor guide you to the best approach in this subject.



Special Purpose Examination (SPEX) has shown itself to be incredibly difficult. Failing this exam two, three and even four times has occurred frequently by test candidates. The cost in time and money can be cut down substantially for examinees by proper preparation and study for this exam. A tutor who has a wide ranging knowledge of this exam and who has come in contact with a multitude test candidates is well suited to help the potential examinee.  Please contact Mark Davis MD at platomd@gmail.com to inquire concerning fees and study times available.



Mark Davis MD


SPEX Tutor and Mentor

Monday, September 18, 2017

Drugged Up Maryland


                                             Drugged Up Maryland



Drugs have found their way into every facet of Maryland life. Children are overdosed with amphetamines. While our aged population is controlled by third generation antidepressants. Those in between have alcohol, opioids, psychotropic drugs and now Marijuana. Controlling the masses has never been easier.

Marijuana industry is coming to the entitlement state. Initially 14 licensees have been chosen from a group of 140. Though the state’s Marijuana Commission notes the newly licensed were carefully picked evidence suggests many are politically well connected. Claiming “Medical Marijuana” will be of the purest variety by their choices the Commission needs to explain why not one pharmaceutical company was chosen. Yet someone from the casino industry was.

Decriminalization of Marijuana at the state level has been on the road to reality for years. In Maryland the drug epidemic, both legal and illegal, has gone beyond manageable levels. Adding Marijuana to the mix elevates the problem exponentially. As long as the drug is used in the privacy of one’s home who is to argue with its need and questionable medical necessity. Sense and sensibility dictates the latter will not be the norm. Instead people will mix Marijuana with the other drugs they utilize, including alcohol, resulting an increase in fatalities more expansive than currently is seen. Decriminalization absolutely, providing this drug through state approved outlets is extremely questionable and introduces a series of unknowns.

Physicians, who chose to prescribe Marijuana, must be on a state approved list. Once approved they must certify medical necessity to the patients seeking this drug. After approval the patient can take his or her Marijuana Identification card to a dispensary and receive a limited amount of this drug. Knowing most of the prescribed drug is not going to be used for its medically intended purpose who will be held responsible when irrationality of its use enters the picture? Will physicians be held responsible when a vehicular crash occurs by someone with excess drug in their systems (presently blood level excess has not been set)? If a physician approves too many requests will his or her license be impaired?  And the list of unknowns goes on.

Maryland Legislature pays lip service to those whose minds and bodies have been crushed by the never ending supply of drugs consumed by its residents. Marijuana should never have been criminalized. With that stated drug sales should not be supported by state mandate either. Enter a busy emergency and watch as the bodies of drug victims roll in. Marijuana may not be nearly as toxic as opioids. When combined with alcohol or other deadly substances bad results are inevitable. Does this reporter have the answers, no I don’t. Nevertheless neither does the Maryland hierarchy. I hope and pray that I am wrong. Yet experience outside Maryland should have taught those in power something. Apparently it hasn’t.

Mark Davis MD


onandoffthehill.com

superbbookreviews.com

Tuesday, September 5, 2017

Strange Case of Doctor Nikita Levy and the Maryland Board of Physicians lack of Response


Strange Case of Doctor Nikita Levy and the Maryland Board of Physicians lack of Response



Doctor Nikita Levy, an Ob-gyn physician, purportedly photographed the vulnerable parts of thousands of women before his secret was outed in February 2013. A savvy John Hopkins Hospital employee noticed that Dr. Levy had a small device on his person resembling a camera. Soon after this revelation the unnamed employee reported Dr. Levy to Hopkins hierarchy who subsequently fired him. Investigations displayed Dr. Levy had a large cache of photos in his personal possession which allegedly contained those of both adult females and children. Dr. Levy was an employee of Hopkins for more than 2 decades. Indications are his photo spree started on or about 2005. There is no history of outrageous medical activity prior to this time.



Within 2 weeks of his disengagement from Hopkins Dr. Levy committed suicide reportedly by suffocation utilizing Helium as a catalyst to expedite his death. The horror to his family and the patients affected is insurmountable. In the month leading up to this article over 8,000 checks were mailed to Dr. Levy’s patients as part of a 190 million dollar malpractice settlement. Media sources note lawyers received 32 million of this amount. This case has more questions than answers.



