The primary mission of the Nevada State Board of Medical Examiners is to protect the public. The public assumes that a physician holding a Nevada license is competent. The validity of a licensure process that assesses cognitive knowledge, clinical judgment and ethical behavior only once in a practice lifetime must be seriously questioned. Other professionals, most notably airline pilots, must demonstrate their competence through rigorous skill testing annually. Why have physicians been exempt?

Patients trust doctors with their lives and well-being. They need to have confidence that their doctor is competent in his field and abides by high standards. The vast majority of doctors meet this expectation, but our current licensure procedure does not give the public sufficient confidence that poorly performing doctors are being identified and early action is being taken to protect patients. This process also does not support doctors as effectively as possible in maintaining and improving the quality of their practice.

The American Board of Medical Specialties approved this description of the competent physician: "the competent physician should possess the medical knowledge, judgment, professionalism and clinical and communication skills to provide high-quality patient care. Patient care encompasses the promotion of health, prevention of disease, and diagnosis, treatment, and management of medical conditions with compassion and respect for patients and their families. Maintenance of competence should be demonstrated throughout the physician’s career of lifelong learning and ongoing improvement of practice".

Pursuant to Nevada Revised Statutes 630.197 and 630.288, and Nevada Administrative Codes 630.153 and 630.157, physicians are reminded that all Nevada licenses expire June 30, 2001. Please be aware that if you practice beyond June 30, 2001, without first renewing your license, you will be doing so as an illegal practitioner in this state and committing a felony. Extensions are not allowed for any reason! Nevada has no grace period! Should your license be suspended for non-payment, the registration fee to reinstate your license is doubled; therefore, a payment of $1,200.00 will be required for licensure reinstatement.

Applications for renewal of license for the upcoming 2001 - 2003 biennium have already been mailed to every physician to whom a license was issued during or renewed for the current biennium, July 1, 1999 - June 30, 2001. Your completed renewal form, proof of 40 hours of Category 1, AMA-approved Continuing Medical Education (CME) credit, along with the proper fee, must be received at the board office by no later than July 1, 2001. Failure to renew on or before July 1, 2001, may result in insurance/Medicare/Medicaid claims being denied, lack of malpractice insurance coverage and/or other liabilities regarding the practice of medicine. You are encouraged to renew promptly upon receipt of your renewal notice. The Medical Practice Act does not allow the board to grant waivers for extenuating circumstances.

PLEASE BE REMINDED that physicians are required to provide the board with proof of 40 hours of Category I, AMA-approved CME credit for each biennial registration period. Of the 40 hour requirement, physicians are required to provide 2 of the hours in medical ethics and 20 of the hours in the physician's scope of practice or specialty. Physicians are required to comply with this CME requirement when re-registering for the 1999 - 2001 biennial registration period. Physicians must, therefore, complete this required CME prior to July 1, 2001.

NAC 630.153(2) exempts a licensee from the 40 hours of CME ONLY if he or she has completed a full year of residency or fellowship training in the United States or Canada during the time period July 1, 1999 through June 30, 2001.

Per NAC 630.157(1), CME requirements for those INITIALLY licensed to practice in Nevada during the time period July 1, 1999 through June 30, 2001 are as follow:

(a) if INITIALLY licensed to practice in Nevada during the time period July 1, 1999 through December 31, 1999, 40 hours of CME are required, with 2 of the 40 hours to be in medical ethics and 20 of the 40 hours in the physician's scope of practice or specialty;

(b) if INITIALLY licensed to practice in Nevada during the time period January 1, 2000 through June 30, 2000, 30 hours of CME are required, with 2 of the 30 hours to be in medical ethics and 20 of the 30 hours in the physician's scope of practice or specialty;

(c) if INITIALLY licensed to practice in Nevada during the time period July 1, 2000 through December 31, 2000, 20 hours of CME are required, with 2 of the 20 hours to be in medical ethics and 18 of the 20 hours in the physician's scope of practice or specialty; and

(d) if INITIALLY licensed to practice in Nevada during the time period January 1, 2001 through June 30, 2001, 10 hours of CME are required, with 2 of the 10 hours to be in medical ethics and 8 of the 10 hours in the physician's scope of practice or specialty.

