When Public Citizen ranked the Nevada State Board of Medical Examiners (NSBME) among the five worst medical boards in the U.S. in 2007, the distinction was nothing new for the troubled board.  The NSBME's dismal record in fulfilling its mandate to protect patients from unfit doctors has been the subject of public controversy for years.  In 2002, KVBC-TV reported that the legislature was about to "discipline the discipliners" after the station ran an exposé of the Medical Board's lax approach to physicians with multiple malpractice claims.  Two years later, Reno Gazette Journal reporter Frank Mullen wrote a series of articles detailing the Medical Board's continuing failure to reign in dangerous doctors and safeguard the rights of upstanding physicians.   As you can see from the summaries below of a selection of cases from 2005 to the present, nothing has been done to correct this obvious dysfunctionality.

In considering the Medical Board's mishandling of these cases, remember that the Board refuses to act on the overwhelming majority of complaints.  In 2006, for example, the Board opened over six hundred investigations, mostly in response to complaints from the public.  However, it took disciplinary action in only 20 cases, and these actions did not, for the most part, prevent the doctors involved from conducting their business as usual.

Also note that the Board could not cry poverty as an excuse for its failures, that is, at least until this year.  In 2003, the Board enjoyed a $3.35 million dollar surplus, a remarkable stash for a state licensing board.  That figure dropped fairly steadily, and in 2006, it stood at just over a million dollars, which the Board defined as a prudent reserve.  However, during 2007, its unrestricted net assets plummeted by 90% due to a loss of almost $700,000, which, according to Board members, could not be attributed to any specific cause.  The Board consequently concluded that even though its total assets had risen over $2 million or 75% in 2007, it would seek legislative approval to raise fees above the current statutory maximum at the earliest opportunity. 

Nevada Doctors in the News, 2005-2008

 Dr. Depak Desai, who served on the the Nevada State Board of Medical Examiners from 1993 until 2001, was ordered to pay $2,500 in 1996 to settle a complaint against him for falsely advertising that the doctors on his staff at the Gastroenterology Center of Nevada were board-certified.

But the real threat that Desai posed to the public did not come to light until the Southern Nevada Health District announced on February 28, 2008 that as many as 40,000 people may have been exposed to hepatitis C and other blood-borne diseases due to widespread mishandling of syringes at the Southern Nevada Endoscopy Center over the past four years.  Desai owns and manages the clinic along with other lesser partners.  During the investigation into dangerous procedures at Desai's business, doctors, nurses, and other staff acknowledged that the improper use of syringes, as well as failure to clean medical equipment, was routine despite obvious risks to public safety.  Investigations of Desai's other clinics were still underway when health officials sent out letters to 40,000 people advising them to be tested for hepatitis B, hepatitis C, and HIV. 

The Medical Board knew nothing about the Health District investigation until it was announced to the public, but the thousands placed at risk can only wonder whether Desai and his colleagues will ever be called to account for their misdeeds.  In the immediate aftermath of revelations about unsafe practices at Desai's clinic, the Board could have suspended his license on an emergency basis, as it sometimes does when it receives reports that doctors have been engaged in dangerous conduct or criminal activity.  Instead, Board President Dr. Javaid Anwar and Executive Director Tony Clark brokered an agreement that allowed Desai to suspend his practice  temporarily while keeping his license free from any record of disciplinary action. Then, in response to public outcry, Governor Jim Gibbons, who had selected Desai to serve on his Healthcare Transition Team in 2006, asked Clark and Anwar, as well as Vice President Dr. Sohail Anjum and board member Dr. Daniel McBride, to resign from the Board in view of their ties to Desai.

McBride is refusing to tender his resignation even though, as Paul Harism reported in the Las Vegas Review Journal, he served as chairman of the Nevada Mutual Insurance Company, which provides malpractice insurance to physicians.  Under a barrage of criticism for this clear conflict of interest, McBride apparently gave up his position at Nevada Mutual, as did Desai, who also worked for the company until he reportedly withdrew in the wake of the scandal. 

