|
State of NevadaBoard of Medical Examiners Newsletter |
|---|
| CHERYL A. HUG-ENGLISH, M.D., President JACULINE C. JONES, Ed.D., Vice President JOEL N. LUBRITZ, M.D., Secretary-Treasurer |
PAUL A. STEWART, M.D. DONALD H. BAEPLER, Ph.D., D.Sc. ROBIN L. TITUS, M.D. MARLENE J. KIRCH SOHAIL U. ANJUM, M.D. STEPHEN K. MONTOYA, M.D. |
| VOLUME 27 | APRIL 2002 |
PRESIDENT'S MESSAGE
The practice of medicine today involves not only patient care, but complex issues of privacy, patient rights, as well as legal and ethical issues. It is not only physicians who struggle to deal with these questions. State legislatures are beginning to get involved with medical questions as well. In the past few months, I have been asked on several occasions to appear on the board’s behalf before committees of the Nevada State Legislature. Two specific issues have recently been reviewed by the legislature.
The first topic involved questions relating to what specific requirements physicians have for education on suicide prevention. There was a proposal suggested to mandate CME credits in suicide prevention, and although the board does not support this approach, and I spoke in opposition to it, the suicide statistics certainly warrant each physician becoming familiar with suicide risk factors and prevention strategies. Nevada has the highest suicide rate in the nation, with a rate almost twice the national average. Many suicide victims, particularly those 65 years and older, have visited a health care professional shortly before their suicide. As physicians, we need to take an active role in identifying those at risk and seeking appropriate treatment and referrals.
The second matter that has been discussed at the Nevada State Legislature concerns the reporting of medical errors. Lots of documentation was given about types of medical errors, where they are most apt to occur, and how best to minimize errors. Questions were raised as to whether appropriate systems are in place to minimize as well as report errors that occur. This is an ongoing dialog, and as yet no solutions have been proposed.
Certainly it is clear that there are many questions and uncertainties confronting the practice of medicine. I will continue to try to keep physicians informed as issues are raised that may impact the current practice of medicine.
A WORD FROM THE PRACTITIONER OF RESPIRATORY CARE
ADVISORY COMMITTEE OF THE BOARD
The law governing the practice of practitioners of respiratory care includes language that delineates the status of both graduates, interns and students. Graduates of the National Board for Respiratory Care accredited programs awaiting completion of the certification examination and allowed to practice as interns are addressed in NRS 630.277. Students are included in the section that lists and qualifies non-applicability of the law (NRS 630.047). The entire Nevada Revised Statues (NRS) and Nevada Administrative Code (NAC) covering physicians, physician assistants, and practitioners of respiratory care are available via the Nevada Board of Medical Examiners Web site: www.state.nv.us/medical/. Provided below is the language that speaks to practitioner of respiratory care graduates, interns and students:
NRS 630.277(3) Any person who has completed the educational requirements set forth in paragraphs (a) and (b) of subsection 1 may practice respiratory care pursuant to a program of practical training as an intern in respiratory care for not more than 12 months after completing those educational requirements.
The educational requirements set forth in (a) and (b) of subsection one of
NRS 630.277 are:
NRS 630.277
(a) Have a high school diploma or general equivalency diploma.
(b) Complete an educational program for respiratory care which has been
approved by the National Board for Respiratory Care or its successor
organization.
At this time, the Nevada State Board of Medical Examiners is not requiring licenses for interns.
Provisions for the practice of respiratory care by a student are contained in NRS 630.047 subsections (e) and (f). This section of the law lists and qualifies the exemption status of various entities. Practitioner of respiratory care students may provide respiratory care without a license under the following conditions:
NRS 630.047
(c) The practice of respiratory care by a student as a part of a
program of
study in respiratory care that is approved by the board, or is recognized by
a national organization that is approved by the board to review such
programs, if the student is enrolled in the program and provides
respiratory care only under the supervision of a practitioner of respiratory
care.
(f) The practice of respiratory care by a student who:
(1) is enrolled in a clinical program of study in respiratory
care
which has been approved by the board;
(2) is employed by a medical facility, as defined in NRS
449.0151;and
(3) provides respiratory care to patients who are not in a
critical
medical condition or, in an emergency, to patients who are in a
critical condition and a practitioner of respiratory care is not
immediately available to provide that care and the student is
directed by a physician to provide respiratory care under his
supervision until a practitioner of respiratory care is available.
Note that the clinical program of study in respiratory care must first be approved by the Nevada State Board of Medical Examiners. To date, no such clinical programs of study have requested approval and been approved by the board. Licensed practitioners and employers should be familiar with these and all other provisions of the respiratory care statutes and regulations, and should contact the board with questions on applicability of the statutes and regulations.