The application for renewal of license is a legal document requiring a signature (stamped signatures are not acceptable). It is your responsibility to verify the accuracy of submitted information, and to add or correct information where applicable. Do not delegate this task!

The board cannot be responsible for the non-delivery or untimely delivery of applications for renewal of license by the United States Postal Service. If you have not received a biennial renewal notice from the board by May 1, 2001, please contact the board's office at 775/688-2559 in Reno or 888/890-8210 if calling from elsewhere within the state of Nevada. Board staff will be happy to verify your address of record. If your address is different from that on record at the board office, you may fax your address change to 775/688-2321 in Reno. Your change of address will be recorded, and a "duplicate" application for renewal of license will be mailed to you upon your request.

The change of status process can take from three to six months to complete, depending upon the time of year and the dates of the board meetings.

Pursuant to NRS Chapter 630, in order to change your license status from inactive or retired to active, or to reinstate your license to active, you must:

(1) Submit a notification to the board of your intent to resume the practice of medicine in Nevada;

(2) Submit a notarized, sworn affidavit to the board describing your activities during your inactive/retired/suspended status;

(3) Submit your completed Application for Active Status Registration renewal form;

(4) Request licensure verifications (letters of good standing) from all states where you have ever been licensed (whether currently licensed there or not);

(5) Pay the applicable registration fee in the form of a cashier's check or money order. Note: the amount of money you paid for your current status registration fee will not be applied toward the active status registration fee you will be charged;

(6) Submit proof that you have completed 40 hours of Category I, AMA-approved CME credit within the preceding 24 months. Two of the 40 hours must be in medical ethics and twenty of the 40 hours in your scope of practice or specialty;

(7) Complete a Child Support Information form.

If you did not practice allopathic medicine for a period of more than 12 consecutive months prior to your applying for change of status to active, the board may require you to take an examination to test your medical competency. If the board determines that your conduct while not practicing medicine in Nevada would have warranted denial of an initial application for a Nevada medical license, the board may refuse to change your license status to active.

The board conducts a background investigation of every application for change of status to active and if board staff become aware of circumstances warranting a personal appearance at a board meeting, you will be notified. Whether or not a personal appearance is warranted, your application for status change to active must be completed 45 days prior to any regularly scheduled board meeting in order for it to be placed on the meeting agenda. The next three board meetings are scheduled to be held June 2, 2001, September 8, 2001, and December 2, 2001.

If your change of status application is placed before the board for review, acceptance or denial, and the board votes to not accept your change of status application, this non-acceptance becomes a reportable action to, among other entities, the National Practitioner Data Bank.

Under Nevada law, a public body cannot hold a meeting to consider the character, alleged misconduct, professional competence, or physical or mental health of any person unless it has given written notice to that person of the time and place of the meeting. The written notice must be sent by certified mail to the last known address of that person at least 21 days before the meeting. A public body must receive proof of service of the notice before such a meeting may be held.

For additional information or assistance concerning changes of status to active, please call a license specialist at the board office at 775/688-2559 in Reno or 888/890-8210 if calling from elsewhere within the state of Nevada.
 

Harriston Lee Bass, Jr., M.D. was found guilty in 1993 of gross malpractice and malpractice. He appealed to the District Court and then to the Nevada Supreme Court. The Nevada Supreme Court upheld the action of the board. His petition for re-hearing was denied by the Nevada Supreme Court on September 18, 2000. He then sought to appeal to the United States Supreme Court. The United States Supreme Court denied his petition for a Writ of Certiorari on March 19, 2001, thereby deciding not to hear his appeal. He has filed a Petition for Rehearing with the U.S. Supreme Court.