In light of McBride's involvement with the insurance industry, it would be helpful to learn more about his role in the Medical Board's 2005 decision to delete all information related to malpractice claims from its web site, as well as his connections to "Keep Our Doctors in Nevada," one of the leading groups lobbying for tort reform in recent years.  And it would likewise be enlightening to find out how many of the doctors disciplined by the Medical Board during McBride's tenure signed up and paid for the CME courses offered on Nevada Mutual's web site.

A few days after McBride rejected the Governor's call to resign, Anwar announced that he would not allow his own conflicts of interest to force him from the Medical Board.  Having recused himself from all Board actions related to the crisis, Anwar did not address whether his continuing presence would impair public confidence, nor did he detail the interactions between his company, Quality Care Consultants, and Desai's clinics.   According to the Las Vegas Sun, Quality Care Consultants, which is co-owned by Ikram Khan, former Medical Board member and advisor to Governor Gibbons, evaluated Desai's Endoscopy Center in 2007 to see if it measured up to industry standards.  While acknowledging being "paid in full," Anwar did not disclose whether his company had detected any of the dangerous practices that health officials now say went on at the clinic for years, nor did he say whether Quality Care Consultants had given Desai any tips on reducing costs. Saving money was reportedly Desai's main reason for rejecting standard procedures despite the health risks involved. 

Whatever the outcome of ongoing investigations, Desai can take comfort in the results of the "Keep Our Doctors in Nevada" campaign, which benefitted from a $25,000 contribution from his business, and which made it extremely hard for injured patients to sue for malpractice.  Relying on misleading statistics gathered by medical industry groups, tort-reform backers persuaded voters that crowds of doctors were fleeing Nevada to escape steep insurance premiums.  But now Nevadans are reconsidering their support for tort reform with the realization that the caps placed on damage awards may limit compensation even in cases in which gross negligence exposed patients to potentially fatal diseases.   

For insight into how incompetent doctors have tried to use this poorly conceived legislation to squash entirely reasonable claims, see Borger v. Lovett, in which the Nevada Supreme Court ruled that Desai and James Lovett, MD could not evade a lawsuit by drawing  narrow distinctions about which specialists are qualified to provide expert testimony on behalf of patients who have been harmed.   

Update May, 2008: 

Medical Board tries to explain its apparent failure to take meaningful action

Gibbons criticizes the Board's failure to contact temporary members appointed to address NV's health care crisis

Dr. David Linden, who is licensed both in Nevada and in Oklahoma, was featured in a major story in the New York Times in 2007 after the FDA found that he had imprisoned a subject of a research study at his psychiatric clinic in Oklahoma City.  The Times also reported that Linden's Oklahoma license had been suspended in November 2006 for three months by that state's medical board  because two of his patients had contracted herpes from him due to improper sexual contact.

While Linden's 90-day suspension for such egregious misconduct might have seemed too light to most people, it apparently seemed too harsh to the Nevada State Board of Medical Board Examiners (NSBME), which elected not to prevent him from practicing psychiatry even for a day, but chose instead to place him on probation.  Now it seems that the NSBME's efforts to protect Linden from himself, instead of protecting his patients, have backfired: He is back in the public eye after having been arrested on February 28, 2008 for passing over $300,000 in bad checks in Las Vegas casinos.   

Dr. Dana Marks, an emergency room doctor licensed in Nevada since 2000, was charged in November 2007 with unlawfully dispensing painkillers to topless dancers at a club he frequented in Reno.  According to the police complaint, Marks wrote a total of 18 prescriptions for hydrocodone for two dancers at the Wild Orchid Adult Cabaret over the course of several months.  At the time of his arrest, Marks' record with the Nevada Medical Board was clean, and the Board has apparently not taken any action against him since then.  It is not known if he is still treating patients in Nevada.

