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'Telemedicine' plan gets cool reception: Medical board might not have legal footing
RENO, Nov 07, 2009 (Las Vegas Review-Journal - McClatchy-Tribune Information Services via COMTEX) --
A California company might become the first from another state to practice "telemedicine" in Nevada.
The Board of Medical Examiners was told Friday by its lawyers that it cannot prevent the Clinician Medical Group of Bakersfield from using television technology to treat Nevadans.
Board lawyers Edward Cousineau and Lyn Beggs said state laws allow the company to do so.
A representative of Clinician Medical Group told the medical board that his company wants to use video teleconferencing equipment to treat patients in "medically underserved" areas of Nevada.
Thomas Bell, chief executive officer of the group, said telemedicine allows rural Nevadans to be treated by medical specialists and other doctors who do not have offices in their communities.
He said an endocrinologist at his company's headquarters might use teleconferencing equipment to treat a patient at a clinic or hospital in Winnemucca, a small town in Northern Nevada.
A nurse or a physician's assistant would be with the patient, while the doctor was hundreds of miles away.
The state law allowing telemedicine, however, does not restrict out-of-state doctors from treating patients only in poor rural communities. They could use the technology in wealthier and more populous urban areas such as Reno and Las Vegas.
Almost immediately after listening to Bell's presentation, board members and Douglas Cooper, the board's interim executive director, raised objections.
Cooper said the California physicians would need to be licensed in Nevada. And to issue prescriptions, they would be required by law to "physically" examine the patient at least once every six months.
Bell said his doctors are prepared to take steps to secure Nevada licenses, but questioned whether a doctor who practices telemedicine must be physically present with the patients.
"These cameras can zoom in on parts of the body," he said.
Board members and other doctors clearly were worried about the proposal.
"This is a big issue," said Dr. Michael Fischer, a member of the medical board.
Fischer suggested the board assign board members or staff to study the effects of the California telemedicine plan.
"We are deciding whether telemedicine from outside Nevada is a good idea," said Dr. Charles Held, the board chairman.
But Cousineau said the board lacks that authority because "nothing in state law prevents them (the California company) from practicing telemedicine."
Bell said teleconferencing equipment -- which the medical board itself used Friday to broadcast the meeting between Reno and Las Vegas -- costs $5,000 to $6,000.
Held said the telemedicine offered by the California company would benefit medically underserved areas such as Winnemucca, Gabbs and Mina.
But he added they scarcely can afford functioning blood pressure equipment.
"The places that need it can't afford it," he said.
Bell told the board his company has been using telemedicine to treat inmates in California prisons since 2005. It recently began working with Barton Memorial Hospital in South Lake Tahoe, Calif.
Barton has satellite facilities a few miles away in the Nevada communities of Stateline and Gardnerville that "asked for our assistance," according to Bell.
That set off Held, a Gardnerville physician.
"Gardnerville is not an underserved community," said Held, noting it has many doctors and lies only a few miles south of Carson City.
By state law, Nevada-based doctors can and have been practicing telemedicine for more than a decade.
Doctors at the University of Nevada's School of Medicine use teleconferencing equipment to assist in clinics and hospitals throughout the state, according to spokeswoman Ann McMillin.
Assistant Dean Caroline Ford said the medical school has invested millions of dollars in technology and has 50 medical sites in Nevada where telemedicine is practiced.
"Ninety-nine percent of the rural clinics and critical access hospitals and almost all tribal health centers are connected," said Ford by telephone.
Under that system, doctors not connected to the medical school can pay a fee to use the equipment to treat patients. Ford said the medical board needs to talk to the Legislature about the ramifications of doctors from other states practicing telemedicine in Nevada.
But Dr. Benjamin Rodriguez, the board's vice chairman, said he had no "problems as long as they comply with the laws of Nevada."
Beggs reiterated the board cannot block an out-of-state company from utilizing telemedicine, but she added that its physicians "certainly will need to be regulated."
In an interview, Bell said his company is exploring the possibility of telemedicine in Nevada but has no firm date of when it actually would begin.
"We are getting things lined up," he said. "We thought we would go to the board first to see if there were licensing difficulties."
Contact Capital Bureau Chief Ed Vogel at evogel@reviewjournal.com or 775-687-3901.
To see more of the Review-Journal or to subscribe to the newspaper, go to
http://www.lvrj.com. Copyright (c) 2009, Las Vegas Review-Journal Distributed by
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