LEGAL UPDATE #2: FEDERAL DISTRICT COURT DISMISSES WARREN S. GILBERT, M.D.'S LAWSUIT AGAINST BOARD                                                               By: Richard J. Legarza, J.D., General Counsel

On July 5, 2000, Warren S. Gilbert, M.D., filed a complaint in the United States Federal District Court, for the District of Nevada, against the executive director of the Nevada State Board of Medical Examiners, and the Five (5) members of the Nevada State Board of Medical Examiners who participated in a hearing on alleged violations of the Medical Practice Act of the state of Nevada by Dr. Gilbert.

Dr. Gilbert alleged in his complaint that despite a lack of evidence, the Board found him in violation of the regulations relating to the practice of medicine and revoked his license, staying the revocation based upon numerous restrictions and conditions on his license, and that such conduct by the Board, acting under color of state law, deprived Dr. Gilbert of rights, privileges or immunities secured by the Constitution and the laws of Nevada and the United States and violated the provisions of 42 U.S.C. 1983.

Prior to the filing his complaint in Federal District Court, the Nevada State Board of Medical Examiners had filed a formal complaint on April 11, 1995, against Dr. Gilbert alleging violations of the Medical Practice Act of the state of Nevada. A hearing was conducted before the Board of Medical Examiners at which time evidence was presented and Dr. Gilbert was represented by legal counsel. The Board found Dr. Gilbert had violated the Medical Practice Act. Dr. Gilbert filed a petition for judicial review in the Second Judicial District Court of the state of Nevada, a hearing was held, and on January 14, 1997, the district court issued its order affirming the decision of the Board of Medical Examiners. Dr. Gilbert filed an appeal with the Nevada Supreme Court, and on April 13, 1999, oral arguments were held before the Nevada Supreme Court, and on May 10, 1999, the Nevada Supreme Court issued an Order dismissing Dr. Gilbert’s appeal.

The investigative staff of the board often receives inquires regarding a perceived conflict between a physician’s responsibility to maintain patient confidentiality and his or her responsibility to respond to board investigations. This concern provides a good opportunity to explain one of the purposes of investigations and the role of physicians in the process.

Investigations of alleged violations of the Nevada Medical Practice Act are initiated by complaints. The Investigative Committee of the board has the responsibility to investigate these complaints. This three-member committee is chaired by the secretary-treasurer of the board and is composed of at least one public member who is not a licensed physician.

To adequately investigate a complaint, the investigative staff of the Investigative Committee must frequently obtain health care records and other information pertaining to a physician’s course of treatment. If a physician receives a request from the committee for patient records, he or she is obligated under Nevada law to supply a copy of the same to the committee or to a representative of the committee.

Whenever the Investigative Committee, a patient or an authorized representative of the patient, requests a copy of the patient’s records the physician must respond. Some physicians express concern about releasing the records and other information to the committee for fear of breaching patient confidentiality. Patient confidentiality is not breached in this instance, since release of the patient records is required by statute. Furthermore, the board maintains confidentiality of the records and the patient’s identity throughout the investigative process. By promptly and completely responding to committee requests for information, physicians assist the board in ensuring that patients continually receive the appropriate level of care.

Another frequent misconception is the notion that a physician can only release patient records actually produced by that physician. The Nevada Medical Practice Act defines health care records as any reports, notes, orders, photographs, X-rays or other recorded data or information produced or received by the physician. This means that all patient records, whether or not they were produced by the supplying physician, must be released when properly requested.

        1) Restricted licenses issued under NRS 630.164 (rural exemption): 33 licenses issued

        2) Temporary licenses issued to physicians in medically underserved rural areas: 71 licenses issued

        3) Unrestricted licenses issued to physicians in medically underserved rural areas: 113 licenses issued

        4) Temporary licenses issued to physicians in medically underserved urban areas: 56 licenses issued

        5) Unrestricted licenses issued to physicians in medically underserved urban areas: 27 licenses issued

LICENSURE STATISTICS _ MEDICAL DOCTORS

For year 2000 there were 176 physician assistants holding licensure in Nevada. 43 physician assistants were licensed for the first time by the BME during 2000. The chart below reflects a breakdown of the number of licensed physician assistants practicing in Nevada, by county, from 1992 through 2000.

