The media in medical regulation

By Jon Ralston (contact)

Friday, Sept. 25, 2009 | 2:01 a.m.

Doctors are confused about what the law regulating injections says. The board that regulates physicians is confused about nearly everything. And the governor, as usual, is not only confused, but by his actions has confused the situation even more.

There is a whole lot of confusion goin’ on, with fingers pointed at everyone involved, including the Fourth Estate (c’est moi) for daring to suggest that a foreign doctor working as a medical assistant is being treated differently (charged with injecting Botox and facing criminal sanctions) from many, many medical assistants, including one in a regulatory board member’s office, who are not being prosecuted for violating state law.

Welcome to Nevada, where physician regulation is an oxymoron, where the Board of Medical Examiners, prodded by the Gibbons Lack of Administration, passed an emergency regulation despite the absence of a clear emergency, where an entire class of employees (medical assistants) not defined in state law and not required to have a scintilla of training have been allowed to inject dangerous drugs, among other things.

I am fond of occasionally referring to Nevada as a Third World country because of its primitive approaches in so many arenas. But I have to believe the medical safeguards in some Third World countries are more stringent than those here. And yet what we have are government officials seemingly worried about their own turf and credibility, thus seeking to blame everyone but themselves and using a claim of confusion to cloak ineptitude and inaction.

Let me try to bring some clarity:

• Medical assistants have been injecting Botox and other drugs and performing other nurse-like or physician-like practices for decades. This is against the law, but has been winked and nodded at by regulators.

• The state Board of Medical Examiners has been inconsistent about enforcing this law, with Executive Director Louis Ling writing just seven months ago that the board’s policy was that assistants could not inject — even as board member Dr. Benjamin Rodriguez, a respected Las Vegas plastic surgeon, was having his medical assistant inject.

• The governor’s office, after much media attention and a week after Jim Gibbons reappointed Rodriguez, threw together an emergency regulation, solemnly invoking the coming flu season and the H1N1 threat. But the regulation was so poorly conceived that it would have shut down flu-shot clinics. And because a couple of medical board members had to rush off to luncheons, the board cut off public comment, rushed to vote on the regulation and sparked a lawsuit that has held up its implementation.

Clear now?

I know it seems self-serving for a journalist to defend the media. But I am outraged at the obloquy directed at the Fourth Estate for probing an area that has received so little attention and for questioning why Betty Guerra, a medical assistant at a spa, was charged with practicing medicine without a license while medical assistants across the state have been performing the same functions for doctors.

Seems the story here is that the special Las Vegas drug known as juice can be injected (and apparently by a medical assistant) at doctor’s offices but not at spas. Ling and others have flayed the media for causing confusion when it is the elected and appointed folks charged with protecting patients from medical assistants requiring no training and doctors manipulating the system who might want to heal themselves.

Remember it was Gibbons, as the endoscopy crisis unfolded last year, who decried media “buffoonery” he said was preventing people from seeking care. “This hysteria has been created by people not getting the right information,” he thundered to the Reno Gazette-Journal, as usual unencumbered by facts and bereft of any sense of irony.

That calumny has been repeated by state officials as the latest scandal has unfolded, one that may not have infected patients with life-threatening diseases but one that has revealed regulators who have tacitly condoned illegal conduct for years — conduct that could result in serious, perhaps deadly, harm to victims.

So the result of these actions in the topsy-turvy place known as Gibbonsworld is to sow the hysteria Ø once decried, induce the lawyer who filed an open meeting complaint to suggest a special session to overhaul the regulatory system and create uncertainty in doctor’s offices and medical spas about what is legal.

Assemblywoman Sheila Leslie has submitted a bill draft to require regulation of medical assistants and you can be sure others will follow, including giving the governor power to remove board members. But until then — and maybe even afterward if the Legislature further confuses the issue — chaos and uncertainty reign.

Frankly, I’m surprised the world-renowned Cleveland Clinic would want anything to do with this state.