Friday, March 18, 2005 | 9:33 a.m.
Two legislative proposals designed to protect patients could end up driving up health care costs by creating more paperwork, doctors' groups say.
One bill, proposed by Assemblywoman Susan Gerhardt, D-Henderson, would require reporting to the state all surgeries performed in doctors' offices that involve sedation.
The other, sponsored by Assemblyman William Horne, D-Las Vegas, would require criminal background checks of applicants for medical licenses.
The lawmakers say a little paperwork is a small price to pay for potentially saving lives. But the Nevada State Medical Association and the state Board of Medical Examiners both say that while they are not opposing the bills, they worry that their requirements could be burdensome.
Horne says his bill, which he calls the Patient Protection Act, was inspired by the case of Dr. David Evans, a University of Nevada medical resident who has been charged in Nevada with 61 felony counts related to child molesting and possessing child pornography.
But Horne acknowledges that his bill would not have caught Evans, who had no criminal record. Still, Horne said, Evans's example shows the potential for patients to be endangered by doctors who commit crimes.
"I don't want Nevada to be a safe haven for predators who couldn't get licensed in another state," Horne said.
The medical board's executive secretary, Tony Clark, said the background check requirement would be just another obstacle keeping doctors from coming to Nevada, which faces a shortage of medical care.
"It really is a logistics problem," Clark said. "Doctors coming to Nevada to get licensed already complain" about the hassles of the licensing process, and a criminal check "would add six or eight or 12 months to the time that an applicant is in temporary status."
Would-be licensees are asked on their applications whether they have been convicted of any felonies, and they are closely monitored throughout medical school and the residency process, Clark said. He said the additional safeguard thus probably wouldn't uncover any new information.
In the end, Clark said, the medical board will have to increase its license fees to pay for the background checks, and doctors will pass the costs on to patients. "Consumers will end up paying for that," he said.
Horne said he recognized that the state has a backlog of background checks, but said that wasn't reason enough to forgo diligence.
"I don't want to explain to a parent or a spouse, sorry, but it was too expensive, too inconvenient, to do a background check, and I'm sorry you were harmed by this doctor," Horne said.
The checks would mainly serve as a deterrent to prevent physicians with something to hide from hiding from their pasts in Nevada, Horne said.
The other bill that has raised doctors' concerns about adding to their paperwork is one that would ask for data on office-based surgeries.
Some studies have shown that deaths and injuries are more likely to result from surgeries that take place in doctors' offices than those done in hospitals. Hospital procedures are monitored and regulated, but office-based ones are not in Nevada.
Gerhardt said the idea behind the bill was simply to gather information on what goes on in such surgeries to see if further regulation is required. The bill would require doctors to give the medical board an accounting of procedures involving anesthesia once every two years when they renew their licenses.
But that requirement "would be a mammoth problem for the board, which would receive these reports," said Larry Matheis, executive director of the state medical association.
The office surgeries probably number in the "tens of millions," Matheis said, and range "from removing a mole to oral surgery."
If there are problems with certain types of surgeries, Matheis said, regulations should be made for just those procedures. But Gerhardt's bill requires reporting based only on the level of sedation used in the surgery, regardless of what procedure is being performed.
"If there are particular procedures in office-based surgery that are leading to hospitalization, we should address those," he said. "To have a massive database of all surgical procedures -- I'm not sure what is the use of that."
Gerhardt said that because such procedures aren't tracked, there's no way to know where problems, if any, are occurring. The bill requires reporting only of "sentinel events" -- procedures that don't turn out as expected -- and only once every two years, she said.
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