Law could deter psychiatrists from coming to state

Thursday, Sept. 6, 2001 | 11:22 a.m.

CARSON CITY -- Mental health services and the safety of the public in Clark County are being threatened by a fight between two state agencies over a new law.

An interpretation of the law by the Nevada State Board of Medical Examiners will make it nearly impossible for the mental health system to obtain out-of-state psychiatrists to come to Nevada to work temporarily, Frances Brown, chairwoman of the state Commission on Mental Health and Developmental Services, said.

The interpretation of the law, Brown said, has created an "extreme shortage of qualified psychiatrists" almost overnight.

Although a shortage might develop, Larry Lessly, executive director of the medical examiners board, said the 2001 Legislature passed the law, and he cannot grant any waivers.

The law, which took effect in July, affects all physicians coming into Nevada to work temporarily. They now must take a competency examination if they have not taken one in 10 years.

"This weeds out the incompetents," Lessly said. "If you have basic medical competency, you can pass it."

Mentally ill patients under state care have the right to be treated by an out-of-state physician who has the same qualifications as a Nevada doctor, Lessly said.

State mental health officials plan to attend a Saturday meeting of the medical examiners board in Reno to ask for relief, but Lessly said nothing can be done.

Out-of-state doctors can go to computer centers across the nation to take the exam, Lessly said.

Brown, in a letter sent to Gov. Kenny Guinn, said recruitment of permanent psychiatrists has been a problem for years. Carlos Brandenburg, administrator of the state Division of Mental Health and Developmental Services, said the vacancies were filled by "rent a doc" psychiatrists who are licensed in other states and come to Nevada to work temporarily.

They were not required to take the basic examination in the past.

More than 8,300 seriously mentally ill patients are under state care in Clark County, and more than 1,600 are in Washoe County, Brown said. But although 18 psychiatrists are authorized at the Southern Nevada Adult Mental Health Services, only six full-time psychiatrists and one part-time psychiatrist are on staff.

The facility has only three temporary psychiatrists, and two will leave in September and one in October, Brown said. Only one temporary psychiatrist has been able to obtain a temporary license since the law took effect.

She predicted "significant" consequences if there is no waiver of the examinations.

"Outpatient programs will have to be curtailed in September to maintain staffing levels in the hospital," Brown said. "This will lead to a decrease in the level of services being provided to seriously mentally ill clients in the community.

"As a result, a significant number of relapses will occur requiring inpatient admission into a system that is currently stretched maximally to provide care to the increasing population of Las Vegas and Clark County.

"While an increase in risk to public safety is hard to predict, the population served as ongoing contacts with the law enforcement and judicial systems. As you know, in Clark County there were two mentally ill clients killed by police this past year."

Lessly said he has "gone out of his way for years to take care of the mental health needs" by granting temporary licenses to out-of-state physicians. They were non-renewable licenses for 90 days, but Lessly said he extended them to help the program.

The law allowing temporary licensure, he said, was originally passed to help rural Nevada, which is medically underserved.