Doctors seek easing of state rules

By Cy Ryan (contact)

Thursday, April 3, 2003 | 11 a.m.

CARSON CITY -- Doctors are asking the Legislature to make it tougher for a state regulatory board to revoke the licenses of physicians who are found guilty of misconduct, and they also want to make it easier for new doctors to practice in Nevada.

Senate Bill 389, sponsored by Sen. Ann O'Connell, R-Las Vegas, calls for those changes and others regarding the state Board of Medical Examiners. The bill represents the latest chapter in the fight between doctors -- mostly in Southern Nevada -- and the board that regulates their profession.

The Senate Commerce and Labor Committee heard the doctors' arguments for the changes Wednesday and will listen to the board's objections Friday.

The bill would require the examiners board to have "clear and convincing evidence" of malpractice before moving to revoke a license of a physician. At present the board needs only a preponderance of evidence of malpractice to yank a license.

Dr. Donald Havins of the Clark County Medical Society told the committee that revocation of a license "destroys a professional career" and the higher evidentiary standard should be required.

Havins also advocated that the examiners board be able to issue a warning letter to a physician before taking disciplinary action.

Cheryl Hug-English, president of the board, said after the hearing that the board does not support any change in the law that would make it tougher to toss out errant doctors.

"This would make it exceedingly difficult to discipline doctors," Hug-English said. And she complained that the bill would not allow disciplinary actions to proceed until there were two instances of misconduct.

The discussion of the bill came less than a week after the Public Citizen's Health Research Group of Washington, a nonprofit consumer advocacy group, released a report that said Nevada ranked 40th in the nation in taking serious disciplinary action against its doctors last year. Public Citizen has been keeping track of disciplinary actions against doctors for years.

The rankings are based upon the rate of serious disciplinary actions taken against doctors. The national average was 3.56 serious disciplinary actions per 1,000 physicians, according to the study. Nevada's rate was 2.31 per 1,000 doctors.

Hug-English said last week that the report and the low ranking was misleading. It didn't necessarily mean that Nevada was lax about punishing bad doctors, she said, because Nevada has the toughest standards in the nation in licensing doctors and that helps reduce the amount of malpractice and misconduct, which in turn reduces the need for the most serious disciplinary action.

Public Citizen classified only license revocations, suspensions, probation or surrender of license as serious disciplinary actions. Nevada had only nine of those in 2002.

Hug-English said last week that Nevada's tough standards protected patients in Nevada. She said this week that SB389 would be a double whammy for patient protection -- weakening disciplinary authority and lowering the standards for doctors.

But Larry Matheis, executive director of the Nevada State Medical Association, and Havins pushed for the changes.

Waiving one or more of the medical licensing standards in Nevada could have numerous benefits, they said.

Before a doctor can qualify for a license to practice in Nevada, he or she must complete three years of progressive post-secondary education in a residency setting. Eleven other states require two years and the rest require only one year of progressive education before being eligible for a license.

Matheis noted Nevada has had a problem recruiting a state health officer because of the requirement he or she must have three years of post-graduate medical training, which is the strictest standard in the nation.

Havins also said that if a mysterious disease cropped up in Nevada, outside experts would be prohibited from practicing in Nevada.

The bill would also require the medical examiners board to transfer $2.5 million from its reserve to a state-created fund to help pay for malpractice insurance for doctors. Hug-English said the board does not have that money since it recently lowered the biennial registration fees of doctors.

In addition to the $2.5 million, all doctors would pay an additional $200 a year and hospitals would be charged an extra $50 per birth to put into this subsidy fund for malpractice insurance payments. The doctors would be able to tap the fund for up to $30,000 to cover the increased insurance premiums.

Matheis said the medical association doesn't have a consensus opinion about the subsidy proposal. He said many doctors don't think they should be taxed to contribute to the subsidy.

Sen. Warren Hardy, R-Las Vegas, said he has concerns about subsidizing doctors with malpractice claims against them. And he said he has difficulty with imposing a "baby tax."

Dr. Larry Tarno of Las Vegas, representing the state Board of Osteopathic Medicine, said, "We may be creating something to subsidize the bad" doctors. The bill would also strip $100,000 from the osteopathic board, and Tarno said the board doesn't have that money.

Scott Craigie, representing the state medical association, also offered an amendment to require the medical examiners board to televise its meetings.

"One of the biggest concerns of my client is it is nearly impossible to access the meetings," he said.

The board holds most of its meetings at its headquarters in Reno. It convened its last meeting in Las Vegas but only three members of the public showed up.

Craigie said there was a "lack of faith in the board" by doctors because all the meetings are held in Reno without any television or Internet connection to the rest of the state.

The board decided against the teleconferencing because of the additional costs.

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