Medical board stronger, but is it up to task?

By Steve Kanigher

Sunday, March 9, 2008 | 3 a.m.

The investigation into a Las Vegas clinic whose flawed medical procedures led to a hepatitis C outbreak has thrust the Nevada State Board of Medical Examiners into uncharted territory — a massively complex puzzle that has become a national concern.

The question now is whether the board is up to the task. Until recently, trial lawyers, consumer advocacy groups and other critics of the board considered it less than competent, understaffed and more protective of doctors than of the public.

A case in point: Dr. Harriston Bass Jr. of Las Vegas was found guilty Wednesday of second-degree murder for illegally selling painkillers linked to the fatal 2005 overdose of a 38-year-old woman. Twelve years before he sold the painkillers, the board had placed Bass on three years’ probation on charges of gross malpractice related to surgeries he’d performed. As a condition of his probation, Bass was to complete 120 hours of continuing medical education.

But Bass cleared probation without taking the required courses. The board said it didn’t have time to monitor compliance. (A review by the board in 2004 found 32 other doctors had not complied fully with its orders.)

In recent years, the board has performed much better, Executive Director Tony Clark and two board members told the Sun.

Clark, who has held the job since 2004; Dr. Javaid Anwar, board president; and Donal Baepler, senior board member, credit the increase in the number of investigators from three to seven and the addition of a second full-time attorney with the improved performance. The board has made several changes in management and stepped up its public outreach through speaking engagements and advertising.

Still, the board thinks it walks a fine line between protecting the public from bad doctors and making sure good doctors are not unnecessarily impugned. “Many physicians still think we’re just out there to get them,” said Anwar, a Las Vegas internal medicine specialist. “We spend a lot of time trying to throw fish nets out to catch bad doctors.”

Some observers say they will reserve judgment until they see how the board handles the Endoscopy Center of Southern Nevada case. “The Endoscopy Center could be an important test case to see whether (it’s) aggressive enough to handle what appears to be an egregious example of inappropriate medical practices,” said Las Vegas attorney George Bochanis, president of the Nevada Justice Association, which represents trial lawyers. “There is still a perception out there that the medical board isn’t overly aggressive with investigating doctors, but it’s better than it once was.”

The board consists of six physicians and three members representing the public, all appointed by the governor, with staggered terms. Eight members were appointed by then-Gov. Kenny Guinn. Gov. Jim Gibbons’ lone appointee, Renee West, president and chief operating officer of the Excalibur, joined the board in July as a public member.

The board metes out discipline generally for malpractice or professional incompetence, although other targets include doctors who have had problems with drugs or alcohol, sexual misconduct or abandonment of patients, indiscriminate prescribing of drugs or billing for services not rendered.

Baepler, a former UNLV president and chancellor of the Nevada System of Higher Education, said he thinks the board is capable of tackling the Endoscopy Center case and will likely render a decision within three months. “We are adequately set up with our legal staff and investigative staff to handle this,” he said. “We may delay a couple of other cases because we want to get this resolved.”

The board, which generates most of its operating revenue from fees for license applications and annual license registrations, also has jurisdiction over physician assistants and practitioners of respiratory care.

From 1985 through 2006, the board took 356 disciplinary actions against physicians, including the revocation of 110 licenses. That’s just a fraction of the 4,183 active licensed physicians in the state in 2006. In that year the board took 20 disciplinary actions, revoking three licenses.

Data are not complete for 2007. The Sun determined from information on the board’s Web site that it took at least 23 disciplinary actions against doctors last year, including the revocation of three licenses.

Here’s what the board had to say about those three cases:

• Dr. James L. Allen of Petersburg, Va., who specialized in emergency medicine, pleaded guilty and was convicted of one count of possession of child pornography. As of September he was not eligible to reapply for a Nevada license for three years.

• Dr. David Glenn Evans of St. George, Utah, a pediatrician, pleaded guilty to two counts of sexual assault of a minor under age 14.

• Dr. Doyle Stuart Steele of Las Vegas, who specialized in obstetrics and gynecology, was convicted of felonies for unlawful possession and distribution of a controlled substance, and for conspiracy.

As recently as last year, the board was criticized scathingly by the nonprofit consumer advocacy group Public Citizen in Washington for doing a subpar job of seriously disciplining physicians. Public Citizen reported that from 2004 through 2006, the board took serious action against only 1.68 doctors per 1,000, well below the national average of 3.18. That placed Nevada 46th among the states.

Dr. Sidney Wolfe, director of the Public Citizen Health Research Group, said states that rank low generally suffer from inadequate leadership, staffing and funding plus conflicts of interest between the medical board and the doctors it regulates. Nevada, he said, leans on public reprimands too heavily and simply doesn’t punish its doctors as harshly as other states.

“For a serious offense to be greeted with a nonserious disciplinary action is not acceptable,” Wolfe said. “Doctors are getting off too easily with things that should result in at least a probation, suspension or revocation of their license.”

Clark bristled at the group’s study, arguing it was severely flawed because it didn’t take into account the board’s efforts to seek help for doctors guilty of minor infractions. Clark also said Nevada might rank low in doctor discipline because it has more competent doctors thanks to tougher than average licensing standards, including a requirement that physicians obtain three years of postgraduate in-residency experience. The only other state that requires that much experience is Arkansas, he said.

And finally, Clark said, Nevada would have been downgraded because 2004, the first year covered by the study, was a rough year for the board. A shake-up that year led to Clark’s appointment.

“We have done a lot more since then in terms of severe discipline,” Clark said. “But if you have better-educated doctors like we have, you should have fewer problems with their treatment of patients.”

Larry Matheis, executive director of the Nevada State Medical Association, said the board has significantly improved since Clark’s appointment.

The members “are going after many more cases, and they’re far more professional. They’re making an effort to be more transparent. People want timely information about their doctors or the doctors they may go to, and the board has done a much better job of that.”

Matheis also said that launching an investigation of the Endoscopy Center this quickly is something that wouldn’t have happened a few years ago, when the board would have played it safe and waited for the other investigations to wrap up before proceeding.

Sun reporters Cy Ryan and Alex Richards contributed to this story.