YEAR                 1992          1993          1994          1995          1996          1997          1998          1999          2000

COUNTY
Carson City `           5              5               5               3                3               2                5                7              9
Churchill                 0               0              0                0                0               0                0               2               2
Clark                    40              44             58             72              72              77              94            118           116
Douglas                   0               0              0               0                0               0                  1              1               2
Elko                       1               2              4               4                4               7                  9              6               6
Esmeralda              0               0              0               0                0               0                  0              0               0
Eureka                   0               0              0               0                1                1                1              1               1
Humboldt                 0              0               0               0                0               0                  0              0               0
Lander                    0             0               0                0                0               0                  0              0               0
Lincoln                   1              2               1                1               1                0                  0              0               0
Lyon                      0              0               0                0               1                2                  2              4               4
Mineral                   1              2               2               2               2                  1                1               1               1
Nye                       4               4               3               3               3                  3                3               6               8
Pershing                0               1               1               1               1                  1                1               1               0
Storey                   0               0               0               0                0                0                0               0               0
Washoe                3               4                7             10              10              18               23             26              25
White Pine            1               1                1               2                2               1                  1               1               2
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

                                                                                                                                                                    RATIO OF
                                                                                                                                                                      ACTIVE
                                                                                                                                                               IN-STATE M.D.'S
                                                                                                                                                                   PER 100,000
YEAR *                  ACTIVE IN-STATE                  NEW LICENSES                  STATE POPULATION                  POPULATION

1980                              1,158                                      201                                      800,000                                        144
1981                             1,196                                       285                                        851,150                                        140
1982                             1,308                                       234                                        878,260                                        148
1983                             1,367                                       199                                        905,660                                        151
1984                             1,366                                       205                                        933,010                                       146
1985                              1,442                                      192                                      969,370                                       148
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
1986                              1,524                                      134                                   1,010,280                                       151
1987                              1,487                                      142                                   1,057,030                                       141
1988                              1,611                                      216                                   1,124,650                                       143
1989                              1,666                                      199                                   1,197,260                                       139
1990                              1,811                                      202                                   1,283,490                                       141
1991                              1,895                                      233                                   1,300,000                                       146
1992                              2,014                                      241                                   1,348,400                                       149
1993                              2,144                                      308                                   1,389,000                                       154
1994                              2,322                                      333                                   1,493,000                                       155
1995                              2,424                                      331                                   1,583,000                                       153
1996                              2,686                                      427                                   1,638,000                                       158
1997                              2,760                                      442                                   1,741,000                                       159
1998                              2,965                                      391                                   1,875,000                                       158
1999                              3,113                                      377                                   2,034,000                                       153
2000                              3,295                                      411                                   2,115,000                                       156

* CALENDAR YEAR (JANUARY - DECEMBER)

                                        1980 - 2000:  Total new licenses issued                               5,703
                                          21 years          Average new licenses per year                     272
                                                                  Net gain in population                         1,315,000
                                                                  Net gain in M.D.'s                                     2,137
                                                                  Average net gain in M.D.'s per year              102

2000                         12                               1                                                                         3                                  16
1999                         10                               1                                                                         4                                   15
1998                           8                              5                                                                        3                                  16
1997                           8                              2                                                                        6                                  16
1996                           9                              7                                                                        4                                  20
1995                           1                              1                                2                                     21                                 25
1994                           2                              4                                                                        8                                  14
1993                           1                              3                                1                                      10                                15
1992                            3                                                               1                                       9                                 13
1991                           3                                                                                                        10                                 13
1990                           1                              2                                                                         11                                 14
1989                            2                              1                                1                                       8                                 12
1988                            6                              4                                2                                       5                                  17
1987                            2                              4                                3                                       3                                  12
1986                            2                              1                                1                                       3                                   7
1985                          11                              3                                3                                      11                                 28

Two party notification to the board regarding termination.   NAC 630.340. Period of validity of license; termination of employment; disciplinary action; refusal to license. (NRS 630.130, 630.275)  2. The supervising physician shall immediately notify the board of termination of employment of a physician assistant. The supervising physician and the physician assistant shall submit to the board a summary of reasons for and circumstances of the termination of employment.

