AB 364 — Revises provisions governing the Board of Medical Examiners. (BDR 54-148)

Existing law establishes a rural clinic as a medical facility in a rural area where medical services are provided by a physician assistant or advanced practice of this bill removes the requirement that a rural clinic be supervised by a physician.

- *AB364_R1* – 3 – THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

NRS 629.047630.050 is hereby amended to read as follows:

629.047630.050 1.

IfThe aBoard physicianof ,Medical aExaminers physicianconsists assistant or an advanced practice registered nurse determines that, in his or her professional judgment, a patient’s epilepsy severely impairs the ability of the[nine] patient11 tomembers safelyappointed operateby a motor vehicle, the physicianGovernor. , physician assistant or advanced practice registered nurse shall:

(a) Adequately inform the patient of the dangers of operating a motor vehicle with his or her condition until such time as the physician , physician assistant or advanced practice registered nurse or another physician , physician assistant or advanced practice registered nurse informs the patient that the patient’s condition does not severely impair the ability of the patient to safely operate a motor vehicle.

(b) Sign a written statement verifying that the physician , physician assistant or advanced practice registered nurse informed the patient of all material facts and information required by paragraph (a).

The physician , physician assistant or advanced practice registered nurse shall, to the extent practicable, provide a copy of the statement signed by the physician , physician assistant or advanced practice registered nurse to the patient.

The statement signed by the physician , physician assistant or advanced practice registered nurse pursuant to this paragraph shall be deemed a health care record.

(c) Within 15 days after making such a determination, provide to the Department a copy of the statement signed by the physician , physician assistant or advanced practice registered nurse pursuant to paragraph (b).

A statement received by the Department pursuant to this paragraph:

may be disclosed to the patient;

andat the contents of the statement (2) May be used by the Department solely to determine the eligibility of the patient to operate a vehicle on the streets and highways of this State.

ExceptNo asperson otherwisemay providedbe inappointed subsectionas 1, a physicianmember ,of athe physicianBoard assistantto orserve anfor advancedmore practicethan registeredtwo nurseconsecutive isfull notterms, requiredbut toa notifyperson themay Departmentbe aboutreappointed aafter patientthe wholapse hasof been4 diagnosedyears. with epilepsy.

No cause of action may be brought against a physician , a physician assistant or an advanced practice registered nurse based on the fact that he or she did not notify the Department about a patient who has been diagnosed with epilepsy unless the physician , physician assistant or advanced practice - *AB364_R1* – 4 – registered nurse does not comply with the requirements set forth in subsection 1.

3.

No cause of action may be brought against a physician , a physician assistant or an advanced practice registered nurse based on the fact that he or she provided a copy of a statement pursuant to subsection 1 unless the physician , physician assistant or advanced practice registered nurse acted with malice, intentional misconduct, gross negligence or intentional or knowing violation of the law.

4.

As used in this section:

(a) “Department” means the Department of Motor Vehicles.

(b) “Patient” means a person who consults or is examined or interviewed by a physician , a physician assistant or an advanced practice registered nurse for the purposes of diagnosis or treatment.

NRS 629.550 is hereby amended to read as follows:

629.550 1.

If a patient communicates to a mental health professional an explicit threat of imminent serious physical harm or death to a clearly identified or identifiable person and, in the judgment of the mental health professional, the patient has the intent and ability to carry out the threat, the mental health professional shall place the patient on a mental health crisis hold pursuant to NRS 433A.160, petition for a court to order the placement of the patient on a mental health crisis hold pursuant to NRS 433A.155 or make a reasonable effort to communicate the threat in a timely manner to:

(a) The person who is the subject of the threat;

(b) The law enforcement agency with the closest physical location to the residence of the person;

and (c) If the person is a minor, the parent or guardian of the person.

2.

A mental health professional shall be deemed to have made a reasonable effort to communicate a threat pursuant to subsection 1 if:

(a) The mental health professional actually communicates the threat in a timely manner;

or (b) The mental health professional makes a good faith attempt to communicate the threat in a timely manner and the failure to actually communicate the threat in a timely manner does not result from the negligence or recklessness of the mental health professional.

3.

A mental health professional who exercises reasonable care in determining that he or she:

(a) Has a duty to take an action described in subsection 1 is not subject to civil or criminal liability or disciplinary action by a professional licensing board for disclosing confidential or privileged information.

- *AB364_R1* – 5 – (b) Does not have a duty to take an action described in subsection 1 is not subject to civil or criminal liability or disciplinary action by a professional licensing board for any damages caused by the actions of a patient.

4.

The provisions of this section do not:

(a) Limit or affect the duty of the mental health professional to report child abuse or neglect pursuant to NRS 432B.220 or the commercial sexual exploitation of a child pursuant to NRS 432C.110;

or (b) Modify any duty of a mental health professional to take precautions to prevent harm by a patient:

(1) Who is in the custody of a hospital or other facility where the mental health professional is employed;

or (2) Who is being discharged from such a facility.

5.