Dr. Kurt Buzard, an ophthalmologic surgeon, was arrested in Las Vegas in 2003 for cocaine possession.  Travelling in a speeding convertible with an unidentified female companion, Buzard was wearing a dog collar, a sheet, and little else when he was pulled over by police on August 24.  Apparently unaware that Buzard had faced similar drug charges in Colorado in 1985, the police ordered him to appear for booking three weeks later.

In June 2006, long after Buzard had cut a deal that allowed him to avoid jail time on the cocaine charge, the Nevada State Board of Medical Examiners publicly reprimanded him for bringing the medical profession into disrepute.  Ultimately, having enabled Buzard to continue performing eye surgeries for almost four years despite his substance abuse problems, the Nevada Medical Board reached an agreement with him to inactivate his medical license.  According to the agreement, Buzard's license has not been revoked or suspended, and he is free to apply to re-activate his license in the future.

In June 2006, the Nevada Medical Board revoked Dr. Harriston Bass's license at an emergency meeting.  The Board had also revoked his license in 1993, after finding him guilty of gross and repeated malpractice that led to the deaths of two of his patients.  However, the Board stayed the revocation, placed him on probation, and enabled him to continue treating patients in Nevada for more than a decade.  Although the Medical Board removed information about malpractice claims from its web site in 2005, John L. Smith, a columnist for the Las Vegas Review Journal, reported that Bass, who became a prison doctor while under probation, was sued by an inmate at the Southern Nevada Correctional Facility in 2001.

Bass's troubled history again resurfaced after Gina Micali, a patient at his PT Cruiser-based mobile clinic, Doc's 24-7, died from a prescription drug overdose on October 6, 2005.  Authorities alleged that Bass sold Micali 300 hydrocodone pills two days before her death and also wrote her a prescription for the drug even though he was not licensed to dispense controlled substances.   Bass was found guilty of second-degree murder on March 5, 2008 in Las Vegas. 

The Medical Board revoked Dr. Doyle Stuart Steele's license to practice medicine in November 2007, five years after it found him not guilty of medical malpractice in the first complaint filed against him.  During that period, Steele was ordered to undergo a mental evaluation after questions were raised about his competency in 2004, and a second complaint was filed against him in January 2005. That complaint alleged that he had failed to report hospital sanctions against him and that he had engaged in sexual relations with one of his patients. 

In July 2005, Steele and his colleague, Dr. Richard Groom, were sued by the family of a man who was killed when one of their former employees, for whom they had reportedly prescribed over 5,000 painkiller pills during the previous year, ran him, along with a woman who was seriously injured, down on June 6, 2004 as they stood on the side of a Las Vegas highway.  Meanwhile, on July 1, 2005, the Medical Board suspended Steele's license pending the outcome of an investigation into whether he had improperly prescribed controlled substances to three patients, including one with whom he had allegedly had sexual relations.

In December 2005, Steele was arrested for writing Oxycontin prescriptions for drug dealers in Virginia and for trading drugs for sex in Las Vegas.  Late last year, after Steele was sentenced to seven years by a Virginia judge, the Nevada Medical Board finally stripped him of his license.   However, in a statement to the press on Steele's case, a Medical Board spokesperson stressed that the revocation was not necessarily permanent: ""People who redeem themselves and re-educate themselves and pay their debt to society would be welcome to re-apply," the board spokesperson said."

In June 2007, Dr. Stephen Seldon and his wife, Deborah Seldon, received national attention when they were charged on various counts by federal authorities after they allegedly injected patients with a cheap substitute for Botox that is not supposed to be used on human beings.  The Seldons face up to 20 years in prison and a fine of up to $100,000 for dispensing adulterated drugs if they are found guilty on all counts.  However, Dr. Seldon has little to fear from the Medical Board, which has yet to take any disciplinary action against him.  In March 2007, after finding Adelaida Resuello, MD guilty of similarly substituting an unapproved botulism toxin for Botox, and also for assisting an unlicensed person to inject the poison into patients, the Board fined her a paltry $2000 and placed her on probation.   And when the Board found Gregory Bryan, MD guilty of injecting people with fake Botox, and of improperly supervising a physician's assistant, it fined him a mere $1,000 and ordered him to take a few courses on charting and medical ethics. 

