[Rev. 10/20/2010 3:20:51 PM]
CHAPTER 633 - OSTEOPATHIC MEDICINE
GENERAL PROVISIONS
633.005 Definitions.
633.011 “Applicant” defined.
633.020 “Board” defined.
633.030 “Contested case” defined.
633.035 “Hearing officer” defined.
633.040 “Licensee” defined.
633.045 “Panel” defined.
633.050 “Party” defined.
STATE BOARD OF OSTEOPATHIC MEDICINE
633.100 Compensation and expenses of members.
633.110 Election of officers.
633.120 Duties of officers.
633.130 Meetings.
633.140 Communications.
LICENSING
633.160 Applications.
633.170 Hospitals approved for required internship.
633.190 Examinations: Form; notice of time and place; use of typewriters.
633.200 Examinations: General rules.
633.210 Interview required for license without examination.
633.220 Special licenses: Application; issuance; period of validity; renewal.
633.230 Special licenses: Suspension or revocation.
633.240 Special licensees not to charge fees to patients.
633.250 Continuing education required for renewal of license.
633.255 Revocation of suspended license upon failure to renew.
633.260 Licensees to file addresses with Board.
633.270 Review of and action on application; burden of proof.
OSTEOPATHIC PHYSICIANS’ ASSISTANTS
633.290 Application to employ assistant.
633.292 Procedure following receipt of application.
633.295 Required qualifications for approval of application.
633.297 Employment of assistant not yet certified.
633.300 Board to issue letter of permission; denial.
633.302 Issuance of certificate; renewal of certificate.
633.305 Change in information included in application; notification regarding termination of employment.
633.310 Renewal of letter of permission.
633.315 Amendment to letter of permission.
633.320 Employment by more than one physician prohibited; exceptions.
633.330 Prohibited acts; revocation of letter of permission; act or omission of assistant responsibility of employing physician; disciplinary action after termination of employment.
STANDARDS OF PRACTICE
633.340 Prohibited procedures and substances.
633.350 Unethical conduct.
633.360 Advertisement of practice.
633.370 Rebuttable presumption of professional incompetence.
REPORTS
633.380 Reports of certain information concerning surgeries: Submission; failure to comply with requirements.
ADMINISTRATIVE PROCEEDINGS
General Provisions
633.400 Conduct and record of hearings.
633.410 Rulings on preliminary matters.
633.420 Appearance and representation of parties.
633.430 Procedure at hearings.
633.440 Proposed findings of fact and conclusions of law.
Disciplinary Proceedings
633.450 Summary suspension of license by Board.
633.454 Hearing officer or panel: Authority of Board; duties; findings and recommendations.
633.457 Hearing officer or panel: Rulings regarding admissibility of evidence; referral of matter to Board.
633.460 Meeting or conference of parties before hearing.
633.463 Prehearing conference.
633.466 Stipulations regarding facts in issue.
633.470 Action by Board after hearing.
633.480 Decision or order by Board.
633.490 Removal of limitation on or restoration of license.
GENERAL PROVISIONS
NAC 633.005 Definitions. (NRS 633.291) As used in this chapter, unless the context otherwise requires, the words and terms defined in NAC 633.011 to 633.050, inclusive, have the meanings ascribed to them in those sections.
(Added to NAC by Bd. of Osteopathic Med. by R057-02, eff. 10-24-2002; A by R208-05, 2-23-2006)
NAC 633.011 “Applicant” defined. (NRS 633.291) “Applicant” means a person who applies for a license to practice osteopathic medicine pursuant to chapter 633 of NRS.
(Added to NAC by Bd. of Osteopathic Med. by R057-02, eff. 10-24-2002)
NAC 633.020 “Board” defined. (NRS 633.291) “Board” means the State Board of Osteopathic Medicine.
[Bd. of Osteopathic Med., Art. I § 3, eff. 9-15-80]—(NAC A by R057-02, 10-24-2002)
NAC 633.030 “Contested case” defined. (NRS 633.291) “Contested case” has the meaning ascribed to it in NRS 233B.032.
(Added to NAC by Bd. of Osteopathic Med. by R057-02, eff. 10-24-2002)
NAC 633.035 “Hearing officer” defined. (NRS 633.291) “Hearing officer” has the meaning ascribed to it in NRS 633.055.
(Added to NAC by Bd. of Osteopathic Med. by R208-05, eff. 2-23-2006)
NAC 633.040 “Licensee” defined. (NRS 633.291) “Licensee” means a person licensed to practice osteopathic medicine pursuant to chapter 633 of NRS.
(Added to NAC by Bd. of Osteopathic Med. by R057-02, eff. 10-24-2002)
NAC 633.045 “Panel” defined. (NRS 633.291) “Panel” has the meaning ascribed to it in NRS 633.105.
(Added to NAC by Bd. of Osteopathic Med. by R208-05, eff. 2-23-2006)
NAC 633.050 “Party” defined. (NRS 633.291) “Party” has the meaning ascribed to it in NRS 233B.035.
(Added to NAC by Bd. of Osteopathic Med. by R057-02, eff. 10-24-2002)
STATE BOARD OF OSTEOPATHIC MEDICINE
NAC 633.100 Compensation and expenses of members. (NRS 633.241, 633.291)
1. Except as otherwise provided in subsection 2, the compensation of the members of the Board is $80 for each day spent in the discharge of official duties. While engaged in the business of the Board, each member and employee of the Board is entitled to receive the per diem allowance and travel expenses provided for state officers and employees generally.
