Bringing doctors, osteopaths under one board would improve the process

Everybody is looking for The Big Fix: What should be done about the boards that regulate doctors in Nevada? How do you handle conflicts? How do you make them more responsive and timely? How do you make the appointments less political and more patient-oriented?

The spotlight has been on the Board of Medical Examiners, which failed to hop to it and instead insisted on that darn due process thing when staffers at endoscopy clinics were accused of using substandard health care practices and spreading hepatitis between patients.

The 2009 Legislature will be deluged with ideas to change the laws and regulation of doctors and nurses. But I’d like to pitch one idea.

Combine the Board of Medical Examiners with the Board of Osteopathic Medicine. Nevada is one of only 14 states that doesn’t.

Osteopaths oppose it because they believe they’re relegated to a minor role with only one or two osteopaths on the board, and aren’t equally represented on a combined board, explained Dr. Larry Tarno, executive director of the Nevada osteopathic board for the past 15 years and a longtime board member before that.

Tarno said the other concern is that osteopaths don’t think medical doctors would understand the manual manipulations osteopaths use, and I couldn’t accept that reason.

If a lay person on a board can judge that, an M.D. can too.

Somehow it just makes sense that one set of regulatory standards should apply to all Nevada physicians.

Some interesting numbers suggest the disciplinary actions aren’t the same at the two boards.

In the past two years, the Medical Examiners disciplined 42 people.

During that same time, the Osteopathic Board disciplined nary a one. Tarno said he handles a lot of issues informally so they never appear before the board.

I’m guessing most patients don’t even know whether their doctor is an M.D. or a D.O., or the difference in training and philosophy between the two. (D.O.s use more manual manipulation techniques and take a more holistic approach.)

The Board of Osteopathic Medicine regulates about 500 doctors; the Board of Medical Examiners regulates about 6,000. But with Touro University in Henderson producing more osteopaths, their numbers in Nevada will be increasing.

The Medical Examiners have nine members, including three lay people. The Osteopathic Board has seven members, including two lay people.

Let’s create one board of 11 people: Keep the three lay people and ration the other seats between M.D.s and D.O.s. Throw in someone from the medical academic world. Toss in a recently retired doctor, who might have fewer conflicts. Do a better job of disclosing conflicts before an appointment.

Creating a Northern and Southern panel for disciplinary actions sounded good initially.

With the long-standing hostility between the North and South, that overworked Northern panel would just be whipping up on our Las Vegas docs, and the Southern panel wouldn’t have as much to do because of the population difference.

A couple of things make me think a combined board would be better.

First, Dr. Tarno is both the part-time executive director, the board’s only investigator, and a one-man investigation committee. He says as a doctor he can understand the issues more quickly than a nonmedical investigator. He laid off his only investigator after two contentious investigations nearly bankrupted the board’s budget.

Maybe he can do it all and do it faster. But should all those decisions be in one person’s hands?

Tarno’s office is in some disarray because his former deputy was charged with embezzlement. Documents have been misplaced and can’t be found.

I asked Tarno for the malpractice information about the newest board member, Scott Manthei, brother of former board chairman Rudy Manthei, one of Gov. Jim Gibbons’ health advisers.

Tarno said he’s looked for it and cannot find it, although he remembers seeing something.

Scott Manthei, an ear, nose and throat guy (OK, otolaryngologist) is out of town and didn’t return my call Friday. Tarno said when Manthei returns, he’ll find out what malpractice issues the board member has and let me know.

At least the Board of Osteopathy’s new Web site (www.bom.nv.gov) says that Manthei does have malpractice issues, even if the details are lost in space.

That’s better than the Medical Examiners’ site (www.medboard.nv.gov) which reveals nothing about its doctors’ malpractice issues.

But let’s save that pet peeve for Monday’s column.

Jane Ann Morrison’s column appears Monday, Thursday and Saturday. E-mail her at Jane@reviewjournal.com or call (702) 383-0275.