Report card: How Nevada protects patients from sexually abusive doctors

Transparency: 42
Is complete and accurate information on physician discipline provided to help patients protect themselves? More...
The best states make it easy for the public to find comprehensive information on physicians, including whether they have been disciplined for sexual abuse or other violations. To assess transparency, the AJC used five measures. Top grades went to states where medical regulators posted disciplinary orders on websites going back at least 15 years; fully detailed the acts that led to sanctions; avoided private orders, reprimands or letters; provided easy web access to clearly labeled doctor information including disciplinary documents; and listed any hospital sanctions, criminal convictions and out-of-state disciplinary actions for each physician.
- Are all orders posted?: 12 of 20
  
  For medical doctors, only public filings since 2008 are online. The board said it is working to scan and link other records. Orders on the osteopathic board website go back to at least 2001.
- Do orders or other information online detail violations that led to sanctions?: 12 of 20
  
  For medical doctors, orders don't always detail the violations that led to sanctions. For osteopaths, disciplinary findings may be in one of several kinds of disciplinary action documents that may be listed for a physician.
- Does doctor profile information include hospital sanctions, criminal charges and orders from other states?: 6 of 20
  
  The osteopathic board information includes other states' disciplinary actions. It does not include hospital sanctions or criminal convictions. The medical board has none of the information listed on doctor profiles.
- Is it easy to find all doctor information on the website?: 8 of 20
  
  There are 11 different types of medical licenses to choose from on drop-down menu. By choosing all to make sure a search is complete, you may get a long list of doctors. Orders on medical profiles may not be linked. The osteopathic board's website is easier to search for information and disciplinary documents.
- Can boards issue private orders or letters?: 4 of 20
  
  Both boards may issue nonpublic "letters of concern"

Duty-to-report laws: 100
Are colleagues and institutions that are aware of potential physician misconduct required to notify regulators? More...
To break the code of silence that can shield abusive doctors, the best states have laws requiring all physicians and health care institutions to notify regulators of potential violations. To assess these laws, the AJC used five measures. Top grades went to states where a broad range of health care facilities, not only hospitals, are required to notify regulators of alleged physician misconduct; where there is a deadline of no more than 30 days for making those reports; where penalties for failing to report are clear and significant; where doctors are required to report fellow practitioners; and where courts or law enforcement agencies must notify regulators when a doctor is criminally convicted.
- Which health care facilities must report doctors to medical regulators?: 20 of 20
  
  If and when a medical facility becomes aware that a person practicing medicine is or is about to become engaged in conduct that constitutes grounds for initiating disciplinary action, it must file a written complaint with the board.
- Does the law set a deadline for them to notify regulators?: 20 of 20
  
  Within 30 days of becoming aware of misconduct or that someone is about to commit misconduct
- Does the law establish penalties for failure to comply?: 20 of 20
  
  Up to $10,000
- Are physicians required to report peers?: 20 of 20
  
  Any physician who becomes aware of that a fellow practitioner has committed conduct that is grounds for disciplinary action must report within 30 days of becoming aware.
- Are courts or prosecutors required to notify regulators of physicians’ criminal convictions?: 20 of 20
  
  The clerk of every court is required to notify the board if a doctor has been convicted of a felony and certain other crimes, within 45 days after such a finding is made.

Board composition: 70
Are consumer members included to balance physicians’ tendency to identify with their colleagues? More...
A blueprint developed by The Federation of State Medical Boards recognized the importance of having independent public members on physician-dominated medical regulatory agencies. To assess the composition of disciplinary agencies, the AJC used three measures, with the most weight given to consumer representation. Top grades went to states where public members make up at least 40 percent of the board; where those members represent consumers and where neither they nor their family members have professional or financial ties to health care; and where women hold at least 40 percent of the board seats.
- Is the public well represented?: 40 of 50
  
  The nine-member medical board has three public members and six physicians. The seven-member osteopathic board has two public members and five physicians.
- Are public members independent and do they represent consumers?: 20 of 25
  
  State law requires one member of each board be someone who represents the interests of persons or agencies that provide health care to the poor, but this member must not be a doctor; the remaining public members cannot hold any health care license or be actively engaged in any health care facility or school or have a financial interest in any matter pertaining to health care, except as a patient. For the osteopathic board, public members' immediate family can't be a licensee or an administrator of a medical facility.
- Are women well represented on the board?: 10 of 25
  
  Two women served on the nine-member medical board as of September. On the osteopathic board, one women was on the seven-member board.

Criminal acts: 36
Are medical regulators and law enforcement made aware of doctors’ criminal conduct? More...
The medical profession has long recognized the power imbalance between doctors and patients. But only in recent years have states enacted three key laws to try to protect vulnerable patients from dangerous doctors. The AJC considered two of these laws the most important. Top grades went to states where physicians must undergo criminal background checks, with fingerprints, at initial license application and periodically; and where doctor-patient sexual contact has been made a criminal offense in recognition that patients cannot give meaningful consent. In addition, the AJC also rated states on whether medical boards that learn of allegations of criminal conduct must alert law enforcement.
- Are physicians required to undergo criminal background checks?: 24 of 40
  
  Required at initial application, with fingerprints
- Is board required by law to notify law enforcement?: 4 of 20
  
  No, but the Board of Medical Examiners says it considers it an obligation to notify law enforcement.
- Has the state criminalized sexual misconduct involving doctors and patients?: 8 of 40
  
  The state has no criminal laws specific to physicians.

Discipline laws: 45
Do state laws strengthen oversight and discipline of problem physicians? More...
Abusive physicians can be protected by laws that limit regulators’ ability to investigate cases and don’t require permanent revocation of doctor licenses for egregious offenses. To assess the legal environment for doctor discipline, the AJC examined four key laws. Top grades went to states that require permanent revocation of doctor licenses for some violations; where physicians who have been convicted of felonies or who have lost their licenses in other states cannot be licensed; where medical regulators are entitled to records and other proceedings of hospital peer review committees that examine doctor misconduct; and where there is a reasonable standard of proof required for disciplinary action against physicians, especially in sexual misconduct cases where there may be no independent witnesses.
- Does state law require revocation for some violations? Can revocation be permanent?: 5 of 25
  
  Doctors whose licenses have been revoked may reapply. State law doesn't require revocation for any type of sexual misconduct or convictions.
- Do medical regulators have the legal right to hospital peer review records and proceedings?: 5 of 25
  
  State law gives no right to access.
- Does state law mandate that regulators deny licenses to physician applicants who have committed certain violations?: 10 of 25
  
  Mandatory denial for applicant whose license was revoked elsewhere for gross medical negligence
- What is the standard of proof for regulators to impose disciplinary sanctions?: 25 of 25
  
  The standard of proof required to discipline a doctor is preponderance of evidence. It basically means "more likely than not." That's also the typical standard for most lawsuits.

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