In September 2006, the Medical Board suspended the medical license of Dr. Layfe Anthony for one year, but then stayed the suspension on the condition that he complete a probationary period in Utah and comply with other restrictions on his practice.  According to the Medical Board, Anthony was subject to this relatively light disciplinary action because he had failed to report sanctions imposed on his Utah license and had also made inaccurate statements in his application for renewal of his license in Nevada.

Among other problems, Dr. Anthony's record includes a conviction for negligent homicide in Utah in 2002 in the death of a woman from Bunkerville, Nevada after she received a liposuction treatment from him.  Anthony caused the woman's death when he provided injectable painkillers to her husband, who had no medical training, and advised him to inject his wife at home because she did not want to return to Anthony's office.  That same year, the DEA revoked Anthony's registration on the grounds that he was not authorized to handle controlled substances in Utah.  In 2004, the Department of Health and Human services denied Anthony's petition to overturn his exclusion from participation in Medicare or any other federal medical program due to his criminal conviction.  Anthony remains under probation in Utah, where the medical licensing board has allowed him to work in a county jail, but the board there recently determined that he is not competent to practice medicine in several areas identified as deficient in a previous evaluation.

Although Anthony is apparently being monitored regularly in Utah, there is no indication that the Medical Board is overseeing his activities in Nevada.

In 2005, when homeopath James Forsythe, MD, was indicted by federal officials for drug-smuggling and other violations, the Reno Gazette Journal revealed that at least 19 people had filed complaints against him with the Medical Board, and a state investigator described him in a sworn affidavit as "one of the five most serious physician offenders known in the state of Nevada."  At the time, Forsythe's record showed that only one disciplinary action had been taken against him.  In 1995, he was fined $1,000 for overbilling for medical tests and was also forced to pay the Board $44,000 that was supposed to be "used by the Board for future protection and awareness, " but there is no evidence that the Board made any effort to protect the public from Forsythe or to make anyone aware of the dangers he posed.

Although he was acquitted of the federal charges in November 2007, the proceedings revealed that Forsythe had improperly diagnosed a patient, who was actually an undercover FDA agent, with hypopituitism without conducting relevant tests, obtained hGH by claiming in a letter to U.S. Customs that he needed it for "personal use," and sold it directly to the patient rather than writing a prescription that could be filled at an ordinary pharmacy.  In another state, the medical board would take pains to hold a licensed physician accountable for these violations, but the NSBME has taken no action in the case. 

In September 2007, the Medical Board found homeopathic MD Frank Shallenberger guilty of one count of medical malpractice as a consequence of his mistreatment of David Horton, who died after Shallenberger misdiagnosed his colon cancer as hemorrhoids, treated him with witch-hazel and other ineffectual remedies, then, after Horton's cancer had spread, unsuccessfully tried to combat the disease with Insulin Potentiation Therapy, a controversial treatment that has yet to be accepted by mainstream oncologists.  In contrast to what happens at most medical boards, where previous misconduct is usually taken into account, the NSBME decided to ignore the fact that Shallenberger had been forced to surrender his license in California in 1995 after the medical board there found him subject to multiple disciplinary actions due to "gross incompetence," "repeated acts of gross negligence," and "acts of dishonesty and corruption which are substantially related to the qualifications, functions, or duties of a physician and surgeon."  Consequently, for his direct contribution to his patient's death, the Nevada Board fined him only $5,000 and ordered him to pay $6,500 in legal costs.

At the same meeting, the Board dismissed a second complaint against Shallenberger, maintaining that it could not discipline him for mistreating a patient with severe cognitive impairments because he also holds a homeopathic license, and homeopaths in Nevada do not have to conform to ordinary standards of medical care even when they are also licensed MD's. 