This article is a snapshot view of two areas of the licensure law that govern
the licensing of practitioners of respiratory care. In the next article, we will
address the provisions relating to continuing education requirements. The
members of the board’s Practitioner of Respiratory Care Advisory Committee,
Michael J. Garcia, R.R.T., Steven E. Kessinger, C.R.T. and Donald W. Wright,
R.R.T., welcome recommendations for future newsletter topics. Please forward
your recommendations to the Nevada State Board of Medical Examiners, attention:
Practitioner of Respiratory Care Advisory Committee.
The board has just recently completed its mass mailing of the newly revised
statutes and regulations governing medical doctors, physician assistants and
practitioners of respiratory care to all licensees of the board. Nevada Revised
Statutes Chapter 630 and Nevada Administrative Code Chapter 630 were mailed to
all licensees, and the statutes pertaining to medical record keeping were
included in the mailings to the medical doctor and physician assistant
licensees. The board urges all licensees to familiarize themselves with the
board’s statutes and regulations and to keep them handy for reference
purposes.
A WORD FROM THE PHYSICIAN
ASSISTANT
ADVISORY COMMITTEE OF THE BOARD
By: John B. Lanzillotta, P.A.-C, Physician Assistant Advisor
At a recent meeting of the Nevada State Board of Medical Examiners, held on March 1, 2002, a new member to the board’s Physician Assistant Advisory Committee was nominated and approved by the board. Brian S. Lauf, P.A.-C, who lives in Sparks and works in Family Practice at a rural health clinic in Fernley, will serve on the advisory committee. Brian fills the position of Susan M. Morgan, P.A.-C, who served on the advisory committee since 1997, as an alternate and then an appointed member. Brian is currently the president of the Nevada Academy of Physician Assistants and a member of the National House of Delegates to the American Academy of Physician Assistants.
The Physician Assistant Advisory Committee, at the request of the board, reviews and makes recommendations to the board regarding matters relating to physician assistant practice, supervision and regulation.
Physician assistants have played an integral part in delivering quality health care in the last thirty years and have a respected niche as medical providers. In the past ten years, state laws that regulate and govern physician assistants have become more uniform and standardized as the American Academy of Physician Assistants have set up Guidelines and Model State Legislation that have helped achieve consistency in practice from state to state. Although there are variations in some regulations from state to state, all states license physician assistants to practice medicine with physician supervision and a physician-directed team health care delivery concept.
Regulations of physician assistants involve credentialing and licensing, scope of practice, definition of supervision and delegated prescriptive authority. Nevada is one of twenty states that mandate continuing competence requirements of certification, re-certification by the National Commission of Physician Assistants and on-going continuing medical education to hold a current license. Physician assistants and supervising physicians are encouraged to review and familiarize themselves with Nevada Administrative Code chapter 630 and Nevada Revised Statutes chapter 630 regarding physician assistant scope of practice, definition of supervision and prescriptive authority. Both new physician assistants and supervising physicians and those already in practice can benefit from in-depth familiarization with the Nevada Administrative Code and Nevada Revised Statutes, as they were developed to protect the public health, safety and welfare, and promote safe and effective medical practice.
In the past, the most common quality assurance complaints made to the Nevada State Board of Medical Examiners concerning physician assistants have been involved with failure to comply with physician assistant governing regulations, particularly those requiring two-party notification to the board of employment termination [NAC 630.340(2)] and the physician assistant's responsibility to notify the board in writing of any changes relating to supervising coverage [NAC 630.360 (4)].
The applicable governing Nevada statutes and regulations are readily available online at http:/www.state.nv.us/medical/ or by calling the board at 775/688-2559 or 888-890-8210 (toll-free from within Nevada) and requesting a copy.
The current Physician Assistant Advisory Committee members are Brian S. Lauf,
P.A.-C, Nancy E. Munoz, P.A.-C and John B. Lanzillotta, P.A.-C. You are welcome
to contact them or the board with any questions on physician assistant practice
issues. The committee members may be reached by calling the board office in Reno
at 775/688-2559 or 888-890-8210 (toll-free from within Nevada).
NEVADA STATE BOARD OF MEDICAL EXAMINERS
DIVERSION PROGRAM
We currently facilitate two groups in Las Vegas. One group is for physicians and physician assistants, and the other is for practitioners of respiratory care. Both groups have 12 participants at present. The Diversion Program also has a facilitated group in the Reno area. In addition to the facilitated groups, both northern and southern Nevada have Caduceus groups that meet on a weekly basis. The Caduceus groups serve as a place for the physician and physician assistant to be with peers and discuss issues pertaining to chemical dependency in a supportive environment.