As used in this section, “mental health professional” includes:

(a) A physician , [or] psychiatrist or physician assistant licensed [to practice medicine] in this State pursuant to chapter 630 or 633 of NRS;

(b) A psychologist who is licensed to practice psychology pursuant to chapter 641 of NRS or authorized to practice psychology in this State pursuant to the Psychology Interjurisdictional Compact enacted in NRS 641.227;

(c) A social worker who:

(1) Holds a master’s degree in social work;

(2) Is licensed as a clinical social worker pursuant to chapter 641B of NRS;

and (3) Is employed by the Division of Public and Behavioral Health of the Department of Health and Human Services;

(d) A registered nurse who:

(1) Is licensed to practice professional nursing pursuant to chapter 632 of NRS;

and (2) Holds a master’s degree in psychiatric nursing or a related field;

(e) A marriage and family therapist licensed pursuant to chapter 641A of NRS;

(f) A clinical professional counselor licensed pursuant to chapter 641A of NRS;

and (g) A person who is working in this State within the scope of his or her employment by the Federal Government, including, without limitation, employment with the Department of Veterans Affairs, the military or the Indian Health Service, and is:

(1) Licensed or certified as a physician, physician assistant, psychologist, marriage and family therapist, clinical professional - *AB364_R1* – 6 – counselor, alcohol and drug counselor or clinical alcohol and drug counselor in another state;

(2) Licensed as a social worker in another state and holds a master’s degree in social work;

or (3) Licensed to practice professional nursing in another state and holds a master’s degree in psychiatric nursing or a related field.

Sec.

3.

NRS 629.600 is hereby amended to read as follows:

629.600 1.

A psychotherapist shall not provide any conversion therapy to a person who is under 18 years of age regardless of the willingness of the person or his or her parent or legal guardian to authorize such therapy.

2.

Any violation of subsection 1 is a ground for disciplinary action by a state board that licenses a psychotherapist as defined in subsection 3.

3.

As used in this section:

(a) “Conversion therapy” means any practice or treatment that seeks to change the sexual orientation or gender identity of a person, including, without limitation, a practice or treatment that seeks to change behaviors or gender expressions or to eliminate or reduce sexual or romantic attractions or feelings toward persons of the same gender.

The term does not include counseling that:

(1) Provides assistance to a person undergoing gender transition;

or (2) Provides acceptance, support and understanding of a person or facilitates a person’s ability to cope, social support and identity exploration and development, including, without limitation, an intervention to prevent or address unlawful conduct or unsafe sexual practices that is neutral as to the sexual-orientation of the person receiving the intervention and does not seek to change the sexual orientation or gender identity of the person receiving the intervention.

(b) “Psychotherapist” means:

(1) A psychiatrist licensed to practice medicine in this State pursuant to chapter 630 of NRS;

(2) A homeopathic physician, advanced practitioner of homeopathy or homeopathic assistant licensed or certified pursuant to chapter 630A of NRS;

(3) A psychiatrist licensed to practice medicine in this State pursuant to chapter 633 of NRS;

(4) A physician assistant licensed pursuant to chapter 630 or 633 of NRS practicing in the specialty of psychiatry;

(5) A psychologist licensed to practice in this State pursuant to chapter 641 of NRS;

- *AB364_R1* – 7 – [(5)] (6) A social worker licensed in this State as an independent social worker or a clinical social worker pursuant to chapter 641B of NRS;

[(6)] (7) A registered nurse holding a master’s degree in the field of psychiatric nursing and licensed to practice professional nursing in this State pursuant to chapter 632 of NRS;

[(7)] (8) A marriage and family therapist or clinical professional counselor licensed in this State pursuant to chapter 641A of NRS;

or [(8)] (9) A person who provides counseling services as part of his or her training for any of the professions listed in subparagraphs (1) to [(7),] (8), inclusive.

Sec.

4.

Chapter 630 of NRS is hereby amended by adding thereto a new section to read as follows:

1.

A physician assistant may practice at:

(a) A medical facility, any facility licensed pursuant to chapter 449 of NRS or any facility that has established a system for evaluating the credentials of and granting practice privileges to physician assistants;

(b) A facility or medical practice owned by a physician or osteopathic physician or a group of physicians or osteopathic physicians;

(c) A federally-qualified health center, as defined in 42 U.S.C.

§ 1396d(l)(2)(B);

(d) A correctional facility or institution;

(e) A state, county, city or district health department;

or (f) Any other location authorized by regulation of the Board.

2.

A physician assistant who has practiced as a physician assistant for less than 6,000 hours shall enter into a written collaborative agreement with a physician that prescribes the manner in which the physician and physician assistant will collaborate.

Upon request of the Board, the physician assistant shall provide the collaborative agreement to the Board.

3.

A physician assistant who changes the field of medicine within which the physician assistant practices must enter into a written collaborative agreement with a physician pursuant to subsection 2 until the physician assistant has practiced as a physician assistant in that field of medicine for not less than 6,000 hours.

Sec.

5.

NRS 630.015 is hereby amended to read as follows:

630.015 “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 - *AB364_R1* – 8 – services [under the supervision of a supervising physician] and who has been issued a license by the Board.

Sec.

6.

(Deleted by amendment.) Sec.

7.

[Six]Six Five members of the Board must be persons who are licensed to practice medicine in this State, are actually engaged in the practice of medicine in this State and have resided and practiced medicine in this State for at least 5 years preceding their respective appointments.

