Executive Summary. Nevada Physician Licensure Statute

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1 Executive Summary Nevada Physician Licensure Statute Licensure Requirements: Those wishing to practice medicine in the state of Nevada need to obtain special volunteer, locum tenens, restricted, temporary, or full medical license. Additionally, Nevada grants a special purpose license to practitioners who are fully licensed in another state to practice telemedicine in Nevada. Licensure Reciprocity: The Nevada Licensure Statute does allow for license reciprocity between states. Licensure Exceptions: The Nevada Licensure Statute allows for the following common exceptions: Consultative Services: Physicians are able to offer consultative services without being required to receive full medical licensure. Military Exception: Those physicians, licensed in any one of the 50 states, are permitted to administer care to military members, as either a civilian contract employee or a military physician officer, without having to first receive additional licensure. Emergency Exception: A physician is permitted to administer care to a person in an emergency situation, regardless if that physician is licensed in the state where the care is taking place. Domestic administration of family remedies. Internet Prescribing of Medications: The Nevada Controlled Substances Statute prohibits a practitioner within the state from prescribing a prescription drug for another person if that practitioner has not physically examined the other person within the past six months and that practitioner reasonably believes that an illegal Internet pharmacy will fill the prescription.

2 For more licensure information,please contact the Nevada State Board of Medical Examiners at (775) or click here for the website. NEVADA PHYSICIAN LICENSURE STATUTE 1 Title 54. Professions, Occupations and Businesses Chapter 630. Physicians, Physician Assistants and Practitioners of Respiratory Care Purpose of Licensing; License is Revocable Privilege 2 According to the Federation of State Medical Boards, the 10 th Amendment police power grants states the right to regulate the practice of medicine. 1. The purpose of licensing physicians, perfusionists, physician assistants and practitioners of respiratory care is to protect the public health and safety and the general welfare of the people of this State. 2. Any license issued pursuant to this chapter is a revocable privilege. All 50 states allow for the military exception. A physician practicing in the military need only be licensed in one state to have licensure reciprocity in all 50 states Applicability 1. This chapter does not apply to: Physicians who wish to practice telemedicine in a state that lacks specific licensure requirements for telehealth providers may be required to seek a full medical license. There are 36 states that require telehealth providers to seek a full medical license in order to practice in that state. Nevada is not one of those states. (a) A medical officer or perfusionist or practitioner of respiratory care of the Armed Services or a medical officer or perfusionist or practitioner of respiratory care of any division or department of the United States in the discharge of his official duties; 3 1 According to the Federation of State Medical Boards, the 10 th Amendment police power grants states the right to regulate the practice of medicine. 2 The right to practice medicine is not a fundamental right and may be revoked due to misconduct or medical incompetence. 3 In the 1960s, when Americans began exploring space travel, NASA started investing in technology that would allow astronauts to receive care at a distance. This process later became known as telemedicine. Shortly thereafter, the military began using telemedicine to triage medical injuries on the battlefield.

3 This statue does not apply to physicians administering consultative services. (b) Physicians who are called into this State, other than on a regular basis, for consultation with or assistance to a physician licensed in this State, and who are legally qualified to practice in the state where they reside; (c) Physicians who are legally qualified to practice in the state where they reside and come into this State on an irregular basis to: A universal exception, accepted by all 50 states, does not require a medical student to obtain full licensure before administering care to a patient, as long as that student is under the supervision of a licensed physician. (1) Obtain medical training approved by the Board from a physician who is licensed in this State; or (2) Provide medical instruction or training approved by the Board to physicians licensed in this State; (d) Any person permitted to practice any other healing art under this title who does so within the scope of that authority, or healing by faith or Christian Science; (e) The practice of respiratory care by a student as part of a program of study in respiratory care that is approved by the Board, or is recognized by a national organization which is approved by the Board to review such programs, if the student is enrolled in the program and provides respiratory care only under the supervision of a practitioner of respiratory care; (f) The practice of respiratory care by a student who: (1) Is enrolled in a clinical program of study in respiratory care which has been approved by the Board; (2) Is employed by a medical facility, as defined in NRS ; and (3) Provides respiratory care to patients who are not in a critical medical condition or, in an emergency, to patients who are in a critical medical condition and a practitioner of respiratory care is not immediately available to provide that care and the student is directed by a physician to provide respiratory care under his supervision until a practitioner of respiratory care is available; (g) The practice of respiratory care by a person on himself or gratuitous respiratory care provided to a friend or a member of a person's family if the