I want to thank the Nevada Hospital Association, as well as all of 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 year 2001 in the amount of $50,000, which was critical to the success of the Health Foundation in maintaining the quality of the Diversion Program during this year.
Churchill Community Hospital Humboldt General Hospital
St. Rose Dominican Hospital Sunrise Hospital Medical Center
Tahoe Pacific Hospital Washoe Health System
University Medical Center Mountain View Hospital
William Bee Ririe Hospital Carson Tahoe Hospital
I am hopeful that the foundation will once again, in this year 2002, continue to receive financial support from the medical facilities in all of Nevada. Dr. Vic Rueckl, Dr. Timothy Coughlin, Dr. Rex Baggett, Dr. Roger Belcourt and I are available to the hospitals for presentations on addiction, disruptive behavior, or to explain the role and functioning of the Diversion Program. We can also answer any questions you might have about diversion and ways to help a colleague or friend who is unable to ask for help himself. Particularly in this time of insurance difficulties, we can all recognize the importance of maintaining physician health and well-being. The foundation can and will assist you with any difficulties you are experiencing with physician health.
Referrals to the Diversion Program come from a variety of sources, although the majority of those referrals come from partners, colleagues and hospitals. In all cases, no records are kept at the medical board level. Confidentiality and anonymity are the goals of both the medical board and the foundation. Information is gathered and verified before the Diversion Program takes action. Should circumstances necessitate, appropriate intervention is planned. Every effort is made to help the physician in a kind, respectful, confidential and therapeutic manner. If evaluation or treatment is indicated, we have three facilities we are utilizing; Talbott Recovery, in Atlanta, Georgia; Farley
Center in Williamsburg, Virginia; and Betty Ford Professionals Recovery Program in Palm Desert, CA. Each participant in the Diversion Program is monitored for five years. Monitoring includes random urine drug screening, weekly Caduceus group, weekly therapy group, and attendance at 12-Step meetings. The success rate for addicted physicians is very high, particularly when intervention is accomplished as early as possible and when colleagues are willing to step in and help their peers.
Do you know a colleague who needs help?
For confidential, expert assistance:
Nevada Health Professionals Assistance Foundation
Carol R. Bowers, R.N.,C.D., Executive Director
(702) 233-6393 OR (702) 521-1398 fax: (702) 242-3560
Your tax deductible contribution to the
Nevada Health Professionals Assistance Foundation
to assist in its important service
to physicians, physician assistants, and practitioners of respiratory care
in administering a Diversion Program
would be greatly appreciated.
Thank you for your generosity and support.
Contributions may be made payable to the
Nevada Health Professionals Assistance Foundation
and mailed to:
LICENSURE STATISTICS - MEDICAL DOCTORS
|
YEAR: |
1987 |
1988 |
1989 |
1990 |
1991 |
1992 |
1993 |
1994 |
1995 |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
||
|
COUNTY |
|||||||||||||||||
|
Carson City |
66 |
74 |
72 |
73 |
79 |
90 |
88 |
95 |
98 |
104 |
110 |
109 |
115 |
127 |
125 |
||
|
Churchill |
13 |
14 |
12 |
11 |
13 |
11 |
13 |
17 |
19 |
19 |
20 |
24 |
25 |
22 |
21 |
||
|
Clark |
789 |
871 |
919 |
1021 |
1114 |
1199 |
1299 |
1418 |
1517 |
1701 |
1763 |
1907 |
2023 |
2153 |
2314 |
||
|
Douglas |
21 |
21 |
23 |
28 |
22 |
24 |
30 |
36 |
37 |
43 |
48 |
54 |
57 |
63 |
67 |
||
|
Elko |
23 |
21 |
23 |
29 |
25 |
24 |