One member of the Board must be a person who is licensed to engage in the practice of respiratory care in this State, is actually engaged in the practice of respiratory care in this State and has resided and practiced respiratory care in this State for at least 5 years preceding his or her appointment.

- 82nd Session (2023) – 2 – 4.

This membermem[3.] must5. not be licensed under the provisions of this chapter.

[3.]The 4.remaining two members of the Board must bechapter.

The remaining two members of the Board must be persons who have resided in this State for at least 5 years and who:

[4.] 5.6.

8.

NRS 630.075 is hereby amended to read as follows:

630.075 The Board may, by majority vote, select physicians , physician assistants and members of the public, who must meet the same qualifications as required for members of the Board, to serve as advisory members of the Board.

One or more advisory members may be designated by the Board to assist a committee of its members in an investigation as provided in NRS 630.311 but may not vote on any matter before the committee.

Advisory members may also serve as members of the panel selected to hear charges as provided in NRS 630.339 and may vote on any recommendation made by the panel to the Board.

Sec.

9.

NRS 630.253 is hereby amended to read as follows:

630.253 1.

The Board shall, as a prerequisite for the:

- *AB364_R1* – 9 – (a) Renewal of a license as a physician assistant;

or (b) Biennial registration of the holder of a license to practice medicine,  require each holder to submit evidence of compliance with the requirements for continuing education as set forth in regulations adopted by the Board.

2.

These requirements:

(a) May provide for the completion of one or more courses of instruction relating to risk management in the performance of medical services.

(b) Must provide for the completion of a course of instruction, within 2 years after initial licensure, relating to the medical consequences of an act of terrorism that involves the use of a weapon of mass destruction.

The course must provide at least 4 hours of instruction that includes instruction in the following subjects:

(1) An overview of acts of terrorism and weapons of mass destruction;

(2) Personal protective equipment required for acts of terrorism;

(3) Common symptoms and methods of treatment associated with exposure to, or injuries caused by, chemical, biological, radioactive and nuclear agents;

(4) Syndromic surveillance and reporting procedures for acts of terrorism that involve biological agents;

and (5) An overview of the information available on, and the use of, the Health Alert Network.

(c) Must provide for the completion by a holder of a license to practice medicine of a course of instruction within 2 years after initial licensure that provides at least 2 hours of instruction on evidence-based suicide prevention and awareness as described in subsection 6.

(d) Must provide for the completion of at least 2 hours of training in the screening, brief intervention and referral to treatment approach to substance use disorder within 2 years after initial licensure.

(e) Must provide for the biennial completion by each psychiatrist and each physician assistant [practicing under the supervision of a psychiatrist of] who practices in the specialty of psychiatry one or more courses of instruction that provide at least 2 hours of instruction relating to cultural competency and diversity, equity and inclusion.

Such instruction:

(1) May include the training provided pursuant to NRS 449.103, where applicable.

- *AB364_R1* – 10 – (2) Must be based upon a range of research from diverse sources.

(3) Must address persons of different cultural backgrounds, including, without limitation:

(I) Persons from various gender, racial and ethnic backgrounds;

(II) Persons from various religious backgrounds;

(III) Lesbian, gay, bisexual, transgender and questioning persons;

(IV) Children and senior citizens;

(V) Veterans;

(VI) Persons with a mental illness;

(VII) Persons with an intellectual disability, developmental disability or physical disability;

and (VIII) Persons who are part of any other population that a psychiatrist or a physician assistant [practicing under the supervision of a psychiatrist] who practices in the specialty of psychiatry may need to better understand, as determined by the Board.

(f) Must allow the holder of a license to receive credit toward the total amount of continuing education required by the Board for the completion of a course of instruction relating to genetic counseling and genetic testing.

The Boardamendatory mayprovisions determineof whethersections to1 includeand in2 aof programthis ofact continuingdo educationnot coursesaffect the current term of instructionappointment relatingof toany theperson medicalwho, consequencesbefore ofthe aneffective actdate of terrorismthis thatact, involvesis thea usemember of athe weaponBoard of massMedical destructionExaminers, inand additioneach member continues to serve until the courseexpiration of instructionhis requiredor byher paragraphterm (b)or ofuntil subsectionthe 2.member vacates his or her office, whichever occurs first.

4.On and after the effective date of this act, the Governor shall make appointments to the Board of Medical Examiners in accordance with NRS 630.060, as amended by section of this act.

The Board shall encourage each holder of a license who treats or cares for persons who are more than 60 years of age to receive, as a portion of their continuing education, education in geriatrics and gerontology, including such topics as:

(a) The skills and knowledge that the licensee needs to address aging issues;

(b) Approaches to providing health care to older persons, including both didactic and clinical approaches;

(c) The biological, behavioral, social and emotional aspects of the aging process;

and (d) The importance of maintenance of function and independence for older persons.

5.

The Board shall encourage each holder of a license to practice medicine to receive, as a portion of his or her continuing education, training concerning methods for educating patients about how to effectively manage medications, including, without limitation, the ability of the patient to request to have the symptom - *AB364_R1* – 11 – or purpose for which a drug is prescribed included on the label attached to the container of the drug.