4 provider of the care does not represent himself as a practitioner of respiratory care; (h) A person who is employed by a physician and provides respiratory care or services as a perfusionist under the supervision of that physician; (i) The maintenance of medical equipment for perfusion or respiratory care that is not attached to a patient; and (j) A person who installs medical equipment for respiratory care that is used in the home and gives instructions regarding the use of that equipment if the person is trained to provide such services and is supervised by a provider of health care who is acting within the authorized scope of his practice. 2. This chapter does not repeal or affect any statute of Nevada regulating or affecting any other healing art. 3. This chapter does not prohibit: All 50 states allow for the emergency exception because it is considered good public policy. (a) Gratuitous services outside of a medical school or medical facility by a person who is not a physician, perfusionist, physician assistant or practitioner of respiratory care in cases of emergency. 4 (b) The domestic administration of family remedies Place at which Act Constituting Practice of Medicine Deemed to Occur Point of service is deemed where the patient is located. For the purposes of this chapter, any act that constitutes the practice of medicine shall be deemed to occur at the place where the patient is located at the time the act is performed Board Prohibited from Adopting Certain Regulations Concerning Collaboration or Consultation Among Providers of Health Care 1. Notwithstanding any other provision of law and except as otherwise provided in this section, the Board shall not adopt any regulations that prohibit or have the effect of 4 CTel Comment: An example of a medical emergency in which a physician is permitted to assist is a car accident on the interstate highway. A physician can render care to save the injured person s life, regardless of where the physician is licensed.

5 prohibiting a physician, perfusionist, physician assistant or practitioner of respiratory care from collaborating or consulting with another provider of health care. 2. The provisions of this section do not prevent the Board from adopting regulations that prohibit a physician, perfusionist, physician assistant or practitioner of respiratory care from aiding or abetting another person in the unlicensed practice of medicine or the unlicensed practice of perfusion or respiratory care. 3. As used in this section, "provider of health care" has the meaning ascribed to it in NRS Requirements for License to Practice Medicine 1. Every person desiring to practice medicine must, before beginning to practice, procure from the Board a license authorizing him to practice. 2. Except as otherwise provided in NRS , and to , inclusive, a license may be issued to any person who: The Nevada State Medical Board has the discretion to create qualifications for medical licensure application. (a) Is a citizen of the United States or is lawfully entitled to remain and work in the United States; (b) Has received the degree of doctor of medicine from a medical school: (1) Approved by the Liaison Committee on Medical Education of the American Medical Association and Association of American Medical Colleges; or (2) Which provides a course of professional instruction equivalent to that provided in medical schools in the United States approved by the Liaison Committee on Medical Education; (c) Is currently certified by a specialty board of the American Board of Medical Specialties and who agrees to maintain the certification for the duration of his licensure, or has passed:

6 For more information on the examination, please click here. (1) All parts of the examination given by the National Board of Medical Examiners; (2) All parts of the Federation Licensing Examination; (3) All parts of the United States Medical Licensing Examination; (4) All parts of a licensing examination given by any state or territory of the United States, if the applicant is certified by a specialty board of the American Board of Medical Specialties; (5) All parts of the examination to become a licentiate of the Medical Council of Canada; or (6) Any combination of the examinations specified in subparagraphs (1), (2) and (3) that the Board determines to be sufficient; (d) Is currently certified by a specialty board of the American Board of Medical Specialties in the specialty of emergency medicine, preventive medicine or family practice and who agrees to maintain certification in at least one of these specialties for the duration of his licensure, or: (1) Has completed 36 months of progressive postgraduate: State Medical Boards often list academic requirements within their statute. (I) Education as a resident in the United States or Canada in a program approved by the Board, the Accreditation Council for Graduate Medical Education or the Coordinating Council of Medical Education of the Canadian Medical Association; or (II) Fellowship training in the United States or Canada approved by the Board or the Accreditation Council for Graduate Medical Education; or (2) Has completed at least 36 months of postgraduate education, not less than 24 months of which must have been completed as a resident after receiving a medical degree from a combined dental and medical degree program approved by the Board; and (e) Passes a written or oral examination, or both, as to his qualifications to practice medicine and provides the Board with a description of the clinical