When asked why the Board had decided to allow Shallenberger to define himself as a homeopath in the second case while defining him as an MD in the Horton case—in which he had actually employed homeopathic methods—General Counsel Bonnie Brand explained that she had no idea what should or should not be included within the bounds of homeopathy.  And when confronted with the Medical Board's own statements stressing that licensed doctors should not be allowed to use homeopathic credentials to shield themselves from disciplinary action, Brand insisted that the Board had absolutely no power over homeopaths. 

The NSBME's Faulty Radar

The recent cases summarized above only include those in which the NSBME took some sort of disciplinary action against physicians whose subsequent wrongdoing landed them in the news.  But since the Medical Board addresses only a tiny fraction of the hundreds of complaints that it receives each year, and since the Board has removed information about malpractice claims from its web site, it is virtually impossible to gage how many incompetent doctors are currently treating patients in Nevada.  Nonetheless, having come under scrutiny, Anwar recently justified making malpractice information more difficult for the public to obtain.  According to the Las Vegas Sun:

Nevada's Self-Styled "Medical Mafia"

Anwar neglected to specify who "they" might be in his statement, but if he was not referring to the patients he is pledged to protect, perhaps he was speaking of the doctors and lawyers involved in a multimillion dollar scheme to defraud clients in medical malpractice cases that began to unravel during the federal trial of Noel Gage, a Las Vegas attorney.  Reportedly one of dozens players in a complex conspiracy, Gage allegedly arranged secret deals with doctors, lawyers, and others that enabled him and his co-conspirators to siphon off millions from settlements at the expense of injured patients.  So far, eleven Nevada physicians have been targeted by the U.S. Attorney's office: Dr. Mark Kabins, Dr. Mark Kraft, Dr. Randy Peoples, Dr. Raimundo Leon, Dr. Brian Lemper, Dr. Jim Thomas, Dr. David Oliveri, Dr. Michael Prater, Dr. Witold Iglikowski, Dr. Benjamin Venger, and Dr. John Thalgott.  Of these, two physicians, Venger and Thalgott, have testified for the prosecution, acknowledging that they participated in order to get kickbacks from Gage and shield themselves from potentially damaging malpractice claims. Gage's case ended in a mistrial on March 18, but US Attorney Gregory Brower said that it would be tried again.

While none of the physicians involved, including the two who have already admitted their own corruption, has ever been disciplined by the Medical Board, it is obvious that the public would have benefitted if the Board had made their malpractice histories known.  Moreover, since the Board removed malpractice information from its web site during exactly the same period when the U.S. Attorney was investigating these doctors for manipulating malpractice cases, the issue of why the Board decided to act as it did when it did needs to be explained.  It could be simply that the Board hoped to steer clear of more bad publicity from its longstanding protection of doctors with multiple claims, but the murky history of malpractice cases in Nevada, along with the dubious evidence used to stoke public support for tort reform, certainly raises questions about its seemingly unprovoked decision to delete information that had been freely available.

Who's in Charge Here?

The Nevada State Senate Committee on Commerce and Labor

  While the governor appoints its members, the NSBME's long-term history of incompetence can be chalked up to the indifference and ineptitude of the legislature, especially the Nevada State Senate Committee on Commerce and Labor, which is supposed to oversee the activities of state licensing boards.  According to the Las Vegas Review Journal, the Committee's Chair, Ralph Townsend, who also serves as Chair of the Legislative Commission, sent letters to the Governor and to various state boards and agencies demanding a searching inquiry into the failures that allowed the state's current health crisis to balloon to such proportions:

In the letters, the Reno Republican asked for an immediate investigation into "the facts surrounding this outrage," which "may well be the largest breach of public trust in the history of the state."...Townsend said the agencies and boards should use all of their statutory and regulatory authority, including subpoena power, to get to the bottom of how the problems occurred.