6.

The Board shall require each holder of a license to practice medicine to receive as a portion of his or her continuing education at least 2 hours of instruction every 4 years on evidence-based suicide prevention and awareness, which may include, without limitation, instruction concerning:

(a) The skills and knowledge that the licensee needs to detect behaviors that may lead to suicide, including, without limitation, post-traumatic stress disorder;

(b) Approaches to engaging other professionals in suicide intervention;

and (c) The detection of suicidal thoughts and ideations and the prevention of suicide.

7.

The Board shall encourage each holder of a license to practice medicine or as a physician assistant to receive, as a portion of his or her continuing education, training and education in the diagnosis of rare diseases, including, without limitation:

(a) Recognizing the symptoms of pediatric cancer;

and (b) Interpreting family history to determine whether such symptoms indicate a normal childhood illness or a condition that requires additional examination.

8.

A holder of a license to practice medicine may not substitute the continuing education credits relating to suicide prevention and awareness required by this section for the purposes of satisfying an equivalent requirement for continuing education in ethics.

9.

Except as otherwise provided in NRS 630.2535, a holder of a license to practice medicine may substitute not more than 2 hours of continuing education credits in pain management, care for persons with an addictive disorder or the screening, brief intervention and referral to treatment approach to substance use disorder for the purposes of satisfying an equivalent requirement for continuing education in ethics.

10.

As used in this section:

(a) “Act of terrorism” has the meaning ascribed to it in NRS 202.4415.

(b) “Biological agent” has the meaning ascribed to it in NRS 202.442.

(c) “Chemical agent” has the meaning ascribed to it in NRS 202.4425.

(d) “Radioactive agent” has the meaning ascribed to it in NRS 202.4437.

(e) “Weapon of mass destruction” has the meaning ascribed to it in NRS 202.4445.

- *AB364_R1* – 12 – Sec.

10.

NRS 630.271 is hereby amended to read as follows:

630.271 1.

A physician assistant shall:

(a) Obtain the informed consent of a patient or the representative of a patient before performing any medical service for the patient;

and (b) Only perform medical services listed in subsection 2 that are within the scope of practice of the physician assistant and which the physician assistant has the necessary education, training and experience to competently perform.

2.

A physician assistant may perform [such] the following medical services [as the physician assistant is authorized to perform by his or her supervising physician.

Such services may include ordering home health care for a patient.

2.

The Board and supervising physician shall limit the authority of a physician assistant to prescribe controlled substances to those schedules of controlled substances that the supervising physician is authorized to prescribe pursuant to state and federal law.] :

(a) Obtaining a history of the health of a patient.

(b) Performing a physical examination of a patient.

(c) Providing medical treatment, including, without limitation, evaluating, diagnosing, developing a treatment plan and managing a condition of a patient.

(d) Ordering, performing and interpreting a diagnostic test or therapeutic procedure, including, without limitation, assigning the test or procedure to another person who is authorized to perform the test or procedure and supervising that person.

(e) Educating a patient on how to maintain or improve his or her health and prevent disease.

(f) Providing a consultation to a patient or writing a medical order for a patient.

(g) Examining and reporting on the health or disability of a person for purposes relating to eligibility for a local, state or federal program.

(h) Providing his or her signature, certification, stamp, verification or endorsement when a signature, certification, stamp, verification or endorsement by a physician is required, if providing such a signature, certification, stamp, verification or endorsement is within the authorized scope of practice of a physician assistant.

(i) Planning and initiating a therapeutic regimen that includes, without limitation, ordering or prescribing the following items:

(1) Medical equipment;

(2) Programs concerning the nutrition of the patient;

- *AB364_R1* – 13 – (3) Whole human blood, plasma, blood product or blood derivative for the purpose of injection or transfusion;

and (4) Diagnostic support services, including, without limitation, home health care, hospice care or physical or occupational therapy.

(j) Prescribing, ordering, dispensing and administering any medical device or drug that is not a controlled substance or dangerous drug.

(k) Prescribing, ordering, dispensing and administering dangerous drugs or controlled substances in schedules II, III, IV or V in accordance with applicable state and federal law.

3.

If a patient requires, may benefit from or requests a medical service that is beyond the scope of practice or experience, knowledge or ability of a physician assistant, the physician assistant shall collaborate with, consult with or refer the patient to another provider of health care who is authorized to perform the service.

4.

As used in this section:

(a) “Dangerous drug” has the meaning ascribed to it in NRS 454.201.

(b) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

(c) “Therapeutic regimen” means a program for the treatment of an illness that is integrated into the daily life of a patient.

11.

NRS 630.273 is hereby amended to read as follows:

630.273 The Board may issue a license as a physician assistant to an applicant who is qualified under the regulations of the Board .

[to perform medical services under the supervision of a supervising physician.] The application for a license as a physician assistant must include all information required to complete the application.

Sec.

12.

NRS 630.275 is hereby amended to read as follows:

630.275 The Board shall adopt regulations regarding the licensure of a physician assistant, including, but not limited to:

1.

The educational and other qualifications of applicants.

2.

The required academic program for applicants.

3.

The procedures for applications for and the issuance of licenses.

