Overhaul of licensing agencies urged

By Marshall Allen (contact)

Tuesday, July 29, 2008 | 2 a.m.

Nevada’s largest physician association is proposing an overhaul of every licensing agency in the state to improve accountability and restore public trust in the disciplinary process.

That can be accomplished, the Nevada State Medical Association says, by consolidating the administrative functions of dozens of professional and occupational licensing boards into one state department. That department would have the responsibility, among other things, of conducting investigations of licensees, a task now undertaken by each of the licensing agencies for its own members.

Some critics of the current system say some agencies are poorly equipped to investigate their licensees, or their efforts are undermined by conflicts of interest.

The consolidation proposal was triggered by perceived failures on the part of the Medical Examiners Board during the hepatitis C investigation.

Larry Matheis, executive director of the Nevada State Medical Association, said doctors want the medical board to be as firm, fair and concerned about the quality of medicine as they are. That requires a fundamental restructuring of licensing boards, he said.

“We can’t move the ball on a lot of these issues about public accountability and responsiveness if we’re going to keep everybody in the same silos they’re in now,” Matheis said of how oversight of the various disciplines is segmented.

The people who run the licensing agencies — who represent employees who could lose their jobs — are not fans of the proposal, which originated with Matheis. A few legislators favor it, according to Matheis. He will present the idea today to the Legislative Committee on Health Care.

Nevada has 42 independent agencies to license and oversee doctors, nurses, chiropractors, contractors, landscape architects and other professionals. The agencies are overseen by free-standing boards of professionals licensed in the categories they oversee. The board members ensure licensees meet certain criteria, evaluate complaints and determine discipline.

The administrative functions of these boards include processing applications, granting licenses, collecting fees, making information about licensees public and conducting investigations. Some of the boards are so small they can’t afford staff, Matheis said.

Matheis said 26 states have consolidated the administrative functions of the agencies into one state department. His proposal calls for a “Department of Professions.” That would leave the free-standing boards to perform such duties as evaluating complaints and adjudicating cases, but remove their supervision of the administrative functions, including conducting investigations. The proposed structure is similar to the State Health Board, Matheis said, which is staffed by the State Health Division.

Such an overhaul could save money by eliminating redundancies, and likely would create a one-stop shop for complaints, improve communication and eliminate real or perceived conflicts of interest — problems that have been highlighted recently in cases involving doctors.

In his letter to state legislators, Matheis cited problems exposed by a Sun investigation that revealed how some doctors were systematically violating federal law by hiring foreign doctors who were supposed to work in medically needy areas and then reassigning them to affluent areas.

The foreign doctors were hired under a program run by the Nevada State Health Division, and its only recourse was to file formal complaints against the employers, who were licensed doctors, with the medical board. State officials never did this. Consolidating the administrative functions of the medical board with the State Health Division would improve such situations by making it more routine to track the behavior of employers, Matheis said.

In the case of the hepatitis C investigation, the medical board was criticized for the perception that conflicts of interest on the board contributed to an under-the-table agreement with Dr. Dipak Desai, owner of the clinic that caused the outbreak. Desai, who had close business ties

to multiple members of the board, was initially allowed to voluntarily stop practicing medicine rather than have his license suspended.

The medical board’s investigative function was compromised in part because the board members supervised the staff, Matheis said.

Many professional boards face similar conflicts of interest, Matheis said.

Tony Clark, executive director of the medical board, said many logistics would prevent Matheis’ plan from working, but the biggest difficulty would be losing the expertise that’s represented on the independent boards.

“One size doesn’t fit all,” he said of the boards.

Also, medical boards across the country, including in Nevada, are certifying the medical investigators who specialize in handling complaints, he said. It’s unrealistic to expect someone who investigates medical doctors to be knowledgeable about other health practitioners, he added.

“The public will end up being the loser in this,” Clark said. “Doctors won’t be licensed as quickly and the investigations will be cursory.”

Debra Scott, executive director of the Nevada State Nursing Board, said research shows that “umbrella” boards like the one Matheis is proposing are less efficient. Her board resolves complaints within 120 days of the date they’re filed, she said. In states with umbrella boards it can take two years, she said.

Assemblywoman Sheila Leslie, D-Reno, chairwoman of the Legislative Committee on Health Care, said she’s leaning toward supporting Matheis’ proposal and recommending that a bill be drafted for the 2009 legislative session.

“We need to restore the public’s confidence that complaints will be handled professionally, immediately and without bias,” Leslie said.

Matheis said he has met with all but one legislator on the committee and all expressed support for the proposal. But he knows he will come under fire.

“I’ve decided to paint a little bull’s-eye on my back and see how this goes,” he said.