7 program completed demonstrating that the applicant's clinical training met the requirements of paragraph (b). 3. The Board may issue a license to practice medicine after the Board verifies, through any readily available source, that the applicant has complied with the provisions of subsection 2. The verification may include, but is not limited to, using the Federation Credentials Verification Service. If any information is verified by a source other than the primary source of the information, the Board may require subsequent verification of the information by the primary source of the information. 4. Notwithstanding any provision of this chapter to the contrary, if after issuing a license to practice medicine the Board obtains information from a primary or other source of information and that information differs from the information provided by the applicant or otherwise received by the Board, the Board may: If a physician is behaving in a dishonorable way, the State Medical Board has the right to suspend the physician s license. (a) Temporarily suspend the license; (b) Promptly review the differing information with the Board as a whole or in a committee appointed by the Board; (c) Declare the license void if the Board or a committee appointed by the Board determines that the information submitted by the applicant was false, fraudulent or intended to deceive the Board; (d) Refer the applicant to the Attorney General for possible criminal prosecution pursuant to NRS ; or (e) If the Board temporarily suspends the license, allow the license to return to active status subject to any terms and conditions specified by the Board, including: A physician who has acted in a dishonorable way may be limited in scope of work by the medical Board. The Nevada State Medical Board has the right to place restrictions on a physician s license that has just been temporarily suspended. (1) Placing the licensee on probation for a specified period with specified conditions; (2) Administering a public reprimand;

8 (3) Limiting the practice of the licensee; CTeL Comment: For example, Physician A has had his license suspended, as a result of showing up to the hospital where he works intoxicated, on multiple occasions. (4) Suspending the license for a specified period or until further order of the Board; (5) Requiring the licensee to participate in a program to correct alcohol or drug dependence or any other impairment; (6) Requiring supervision of the practice of the licensee; (7) Imposing an administrative fine not to exceed $5,000; (8) Requiring the licensee to perform community service without compensation; (9) Requiring the licensee to take a physical or mental examination or an examination testing his competence to practice medicine; (10) Requiring the licensee to complete any training or educational requirements specified by the Board; and (11) Requiring the licensee to submit a corrected application, including the payment of all appropriate fees and costs incident to submitting an application. 5. If the Board determines after reviewing the differing information to allow the license to remain in active status, the action of the Board is not a disciplinary action and must not be reported to any national database. If the Board determines after reviewing the differing information to declare the license void, its action shall be deemed a disciplinary action and shall be reportable to national databases Examinations 1. In addition to the other requirements for licensure, an applicant shall appear personally and pass an oral examination, if required by the Board. 2. The Board may employ specialists and other consultants or examining services in conducting any examinations required by the Board.

9 Limited License to Practice Medicine as Resident Physician 1. Except as otherwise provided in NRS , the Board may issue to a qualified applicant a limited license to practice medicine as a resident physician in a graduate program approved by the Accreditation Council for Graduate Medical Education if he is: (a) A graduate of an accredited medical school in the United States or Canada; or (b) A graduate of a foreign medical school and has received the standard certificate of the Educational Commission for Foreign Medical Graduates or a written statement from that Commission that he passed the examination given by it. 2. The medical school or other institution sponsoring the program shall provide the Board with written confirmation that the applicant has been appointed to a position in the program and is a citizen of the United States or lawfully entitled to remain and work in the United States. A limited license remains valid only while the licensee is actively practicing medicine in the residency program and is legally entitled to work and remain in the United States. 3. The Board may issue a limited license for not more than 1 year but may renew the license if the applicant for the limited license meets the requirements set forth by the Board by regulation. 4. The holder of a limited license may practice medicine only in connection with his duties as a resident physician or under such conditions as are approved by the director of the program. 5. The holder of a limited license granted pursuant to this section may be disciplined by the Board at any time for any of the grounds provided in NRS or to , inclusive.

10 The following statutes provide guidance to those interested in medical prescriptions and internet pharmacies. Title 40. Public Health and Safety Chapter 453. Controlled Substances Illegal Internet Pharmacy Defined 1. Illegal Internet pharmacy means a person located within or outside this State who is not licensed and certified by the Board pursuant to chapter 639 of NRS to engage in the practice of pharmacy via the Internet and who knowingly: (a) Uses or attempts to use the Internet, in whole or in part, to communicate with or obtain information from another person; and (b) Uses or attempts to use such communication or information, in whole or in part, to: (1) Fill or refill a prescription for a prescription drug for the other person; or (2) Deliver or cause, allow or aid in the delivery of a controlled substance, imitation controlled substance, counterfeit substance or prescription drug to the other person. 2. The term does not include a person who is authorized by the provisions of NRS to , inclusive, to dispense or distribute, unless the person is acting outside of that authorization. Nine states (Arkansas, California, Illinois, Indiana, Nevada, New Hampshire, New York, Texas, and Virginia) have passed legislation to regulate online pharmacies. These laws generally require online pharmacies to register with the state, mandate compliance with state licensure laws, and establish the authority of a control board.