The board prior to supervision commencing, must approve a physician who wishes to supervise a physician assistant. Applications for approval may be obtained by contacting the board office. A physician assistant must have an approved supervising physician recorded at the board office at all times when the physician assistant is engaged in active practice. NAC 630.273 provides that the certificate of a physician assistant is valid only so long as the supervising physician employs and supervises the physician assistant.

The investigative staff onsite visits also emphasized strict compliance with NAC 630.360(2), which requires a physician assistant to wear at all times while on duty a placard, plate or insignia which identifies the person as a physician assistant and NAC 630.370, which in part, requires a supervising physician to review regularly the records of patients and initial those records.

NAC 630.380(1) states that a physician assistant is subject to disciplinary action by the board if the physician assistant has held himself out or permitted another to represent him to be a licensed physician, has performed medical services otherwise than at the direction or under the supervision of the supervising physician, or performed services which have not been approved by his supervising physician.

The American Academy of Physician Assistants recently published Guidelines for Ethical Conduct for the Physician Assistant Profession. The guidelines’ emphasis on a PA's role and responsibilities and the PA - physician relationship are concurrent with many of the NAC regulations. PAs practice within the framework and context of physician supervision. The ethical guidelines in describing the PA - physician relationship state, "Supervision should include ongoing communication between the physician and physician assistant regarding patient care."

In portraying the PA’s role and responsibilities, the ethical guidelines cite "Physician Assistant practice flows out of the unique relationship that involves the PA, the physician and the patient.  In addition, PAs practice medicine with physician supervision; therefore, the care that a PA provides is an extension of the care of the supervising physician. The patient - PA relationship is also a patient - PA - physician relationship."

Meeting regularly with your supervising physician, discussing practice issues, patient cases, chart review and signatures ensure good professional quality assurance and preserve the legal and ethical tenets of your professional life.

Members of the Physician Assistant Advisory Committee include Susan Morgan, Nancy Munoz and John Lanzillotta. They may be contacted through the board’s office in Reno by calling 775-688-2559 or, if calling from elsewhere in Nevada, 888-890-8210.

The purpose of the Diversion Program is to provide physicians and physician assistants a confidential means of seeking and obtaining evaluation, treatment, and monitoring for addictive disease, disruptive behavior, and mental or physical impairment. We currently have 48 participants under contract with another 40 participants who have successfully completed their monitoring contracts. Diversion works. The Nevada Health Professionals Assistance Foundation is contracted by the State Board of Medical Examiners to administer the Diversion Program. The entire staff of the Nevada State Board of Medical Examiners and the Nevada Health Professionals Assistance Foundation recognize the value of supporting physician health and have pledged support of this program.

The Nevada Health Professionals Assistance Foundation is pleased to announce the addition of Rex T. Baggett, M.D. to the Board of Directors of the Foundation. Dr. Baggett is from Carson City, has served on the State Board of Medical Examiners, and has extensive experience in physician health issues. We feel very fortunate to have Dr. Baggett on our Board of Directors.

I want to thank the Hospital Association, as well as all the Medical Facilities in Nevada for their support of the Diversion Program. I would like to give special recognition to the following hospitals and/or Medical Centers for contributing to the Nevada Health Professionals Assistance Foundation in the amount of $50,000, which will certainly assist the Foundation in maintaining the quality of the Diversion Program during this year:

                    Churchill Community Hospital                                      Humboldt General Hospital
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