TheThis proceduresact deemedbecomes necessaryeffective byupon thepassage Board for applications for and theapproval. initial issuance of licenses by endorsement pursuant to NRS 630.2751 or 630.2752.

5.~~~~~ 23 - 82nd Session (2023)

[The tests or examinations of applicants required by the Board.

6.

The medical services which a physician assistant may perform, except that a physician assistant may not perform those - *AB364_R1* – 14 – specific functions and duties delegated or restricted by law to persons licensed as dentists, chiropractic physicians, podiatric physicians and optometrists under chapters 631, 634, 635 and 636, respectively, of NRS, or as hearing aid specialists.

7.] The duration, renewal and termination of licenses, including licenses by endorsement.

The Board shall not require a physician assistant to receive or maintain certification by the National Commission on Certification of Physician Assistants, or its successor organization, or by any other nationally recognized organization for the accreditation of physician assistants to satisfy any continuing education requirements for the renewal of licenses.

[8.] 6.

The grounds and procedures respecting disciplinary actions against physician assistants.

[9.

The supervision of medical services of a physician assistant by a supervising physician.

10.] 7.

A physician assistant’s use of equipment that transfers information concerning the medical condition of a patient in this State electronically, telephonically or by fiber optics, including, without limitation, through telehealth, from within or outside this State or the United States.

Sec.

13.

NRS 630.3067 is hereby amended to read as follows:

630.3067 1.

The insurer of a physician or physician assistant licensed under this chapter shall report to the Board:

(a) Any action for malpractice against the physician or physician assistant not later than 45 days after the physician or physician assistant receives service of a summons and complaint for the action;

(b) Any claim for malpractice against the physician or physician assistant that is submitted to arbitration or mediation not later than 45 days after the claim is submitted to arbitration or mediation;

and (c) Any settlement, award, judgment or other disposition of any action or claim described in paragraph (a) or (b) not later than 45 days after the settlement, award, judgment or other disposition.

2.

The Board shall report any failure to comply with subsection 1 by an insurer licensed in this State to the Division of Insurance of the Department of Business and Industry.

If, after a hearing, the Division of Insurance determines that any such insurer failed to comply with the requirements of subsection 1, the Division may impose an administrative fine of not more than $10,000 against the insurer for each such failure to report.

If the administrative fine is not paid when due, the fine must be recovered in a civil action brought by the Attorney General on behalf of the Division.

Sec.

14.

NRS 630.3068 is hereby amended to read as follows:

630.3068 1.

A physician or physician assistant shall report to the Board:

- *AB364_R1* – 15 – (a) Any action for malpractice against the physician or physician assistant not later than 45 days after the physician or physician assistant receives service of a summons and complaint for the action;

(b) Any claim for malpractice against the physician or physician assistant that is submitted to arbitration or mediation not later than 45 days after the claim is submitted to arbitration or mediation;

(c) Any settlement, award, judgment or other disposition of any action or claim described in paragraph (a) or (b) not later than 45 days after the settlement, award, judgment or other disposition;

and (d) Any sanctions imposed against the physician or physician assistant that are reportable to the National Practitioner Data Bank not later than 45 days after the sanctions are imposed.

2.

If the Board finds that a physician or physician assistant has violated any provision of this section, the Board may impose a fine of not more than $5,000 against the physician or physician assistant for each violation, in addition to any other fines or penalties permitted by law.

3.

All reports made by a physician or physician assistant pursuant to this section are public records.

Sec.

15.

NRS 630.3069 is hereby amended to read as follows:

630.3069 If the Board receives a report pursuant to the provisions of NRS 630.3067, 630.3068 or 690B.250 indicating that a judgment has been rendered or an award has been made against a physician or physician assistant regarding an action or claim for malpractice or that such an action or claim against the physician or physician assistant has been resolved by settlement, the Board shall conduct an investigation to determine whether to impose disciplinary action against the physician or physician assistant regarding the action or claim, unless the Board has already commenced or completed such an investigation regarding the action or claim before it receives the report.

Sec.

16.

NRS 630.318 is hereby amended to read as follows:

630.318 1.

If the Board or any investigative committee of the Board has reason to believe that the conduct of any physician or physician assistant has raised a reasonable question as to his or her competence to practice medicine or as a physician assistant, as applicable, with reasonable skill and safety to patients, or if the Board has received a report pursuant to the provisions of NRS 630.3067, 630.3068 or 690B.250 indicating that a judgment has been rendered or an award has been made against a physician or physician assistant regarding an action or claim for malpractice or that such an action or claim against the physician or physician assistant has been resolved by settlement, the Board or committee may order that the physician or physician assistant undergo a - *AB364_R1* – 16 – mental or physical examination, an examination testing his or her competence to practice medicine or as a physician assistant, as applicable, or any other examination designated by the Board to assist the Board or committee in determining the fitness of the physician to practice medicine [.] or the physician assistant to practice as a physician assistant, as applicable.

2.

For the purposes of this section:

(a) Every physician or physician assistant who applies for a license or who is licensed under this chapter shall be deemed to have given consent to submit to a mental or physical examination or an examination testing his or her competence to practice medicine or as a physician assistant, as applicable, when ordered to do so in writing by the Board or an investigative committee of the Board.