11 Unlawful Acts Relating to Filling or Refilling Prescription or Delivering Certain Substances or Drugs; Aiding Unlawful Act Prohibited; Penalties; Multiple Punishments Authorized The Nevada State Statute prohibits the use of internet pharmacies in the disbursement of prescription drugs to patients. 1. A person who is located within this State and who owns, operates, controls, profits from or is employed or paid by an illegal Internet pharmacy shall not: (a) Fill or refill a prescription for a prescription drug for another person located within or outside this State; or (b) Deliver or cause, allow or aid in the delivery of a controlled substance, imitation controlled substance, counterfeit substance or prescription drug to another person located within or outside this State. 2. A person who is located outside this State, who owns, operates, controls, profits from or is employed or paid by an illegal Internet pharmacy and who knows or has reasonable cause to believe that another person is located within this State shall not: (a) Fill or refill a prescription for a prescription drug for the other person; or (b) Deliver or cause, allow or aid in the delivery of a controlled substance, imitation controlled substance, counterfeit substance or prescription drug to the other person. 3. A person shall not knowingly aid another person in any act or transaction that violates the provisions of this section. 4. Except as otherwise provided in subsection 5, a person who violates the provisions of this section is guilty of a category C felony and shall be punished as provided in NRS A person who violates the provisions of this section is guilty of a category B felony and shall be punished by imprisonment in the state prison for a minimum term of not less than 3 years and a maximum term of not more than 15 years, and may be further punished by a fine of not more than $100,000, if the substance or drug involved:

12 (a) Is classified in schedule I; or (b) Proximately causes substantial bodily harm to or the death of the intended recipient of the substance or drug or any other person. 6. The court shall not grant probation to or suspend the sentence of a person punished pursuant to subsection A person may be prosecuted, convicted and punished for a violation of this section whether or not the person is prosecuted, convicted or punished for a violation of any other statute based upon the same act or transaction. The Nevada physician licensure statute specially prohibits the filling or refilling of prescription drugs over the internet through the use of an internet pharmacy Unlawful Acts Relating to Issuance of Prescription; Circumstances under which Practitioner or Person Licensed by Another Jurisdiction is Prohibited from Prescribing Prescription Drug; Aiding Unlawful Act Prohibited; Penalties; Multiple Punishments Authorized 1. A practitioner who is located within this State shall not prescribe a prescription drug for another person located within or outside this State if: (a) The practitioner has not physically examined the other person within the 6 months immediately preceding the date on which the prescription is issued; and (b) The practitioner knows or has reasonable cause to believe that an illegal Internet pharmacy will fill the prescription or otherwise use the prescription to deliver or cause, allow or aid in the delivery of the prescription drug to the other person. 2. A practitioner who is located outside this State and who knows or has reasonable cause to believe that another person is located within this State shall not prescribe a prescription drug for the other person if: CTeL Comment: The purpose of this statute is to protect the public against the harmful substances. (a) The practitioner has not physically examined the other person within the 6 months immediately preceding the date on which the prescription is issued; and

13 (b) The practitioner knows or has reasonable cause to believe that an illegal Internet pharmacy will fill the prescription or otherwise use the prescription to deliver or cause, allow or aid in the delivery of the prescription drug to the other person. 3. A person who is located outside this State, who is licensed by another jurisdiction to prescribe prescription drugs and who knows or has reasonable cause to believe that another person is located within this State shall not prescribe a prescription drug for the other person if: (a) The person has not physically examined the other person within the 6 months immediately preceding the date on which the prescription is issued; and (b) The person knows or has reasonable cause to believe that an illegal Internet pharmacy will fill the prescription or otherwise use the prescription to deliver or cause, allow or aid in the delivery of the prescription drug to the other person. 4. A person shall not knowingly aid another person in any act or transaction that violates the provisions of this section. 5. Except as otherwise provided in subsection 6, a practitioner or any other person who violates the provisions of this section is guilty of a category C felony and shall be punished as provided in NRS A practitioner or any other person who violates the provisions of this section is guilty of a category B felony and shall be punished by imprisonment in the state prison for a minimum term of not less than 3 years and a maximum term of not more than 15 years, and may be further punished by a fine of not more than $100,000, if the substance or drug involved: (a) Is classified in schedule I; or (b) Proximately causes substantial bodily harm to or the death of the intended recipient of the substance or drug or any other person. 7. The court shall not grant probation to or suspend the sentence of a practitioner or any other person punished pursuant to subsection 6.