1)    Why didn’t the Maryland Board of Physicians suspend Dr. Levy’s medical license under an emergency order immediately upon knowing the circumstances of this case? This is within their power

2)    Eight thousand women made claim to funds in the malpractice financial pool. Is the public supposed to believe not one of these women suspected Dr. Levy’s deviance during their exams?

3)    Doctor Levy was exposed to many John Hopkin’s employees during his tenure at this noteworthy institution. Only one employee noticed his deviance with a camera device. This is a stretch of credibility.

4)    Worse is the public to believe not one patient of the 8,000 complained to Hopkin’s hierarchy from 2005 until 2013 concerning the odd behavior of Dr. Levy.

5)    Did the Maryland Board of Physicians treat this case with special deference because Dr. Levy worked for Hopkins? Did Dr. Levy receive special treatment from the medical board for other reasons?

6)    Since Dr. Levy was not cited by the medical board prior to his untimely death his record with the Medical Board will never reflect the facts of this case and the malpractice settlement. Why?

7)    What did Hopkins know about Dr. Levy prior to its employee discovering his camera on or about February 4th 2013?



Maryland Board of Physicians is managed by lawyers. There appears to be purposeful intent on their part to look the other way in this case. Dr. Levy, as reported by local media, continued to have an active medical license at the time of his death. If true the Maryland Board of Physicians is hiding the truth of a former licensee by their silence. The final question is: Why?



Mark Davis MD


Manager of medicalboardusa.com

Sunday, September 3, 2017

Trump will not Dance to KIm Jung-un's Tune


Trump will not Dance to Kim Jung-un’s Tune



Prior presidential administrations appeased North Korea with money and gifts hoping they would move down a civilized path. Ironically North Korea’s nuclear ambitions became more aggressive. America and its allies are inches from a thermonuclear showdown with a megalomaniac who is inviting war on himself and others. Diplomacy is fading as a tool to sedate Kim Jung-un. Since Dennis Rodman could not seduce Kim into compliance with international law perhaps a missile up his rear end will. President Trump is left with few options if Kim’s trigger finger gets itchy.



Newest in Kim’s arsenal purportedly is a Hydrogen bomb. Power in this type of weapon is exponential to the previous devices North Korea had developed. Allies of this isolated nation, including China and Russia, appear to have enabled the building of this horrific weapon. Nevertheless both countries approved sanctions in the United Nations after Kim set off a series of missiles recently. Guam may be the ultimate target of North Korea because of its proximity and American military base there.  President Trump must decide soon whether to continue failing diplomacy or bring the wrath of God down on North Korea’s military. The next few weeks will answer this question.



Mark Davis MD


onandoffthehill.com

medicalboardusa.com

Wednesday, August 30, 2017

Medicalboardusa.com Protecting Physicians from Medical Board Abuses


Medicalboardusa.com Protecting Physicians from Medical Board Abuses




Medicalboardusa.com is a website designed to provide support to physicians who are under the duress of a medical board intervention and or a malicious malpractice case. When targeted physicians become isolated, their stance in the community is diminished and the economic drain is potentially enormous. With the latter in mind this site seeks to connect physicians with others who have been down this road and appropriate people who can protect them. Medicalboardusa.com seeks lawyers who are extremely cognizant of administrative law that governs medical practice. Medical Boards have counsel well versed in this segment of the law and their targets should have equal representation.



Medical Boards have moved on from oversight of their flock to confrontational assaults with physicians. When targeted a physician should expect the worst from their medical colleagues who sit on these tribunals. With the misuse of standards of care and complex regulatory structure medical boards now entrap physicians with bogus compliance cases. These actions are performed to improve their sanction numbers amongst the states. Studies of the Arizona, Texas and Maryland Medical Boards display they have been politicized to a point that they lost the purpose of their original intent. Case after case reviewed displayed only strong legal representation by a lawyer who knew his/her way around the regulatory mind field had successful outcomes. This site should be a first step for accused physicians to discuss their cases before answering any letter from a medical board inquiring about their practice.



Mark Davis MD


Medicalboardusa.com