(b) The testimony or reports of a person who conducts an examination of a physician or physician assistant on behalf of the Board or an investigative committee of the Board pursuant to this section are not privileged communications.

3.

Except in extraordinary circumstances, as determined by the Board, the failure of a physician or physician assistant licensed under this chapter to submit to an examination when directed as provided in this section constitutes an admission of the charges against the physician [.] or physician assistant.

Sec.

17.

NRS 630.400 is hereby amended to read as follows:

630.400 1.

It is unlawful for any person to:

(a) Present to the Board as his or her own the diploma, license or credentials of another;

(b) Give either false or forged evidence of any kind to the Board;

(c) Practice medicine, perfusion or respiratory care under a false or assumed name or falsely personate another licensee;

(d) Except as otherwise provided by a specific statute, practice medicine, perfusion or respiratory care without being licensed under this chapter;

(e) Hold himself or herself out as a perfusionist or use any other term indicating or implying that he or she is a perfusionist without being licensed by the Board;

(f) [Hold] Except as otherwise provided in subsection 2, hold himself or herself out as a physician assistant or use any other term indicating or implying that he or she is a physician assistant without being licensed by the Board;

or (g) Hold himself or herself out as a practitioner of respiratory care or use any other term indicating or implying that he or she is a practitioner of respiratory care without being licensed by the Board.

- *AB364_R1* – 17 – 2.

A person who meets the qualifications for licensure as a physician assistant but who is not licensed pursuant to this chapter may refer to himself or herself as an inactive physician assistant.

3.

Unless a greater penalty is provided pursuant to NRS 200.830 or 200.840, a person who violates any provision of subsection 1:

(a) If no substantial bodily harm results, is guilty of a category D felony;

or (b) If substantial bodily harm results, is guilty of a category C felony,  and shall be punished as provided in NRS 193.130.

[3.] 4.

In addition to any other penalty prescribed by law, if the Board determines that a person has committed any act described in subsection 1, the Board may:

(a) Issue and serve on the person an order to cease and desist until the person obtains from the Board the proper license or otherwise demonstrates that he or she is no longer in violation of subsection 1.

An order to cease and desist must include a telephone number with which the person may contact the Board.

(b) Issue a citation to the person.

A citation issued pursuant to this paragraph must be in writing, describe with particularity the nature of the violation and inform the person of the provisions of this paragraph.

Each activity in which the person is engaged constitutes a separate offense for which a separate citation may be issued.

To appeal a citation, the person must submit a written request for a hearing to the Board not later than 30 days after the date of issuance of the citation.

(c) Assess against the person an administrative fine of not more than $5,000.

(d) Impose any combination of the penalties set forth in paragraphs (a), (b) and (c).

Sec.

18.

NRS 630.415 is hereby amended to read as follows:

630.415 1.

A physician or physician assistant or any agent or employee thereof shall not retaliate or discriminate unfairly against:

(a) An employee of the physician or physician assistant or a person acting on behalf of the employee who in good faith:

(1) Reports to the Board of Medical Examiners information relating to the conduct of the physician or physician assistant which may constitute grounds for initiating disciplinary action against the physician or physician assistant or which otherwise raises a reasonable question regarding the competence of the physician to practice medicine with reasonable skill and safety to patients [;] or the competence of the physician assistant to practice as a - *AB364_R1* – 18 – physician assistant with reasonable skill and safety to patients, as applicable;

or (2) Reports a sentinel event to the Division of Public and Behavioral Health of the Department of Health and Human Services pursuant to NRS 439.835;

(b) A registered nurse, licensed practical nurse, nursing assistant or medication aide - certified who is employed by or contracts to provide nursing services for the physician or physician assistant and who:

(1) In good faith, reports to the physician [,] or physician assistant, the Board of Medical Examiners, the State Board of Nursing, the Legislature or any committee thereof or any other governmental entity:

(I) Any information concerning the willful conduct of another registered nurse, licensed practical nurse, nursing assistant or medication aide - certified which violates any provision of chapter 632 of NRS or which is required to be reported to the State Board of Nursing;

(II) Any concerns regarding patients who may be exposed to a substantial risk of harm as a result of the failure of the physician or physician assistant or any agent or employee thereof to comply with minimum professional or accreditation standards or applicable statutory or regulatory requirements;

or (III) Any other concerns regarding the physician [,] or physician assistant, the agents and employees thereof or any situation that reasonably could result in harm to patients;

or (2) Refuses to engage in conduct that would violate the duty of the registered nurse, licensed practical nurse, nursing assistant or medication aide - certified to protect patients from actual or potential harm, including, without limitation, conduct which would violate any provision of chapter 632 of NRS or which would subject the registered nurse, licensed practical nurse, nursing assistant or medication aide - certified to disciplinary action by the State Board of Nursing;

or (c) An employee of the physician [,] or physician assistant, a person acting on behalf of the employee or a registered nurse, licensed practical nurse, nursing assistant or medication aide - certified who is employed by or contracts to provide nursing services for the physician or physician assistant and who cooperates or otherwise participates in an investigation or proceeding conducted by the Board of Medical Examiners or another governmental entity relating to conduct described in paragraph (a) or (b).