21 |
26 |
29 |
39 |
39 |
41 |
43 |
48 |
50 |
||
|
Esmeralda |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
||
|
Eureka |
1 |
1 |
1 |
1 |
1 |
1 |
0 |
0 |
0 |
2 |
2 |
1 |
1 |
2 |
1 |
||
|
Humboldt |
5 |
6 |
5 |
5 |
6 |
6 |
5 |
5 |
5 |
7 |
7 |
8 |
9 |
8 |
7 |
||
|
Lander |
3 |
3 |
3 |
1 |
2 |
2 |
2 |
2 |
2 |
2 |
2 |
3 |
2 |
2 |
3 |
||
|
Lincoln |
2 |
2 |
2 |
3 |
2 |
1 |
2 |
2 |
2 |
3 |
3 |
3 |
3 |
4 |
2 |
||
|
Lyon |
5 |
5 |
7 |
6 |
4 |
4 |
4 |
5 |
4 |
6 |
7 |
5 |
6 |
7 |
10 |
||
|
Mineral |
5 |
5 |
3 |
3 |
3 |
3 |
5 |
6 |
6 |
7 |
6 |
6 |
5 |
5 |
5 |
||
|
Nye |
8 |
8 |
9 |
9 |
7 |
6 |
6 |
9 |
8 |
11 |
10 |
13 |
15 |
18 |
18 |
||
|
Pershing |
2 |
3 |
4 |
1 |
2 |
2 |
2 |
1 |
0 |
0 |
1 |
3 |
2 |
2 |
2 |
||
|
Storey |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
||
|
Washoe |
540 |
572 |
579 |
617 |
611 |
636 |
661 |
693 |
692 |
734 |
732 |
778 |
797 |
824 |
889 |
||
|
White Pine |
4 |
5 |
4 |
3 |
4 |
5 |
6 |
7 |
5 |
8 |
10 |
10 |
10 |
10 |
9 |
||
|
Total Active Status In-State |
1487 |
1611 |
1666 |
1811 |
1895 |
2014 |
2144 |
2322 |
2424 |
2686 |
2760 |
2965 |
3113 |
3295 |
3523 |
||
|
Total Active Status Out-of-State |
168 |
277 |
212 |
357 |
287 |
463 |
459 |
639 |
516 |
787 |
676 |
882 |
800 |
963 |
824 |
||
|
TOTAL ACTIVE STATUS |
1654 |
1888 |
1878 |
2168 |
2182 |
2477 |
2603 |
2961 |
2840 |
3473 |
3436 |
3847 |
3913 |
4258 |
4347 |
||
|
Total Inactive and Retired Statuses |
982 |
981 |
993 |
987 |
1031 |
1003 |
983 |
960 |
1068 |
1049 |
1174 |
1158 |
1099 |
1084 |
1033 |
||
|
TOTAL LICENSED - ALL STATUSES |
2637 |
2869 |
2871 |
3155 |
3213 |
3480 |
3586 |
3921 |
4008 |
4522 |
4610 |
5005 |
5012 |
5342 |
5380 |
LICENSURE / POPULATION STATISTICS - MEDICAL
DOCTORS
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
2001
3,523
383
2,133,000
165
* CALENDAR YEAR (JANUARY - DECEMBER)
MEDICAL DOCTORS LICENSED TO PRACTICE IN
MEDICALLY UNDERSERVED AREAS OF NEVADA
FROM JULY 1987 THROUGH DECEMBER 2001
1) Restricted licenses issued under NRS 630.164 (rural exemption):
2) Temporary licenses issued to physicians in medically underserved rural
areas:
4) Temporary licenses issued to physicians in medically underserved urban
areas:
5) Unrestricted licenses issued to physicians in medically
underserved urban areas:
YEAR
REVOCATION
PROBATION
SUSPENSION
MISCELLANEOUS *
TOTAL
2001
12
4
4
20
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
* MISCELLANEOUS actions include: - License Restriction
LICENSURE STATISTICS - PRACTITIONERS OF RESPIRATORY CARE
587 practitioners of respiratory care were licensed for the first time by the BME during 2001. The chart below reflects a breakdown of the number of licensed practitioners of respiratory care practicing in Nevada, by county, on December 31, 2001.
YEAR 2001
COUNTY
Carson
City
11
Churchill
5
Clark
399
Douglas
12
Elko
6
Esmeralda
0
Eureka
0
Humboldt
4
Lander
2
Lincoln
2
Lyon
10
Mineral
2
Nye
7
Pershing
0
Storey
1
Washoe
122
White
Pine
2
- - - - - - - - - - - - - - - - - - - - - - - - - - - -
TOTAL
587
LICENSURE STATISTICS - PHYSICIAN ASSISTANTS
For year 2001 there were 194 physician assistants holding licensure in Nevada. 46 physician assistants were licensed for the first time by the BME during 2001. The chart below reflects a breakdown of the number of licensed physician’s assistants practicing in Nevada, by county, from 1992 through 2001.
YEAR 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
COUNTY
Carson
City
5
5
5
3
3
2
5
7
9 11
Churchill
0
0
0
0
0
0
0
2
2
3
Clark
40
44
58
72
72
77
94
118
116 129
Douglas
0
0
0
0
0
0
1
1
2 4
Elko
1
2
4
4
4
7
9
6
6 6
Esmeralda
0
0
0
0
0
0
0
0
0 0
Eureka
0
0
0
0
1
1
1
1
1 0
Humboldt
0
0
0
0
0
0
0
0
0 1
Lander
0
0
0
0
0
0
0
0
0 0
Lincoln
1
2
1
1
1
0
0
0
0 0
Lyon
0
0
0
0
1
2
2
4
4 2
Mineral
1
2
2
2
2
1
1
1
1 2
Nye &