 Townsend's bluster would be more believable if he had not assumed a similar stance four years ago when media reports on the Medical Board's failure to discipline dangerous doctors prompted him and his colleagues to demand a thorough audit of the Board's performance.  Then, when the audit turned out to be nothing but a friendly clap on the back from industry insiders, Townsend and his fellow legislators went back to ignoring the Board's continuing inability to safeguard public health and safety.

Townsend might also have more credibility if he and his Committee had shown some appreciation for integrity in medicine during the 2005-2007 legislative session.  Instead, in April 2007, after hearing testimony from Dean Friesen, an unlicensed pharmacist who is now under investigation for passing himself off as a licensed physician, the Committee unanimously approved a bill to allow unqualified homeopaths to supervise and profit from stem-cell research and clinical applications in Nevada.  The stem-cell bill was part of a larger effort to promote medical tourism by creating the Nevada Institutional Review Board (NIRB), which was designed to circumvent federal regulations and legalize medical devices and treatments that have been or would be outlawed in other states.  The bill nearly died after other legislators realized that it had been concocted by practitioners who had no recognized credentials or experience in either protecting human subjects—which is the primary purpose of institutional review boards—or in any other aspect of medical research.   However,  late on June 3, the day before the session ended, under the guise of a bill that would have eliminated the NIRB in July 2007, the legislature quietly extended its existence for two more years.  Having replaced all references to "2007" with "2009," lawmakers added the last-minute stipulation that the NIRB is authorized to "contract with a private company to conduct studies or other work related to non-embryonic stem cells in bioregenerative stem cell technology." (p. 391-395)

  The Committee's unanimous disregard of Friesen's lack of credentials, along with the Medical Board's refusal to offer any opposition despite the dubious nature of his stem-cell scheme, illustrates the legislature's general incapacity to regulate the delivery of medical care.  "Anything goes," the familiar watchwords of Nevada politics, may be acceptable approaches to gambling and prostitution in the eyes of many state residents, but, as evidenced in the Labor and Commerce Committee's irresponsible promotion of medical tourism, its failure to reverse the Medical Board's long-term slide into complete disarray, and the refusal of other elected and appointed officials to correct glaring problems that have been festering for years,  this dictum doesn't work when it comes to the regulation and supervision of people who are supposed to provide trustworthy medical treatment.

A Sidelight:  Another interesting topic discussed at the September '07 meeting was whether physician Board members should award themselves continuing medical education credits (CME) in ethics as additional compensation for serving on the Board.  In addressing this issue, Chief Deputy Attorney General Christine M. Guerci-Nyhus observed that no other medical board in the country allowed such compensation, and she suggested that questions might be raised about enabling board members, who are in charge of setting standards for CME, to give themselves such an unprecedented perk. Consequently, without considering the ethical problems raised by this proposal, the Board decided that the best way to institute the added compensation would be to go through a "regulatory process."   Late last year, without addressing any of the ethical issues raised by this proposal, and without explaining why service on the Board should count as a course in ethics, the Board adopted the new regulation. 

Ironically, at the same meeting, the Board rejected a proposed rule that would have required members to disclose conflicts of interest, opting instead to sign a statement indicating that members were cognizant of Nevada's rules on ethics in government service.  However, it's not clear if members are now obliged to acknowledge their numerous violations of the state's prohibitions against using government offices to advance personal business interests.  It's also not clear if Board members are required to take the only ethics course offered by the Board, which is entitled "Protecting Your Medical License" —"Protecting Your Patients" apparently did not present itself as a suitable title— nor is it known if any of the physicians listed on this page availed themselves of this free two-hour course.

Additional information:

Urine test litigation nets doctor $100,000  (There is something really fishy here.)

If you don't ask about malpractice, Board of Medical Examiners won't tell

Snake Oil Salesmen Hit Jackpot in Nevada

EDITORIAL: Impotent oversight

Restoring public trust

Amid hepatitis scare in Nevada, 5 nurses hand in licenses   (How many doctors did?)

Page  updated by Susan E. Gallagher, Associate Professor, Political Dept., UMass Lowell, 6/08