2.

A physician or physician assistant or any agent or employee thereof shall not retaliate or discriminate unfairly against an - *AB364_R1* – 19 – employee of the physician or physician assistant or a registered nurse, licensed practical nurse, nursing assistant or medication aide - certificate who is employed by or contracts to provide nursing services for the physician or physician assistant because the employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified has taken an action described in subsection 1.

3.

A physician or physician assistant or any agent or employee thereof shall not prohibit, restrict or attempt to prohibit or restrict by contract, policy, procedure or any other manner the right of an employee of the physician or physician assistant or a registered nurse, licensed practical nurse, nursing assistant or medication aide - certified who is employed by or contracts to provide nursing services for the physician or physician assistant to take an action described in subsection 1.

4.

As used in this section:

(a) “Good faith” means honesty in fact in the reporting of the information or in the cooperation of the investigation concerned.

(b) “Retaliate or discriminate”:

(1) Includes, without limitation, any of the following actions if taken solely because the employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified took an action described in subsection 1:

(I) Frequent or undesirable changes in the location where the person works;

(II) Frequent or undesirable transfers or reassignments;

(III) The issuance of letters of reprimand, letters of admonition or evaluations of poor performance;

(IV) A demotion;

(V) A reduction in pay;

(VI) The denial of a promotion;

(VII) A suspension;

(VIII) A dismissal;

(IX) A transfer;

or (X) Frequent changes in working hours or workdays.

(2) Does not include an action described in sub- subparagraphs (I) to (X), inclusive, of subparagraph (1) if the action is taken in the normal course of employment or as a form of discipline.

Sec.

19.

NRS 630.417 is hereby amended to read as follows:

630.417 1.

An employee of a physician or physician assistant or a registered nurse, licensed practical nurse, nursing assistant or medication aide - certified who is employed by or contracts to provide nursing services for the physician or physician assistant and who believes that he or she has been retaliated or - *AB364_R1* – 20 – discriminated against in violation of NRS 630.415 may file an action in a court of competent jurisdiction.

2.

If a court determines that a violation of NRS 630.415 has occurred, the court may award such damages as it determines to have resulted from the violation, including, without limitation:

(a) Compensatory damages;

(b) Reimbursement of any wages, salary, employment benefits or other compensation denied to or lost by the employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified as a result of the violation;

(c) Attorney’s fees and costs, including, without limitation, fees for expert witnesses;

and (d) Punitive damages, if the facts warrant.

3.

The court shall award interest on the amount of damages at a rate determined pursuant to NRS 17.130.

4.

The court may grant any equitable relief it considers appropriate, including, without limitation, reinstatement of the employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified and any temporary, preliminary or permanent injunctive relief.

5.

If any action to retaliate or discriminate is taken against an employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified within 60 days after the employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified takes any action described in subsection 1 of NRS 630.415, there is a rebuttable presumption that the action taken against the employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified constitutes retaliation or discrimination in violation of NRS 630.415.

6.

A physician or physician assistant or any agent or employee thereof that violates the provisions of NRS 630.415 is subject to a civil penalty of not more than $10,000 for each violation.

The Attorney General or any district attorney of this State may recover the penalty in a civil action brought in the name of the State of Nevada in any court of competent jurisdiction.

7.

Any action under this section must be brought not later than 2 years after the date of the last event constituting the alleged violation for which the action is brought.

8.

As used in this section, “retaliate or discriminate” has the meaning ascribed to it in NRS 630.415.

Sec.

20.

NRS 630A.090 is hereby amended to read as follows:

630A.090 1.

This chapter does not apply to:

- *AB364_R1* – 21 – (a) The practice of dentistry, chiropractic, Oriental medicine, podiatry, optometry, perfusion, respiratory care, faith or Christian Science healing, nursing, veterinary medicine or fitting hearing aids.

(b) A medical officer of the Armed Forces or a medical officer of any division or department of the United States in the discharge of his or her official duties, including, without limitation, providing medical care in a hospital in accordance with an agreement entered into pursuant to NRS 449.2455.

(c) Licensed or certified nurses in the discharge of their duties as nurses.

(d) Homeopathic physicians who are called into this State, other than on a regular basis, for consultation or assistance to any physician licensed in this State, and who are legally qualified to practice in the state or country where they reside.

(e) Physician assistants licensed pursuant to chapter 630 or 633 of NRS.

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:

(a) Gratuitous services of a person in case of emergency.

(b) The domestic administration of family remedies.

4.

This chapter does not authorize a homeopathic physician to practice medicine, including allopathic medicine, except as otherwise provided in NRS 630A.040.

Sec.

21.

NRS 632.473 is hereby amended to read as follows:

632.473 1.

A nurse licensed pursuant to the provisions of this chapter, while working at an institution of the Department of Corrections, may treat patients, including the administration of a dangerous drug, poison or related device, pursuant to orders given by a physician assistant if those orders are given pursuant to a protocol approved by the Board of Medical Examiners .

[and the supervising physician.

The orders must be cosigned by the supervising physician or another physician within 72 hours after treatment.] 2.