14 8. A practitioner or any other person may be prosecuted, convicted and punished for a violation of this section whether or not the practitioner or person is prosecuted, convicted or punished for violating any other specific statute based upon the same act or transaction.

15 APPENDIX Definitions As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS to , inclusive, have the meanings ascribed to them in those sections Administrative Physician Defined Administrative physician means a physician who is licensed only to act in an administrative capacity as an: 1. Officer or employee of a state agency; 2. Independent contractor pursuant to a contract with the State; or 3. Officer, employee or independent contractor of a private insurance company, medical facility or medical care organization, and who does not examine or treat patients in a clinical setting Board Defined Board means the Board of Medical Examiners Healing Art Defined Healing art means any system, treatment, operation, diagnosis, prescription or practice for the ascertainment, cure, relief, palliation, adjustment or correction of any human disease, ailment, deformity, injury, or unhealthy or abnormal physical or mental condition for the practice of which long periods of specialized education and training and a degree of specialized knowledge of an intellectual as well as physical nature are required Medical Facility Defined Medical facility has the meaning ascribed to it in NRS Physician Defined For the purpose of Nevada sales tax exemption for medicine furnished by licensed physician, a chiropractor is not considered a licensed physician. In re Ward, 77 B.R. 805 (1987). Physician means a person who has complied with all the requirements of this chapter for the practice of medicine.

16 Physician Assistant Defined Physician assistant means a person who is a graduate of an academic program approved by the Board or who, by general education, practical training and experience determined to be satisfactory by the Board, is qualified to perform medical services under the supervision of a supervising physician and who has been issued a license by the Board. "Practice of medicine" means: Practice of Medicine Defined 1. To diagnose, treat, correct, prevent or prescribe for any human disease, ailment, injury, infirmity, deformity or other condition, physical or mental, by any means or instrumentality, including, but not limited to, the performance of an autopsy. 2. To apply principles or techniques of medical science in the diagnosis or the prevention of any such conditions. 3. To perform any of the acts described in subsections 1 and 2 by using equipment that transfers information concerning the medical condition of the patient electronically, telephonically or by fiber optics. 4. To offer, undertake, attempt to do or hold oneself out as able to do any of the acts described in subsections 1 and 2. 5 Practice of respiratory care includes: Nevada has amended the definition of "Practice of Medicine" under its medical licensing statute to include "using equipment that transfers information concerning the medical condition of the patient electronically, telephonically or by fiber optics" Practice of Respiratory Care Defined 1. Therapeutic and diagnostic use of medical gases, humidity and aerosols and the maintenance of associated apparatus; 5 According to Op. Atty. Gen. No (1998), the Board of Medical Examiners may regulate the practice of its licensees even where that regulation may adversely affect the practice of licensees who are also licensed by the Board of Homeopathic Examiners.

17 2. The administration of drugs and medications to the cardiopulmonary system; 3. The provision of ventilatory assistance and control; 4. Postural drainage and percussion, breathing exercises and other respiratory rehabilitation procedures; 5. Cardiopulmonary resuscitation and maintenance of natural airways and the insertion and maintenance of artificial airways; 6. Carrying out the written orders of a physician, physician assistant, certified registered nurse anesthetist or an advanced practitioner of nursing relating to respiratory care; 7. Techniques for testing to assist in diagnosis, monitoring, treatment and research related to respiratory care, including the measurement of ventilatory volumes, pressures and flows, collection of blood and other specimens, testing of pulmonary functions and hemodynamic and other related physiological monitoring of the cardiopulmonary system; and 8. Training relating to the practice of respiratory care Practitioner of Respiratory Care Defined Practitioner of respiratory care means a person who is: 1. Certified to engage in the practice of respiratory care by the National Board for Respiratory Care or its successor organization; and 2. Licensed by the Board Respiratory Care Defined Respiratory care means the treatment, management, diagnostic testing, control and care of persons with deficiencies and abnormalities associated with the cardiopulmonary system. The term includes inhalation and respiratory therapy Supervising Physician Defined Supervising physician means an active physician licensed and in good standing in the State of Nevada who supervises a physician assistant.

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