Friday, June 28, 2002 | 4:42 a.m.
WEEKEND EDITION: June 30, 2002
Only two-tenths of 1 percent of all active physicians licensed in Nevada were unworthy of that status last year in the eyes of the state Board of Medical Examiners.
That meant that more than 99 percent of Nevada's 4,347 practicing physicians met state licensing requirements.
Those numbers support physicians' contentions that they are a predominantly upstanding profession with few bad apples. They bristle when lawyers use the phrase "bad doctors" to describe practitioners who have been accused of malpractice because, they say, only a handful of physicians have caused the alleged problems.
"Every profession has a percentage of people who are not at par with the professional community," Las Vegas surgeon Ikram Khan said. "The legal community has it, the business community has it and the medical community has it. But there are maybe two, three or four individuals out of thousands of practitioners who are causing the problems. To say that the problem is across the board is inherently unfair."
The state board last year revoked 12 physicians' licenses, placed four on probation and took miscellaneous disciplinary actions against four more. However, most of those actions were related to charges that did not directly involve patients but rather such infractions as the failure to report disciplinary action in other states or making false statements on applications for license renewal.
Disciplinary actions last year that involved patients included:
A Las Vegas doctor who lost his license after he was charged with 21 counts of prescribing controlled substances "in such a manner as to constitute malpractice."
A Reno physician who was reprimanded, fined $11,700 and ordered to complete 10 hours of education in medical ethics on charges that he performed liposuction on two patients in a manner that constituted malpractice.
A Fallon doctor who was placed on probation and ordered to complete 10 hours of education in the area of post-surgical complications after he was charged with malpractice against two patients. The board found him guilty on one count of malpractice while the other count was dismissed.
Consumers who contact the board can learn the licensing status of a particular doctor. They can learn whether that doctor was found guilty of malpractice in a court of law or reached an out-of-court malpractice settlement. They can also learn whether the state's Medical Dental Legal Screening Panel, which is designed to weed out frivolous lawsuits, found that a malpractice claim against a physician had merit and was worthy of litigation.
But board information off limits to the public includes the doctor's professional background from other states, including lawsuits or disciplinary actions. That information is gathered by the board when doctors apply for their licenses, but is kept confidential.
Las Vegas malpractice attorney Gerald Gillock said information on what a physician did in other states should also be made available to consumers.
"I don't see why it shouldn't be available," Gillock said.
But Larry Matheis, Nevada State Medical Association executive director, suggested that consumers who want to know about a physician's background simply ask that practitioner.
"If you asked a physician where they practiced previously and they don't tell you, I wouldn't go to that physician," Matheis said.
Matheis also said consumers who know the other states where a doctor practiced can contact those states' medical-licensing boards for more information.
The board is informed whenever a physician loses privileges to practice at a particular hospital. Such information is also supposed to be forwarded by the hospitals to the National Practitioner Data Bank, established by Congress in 1986. But neither the board nor the data bank release that information to the public.
Only hospitals, managed-care organizations and state licensing boards can retrieve information on particular physicians from the data bank.
The hospitals and managed-care insurers use the information to determine whether they wish to contract with that physician. In a sense, the data bank can serve as a blacklist because a physician with a bad report from one hospital may find it difficult to get privileges elsewhere.
But because the information is not available to consumers, Las Vegas attorney Dean Hardy, former Nevada Trial Lawyers Association president, said the data bank protects physicians from public scrutiny.
"It's an archaic system designed by good-old-boy doctors to keep good-old-boy doctors practicing," Hardy said.
Matheis, however, defended the data bank's confidentiality.
"Congress knew that if that information was misused, there would be a liability problem," he said.
The data bank disclosed that between September 1990 and December 2000, Nevada hospitals reported 99 cases where a doctor's privileges were revoked or suspended, or the doctor was reprimanded or placed on probation. Those cases ranked Nevada 28th in the nation. California led the nation with 1,014 cases during that period.
But only 13 of Nevada's 33 private and county hospitals, or 39.4 percent, filed reports with the data bank during that period, compared to 47.5 percent nationally.
In its 2000 annual report, the data bank expressed concern that nationally "the number of clinical privileges actions reported remains unreasonably low." That conclusion was based on concerns that hospitals either were not aggressive enough in disciplining doctors or were not reporting all such actions.
But Khan, a former state medical board member, and Dr. John Ellerton, University Medical Center chief of staff, said local hospitals do a good job of disciplining physicians when necessary.
"It is a very rigid system," Khan said. "Believe me. Sometimes it's too rigid."
All Las Vegas Valley hospitals have internal, multitiered systems for reviewing and, if necessary, disciplining physicians who violate their policies. Although the systems vary from hospital to hospital, they generally begin with some form of peer review.
If peers believe a physician should be disciplined, the next step generally involves a hearing by an executive committee made up of other physicians. The ultimate arbiter of disciplinary action, including revocation of hospital privileges, is usually the hospital's board of directors. In the case of county-run UMC, the Clark County Commission serves as the hospital board.
But Ellerton also said all physicians are subject to "constant" peer review, even if there is no intent to discipline them.
"You're trying to ensure a high quality of care at all levels," Ellerton said. "It's fairly intensive at most hospitals."
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