A copy of the protocol under which orders are given by a physician assistant must be available at the institution for review by the nurse.

3.

[This section does not authorize a physician assistant to give orders for the administration of any controlled substance.

4.] For the purposes of this section:

(a) “Physician assistant” means a physician assistant licensed by the Board of Medical Examiners pursuant to chapter 630 of NRS who:

(1) Is employed at an institution of the Department of Corrections;

- *AB364_R1* – 22 – (2) Has been awarded a bachelor’s degree from a college or university recognized by the Board of Medical Examiners;

and (3) Has received at least 40 hours of instruction regarding the prescription of medication as a part of either his or her basic educational qualifications or a program of continuing education approved by the Board of Medical Examiners.

(b) “Protocol” means the written directions for the assessment and management of specified medical conditions, including the drugs and devices the physician assistant is authorized to order .

[, which the physician assistant and the supervising physician have agreed upon as a basis for their practice.

(c) “Supervising physician” has the meaning ascribed to it in NRS 630.025.] Sec.

22.

NRS 632.474 is hereby amended to read as follows:

632.474 A registered nurse who is authorized by a physician , physician assistant or advanced practice registered nurse pursuant to NRS 440.415 may make a pronouncement of death.

Sec.

23.

Chapter 633 of NRS is hereby amended by adding thereto a new section to read as follows:

1.

A physician assistant shall practice at:

(a) A medical facility, any other facility licensed pursuant to chapter 449 of NRS or any facility that has established a system for evaluating the credentials of and granting practice privileges to physician assistants;

(b) A facility or medical practice owned by a physician or osteopathic physician or a group of physicians or osteopathic physicians;

(c) A federally-qualified health center, as defined in 42 U.S.C.

§ 1396d(l)(2)(B);

(d) A correctional facility or institution;

(e) A state, county, city or district health department;

or (f) Any other location authorized by regulation of the Board.

2.

A physician assistant who has practiced as a physician assistant for less than 6,000 hours shall enter into a written collaborative agreement with an osteopathic physician that prescribes the manner in which the osteopathic physician and physician assistant will collaborate.

Upon request of the Board, the physician assistant shall provide the collaborative agreement to the Board.

3.

A physician assistant who changes the field of medicine within which the physician assistant practices must enter into a written collaborative agreement with a physician pursuant to subsection 2 until the physician assistant has practiced as a physician assistant in that field of medicine for not less than 6,000 hours.

- *AB364_R1* – 23 – Sec.

24.

NRS 633.107 is hereby amended to read as follows:

633.107 “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 osteopathic physician] and who has been issued a license by the Board.

Sec.

25.

NRS 633.161 is hereby amended to read as follows:

633.161 1.

Osteopathic physicians and physician assistants have the same rights as physicians or physician assistants, as applicable, of other schools of medicine in all respects, including but not limited to the treatment of patients and the holding of offices in public institutions.

2.

All state and local government regulations relative to the reporting of births and deaths in any matter pertaining to the public health apply to osteopathic physicians and physician assistants with the same effect as to physicians or physician assistants, as applicable, of other schools of medicine.

Such reports by osteopathic physicians and physician assistants shall be accepted by the officers of the agency to which they are made.

Sec.

26.

NRS 633.432 is hereby amended to read as follows:

633.432 1.

A physician assistant shall:

(a) Obtain the informed consent of a patient or the representative of a patient before performing any medical service for the patient;

and (b) Only perform medical services listed in subsection 2 that are within the scope of practice of the physician assistant and which the physician assistant has the necessary education, training and experience to competently perform the service.

2.

A physician assistant may perform [such] the following medical services [as the physician assistant is authorized to perform by his or her supervising osteopathic physician and are within the supervising osteopathic physician’s scope of practice.

Such services may include ordering home health care for a patient.

2.

The Board and supervising osteopathic physician shall limit the authority of a physician assistant to prescribe controlled substances to those schedules of controlled substances that the supervising osteopathic physician is authorized to prescribe pursuant to state and federal law.] :

(a) Obtaining a history of the health of a patient.

(b) Performing a physical examination of a patient.

(c) Providing medical treatment, including, without limitation, evaluating, diagnosing, developing a treatment plan and managing a condition of a patient.

- *AB364_R1* – 24 – (d) Ordering, performing and interpreting a diagnostic test or therapeutic procedure, including, without limitation, assigning the test or procedure to another person who is authorized to perform the test or procedure and supervising that person.

(e) Educating a patient on how to maintain or improve his or her health and prevent disease.

(f) Providing a consultation to a patient or writing a medical order for a patient.

(g) Examining and reporting on the health or disability of a person for purposes relating to eligibility for a local, state or federal program.

(h) Providing his or her signature, certification, stamp, verification or endorsement when a signature, certification, stamp, verification or endorsement by an osteopathic physician is required, if providing such a signature, certification, stamp, verification or endorsement is within the authorized scope of practice of a physician assistant.

(i) Planning and initiating a therapeutic regimen that includes, without limitation, ordering or prescribing the following items:

(1) Medical equipment;

(2) Programs concerning the nutrition of the patient;

(3) Whole human blood, plasma, blood product or blood derivative for the purpose of injection or transfusion;