2. The Board will, after notifying each of its members, reduce the amount of the compensation, per diem allowance and travel expenses authorized for payment to the members of the Board, if the financial resources of the Board warrant the reduction.
[Bd. of Osteopathic Med., Art. II § 2, eff. 9-15-80]—(NAC A 12-13-91)
NAC 633.110 Election of officers. (NRS 633.221, 633.291) The Board will elect its officers by a majority vote of the members at a meeting on a date to be fixed by the Board.
[Bd. of Osteopathic Med., Art. II § 1, eff. 9-15-80]
NAC 633.120 Duties of officers. (NRS 633.291)
1. The President is the Chief Executive Officer of the Board and presides at all meetings of the Board. He represents the Board when it is not in session, signs all papers when authorized by the Board, and performs such other duties as the nature of his office requires and which are assigned to him by the Board.
2. If the President is absent or unable to act, the duties of the office devolve upon the Vice President, and if he is also absent or unable to act, the duties devolve upon the Secretary-Treasurer.
3. The Executive Director shall:
(a) Keep the books and accounts of the Board and the minutes of the meetings of the Board;
(b) Collect and receive all money belonging to the Board;
(c) Execute vouchers for the disbursement of the money;
(d) Perform such other duties as the nature of his office requires and which are assigned to him by the Board; and
(e) Keep the records of the proceedings of the Board relating to the issuance, refusal, renewal, suspension or revocation of licenses to practice osteopathic medicine in the State.
[Bd. of Osteopathic Med., Art. II § 3, eff. 9-15-80]—(NAC A 12-13-91)
NAC 633.130 Meetings. (NRS 633.231, 633.291)
1. The Board will hold at least three meetings per year at a time and place to be determined by the Board.
2. The Executive Director shall give each member written notice of each meeting, containing an agenda of the meeting, not later than 10 days before the meeting, and shall post and mail copies in the manner prescribed by chapter 241 of NRS. Any proper business may be conducted at a regular meeting if it is provided for in the published agenda.
3. The President may call and, at the request of a majority of the members, shall call a special meeting on 5 days’ written notice by certified mail to all other members at any place where or time when a regular meeting could have been convened. The President, in calling a special meeting, shall post and mail the notice containing an agenda pursuant to chapter 241 of NRS.
[Bd. of Osteopathic Med., Art. II § 4, eff. 9-15-80]—(NAC A 12-13-91)
NAC 633.140 Communications. (NRS 633.291) Each communication to a member of the Board which relates to the affairs of the Board and a copy of the member’s reply will immediately be placed in the records of the Board.
[Bd. of Osteopathic Med., Art. I § 5, eff. 9-15-80]
LICENSING
NAC 633.160 Applications. (NRS 633.291, 633.321)
1. Each applicant for a license to practice osteopathic medicine must apply on forms prepared and furnished by the Board.
2. On or after January 1, 2003, each application must be accompanied by:
(a) A physician information profile prepared by the Federation Credentials Verification Service of the Federation of State Medical Boards of the United States; and
(b) An affidavit affirming that:
(1) The applicant is the person named in the application and accompanying material; and
(2) To the best knowledge or belief of the applicant, the application and all accompanying material is complete, correct and consistent, and was obtained without fraud, misrepresentation or mistake.
3. No application will be accepted unless it is accompanied by the appropriate fee prescribed in NRS 633.501. All fees are nonrefundable.
[Bd. of Osteopathic Med., Art. III §§ 1 & 2, eff. 9-15-80]—(NAC A by R057-02, 10-24-2002)
NAC 633.170 Hospitals approved for required internship. (NRS 633.291) The hospitals currently approved by the Bureau of Professional Education of the American Osteopathic Association for the training of interns are approved by the Board.
[Bd. of Osteopathic Med., Art. V § 1, eff. 9-15-80]
NAC 633.190 Examinations: Form; notice of time and place; use of typewriters. (NRS 633.291, 633.331)
1. An examination may be written, oral, demonstrative or any combination thereof which the Board determines.
2. The Board will, at least 15 days before the date set for an examination, notify each applicant in writing of the time and place of his examination.
3. The Board may, upon request, give permission to applicants to use typewriters in writing examinations.
[Bd. of Osteopathic Med., Art. VI §§ 1-3, eff. 9-15-80]
NAC 633.200 Examinations: General rules. (NRS 633.291, 633.331)
1. The questions for an examination may be prepared by the National Board of Osteopathic Examiners, a professional testing service selected by the Board, or by the Board itself, in its sole discretion.
2. Each applicant must furnish his own pen and ink or typewriter. The Board will furnish all other materials for the examination except texts or other reference materials.
3. Each applicant will be assigned a number before the examination.
4. The applicant must use the number assigned to him on all the papers used in the examination and must not use his name.
5. During the examination an applicant may not have on the table on which he is writing any paper or object other than the examination questions and tablet, a blotter, pen and ink, typewriter, eraser, watch and any testing materials supplied by the Board.
6. Immediately after correcting all written examinations or upon completion of an oral or demonstrative examination, each examiner shall forward his report to the Secretary-Treasurer of the Board.
7. After completing all returns of the examination, the Secretary-Treasurer will notify applicants of the results of the examination and issue licenses to successful applicants.
8. An applicant will not be licensed if he fails two or more subjects on the examination, even though he has received a passing grade on the examination as a whole.
9. Any applicant who is reexamined and receives a passing grade on all subjects except one is deemed to have passed the examination.
[Bd. of Osteopathic Med., Art. VI § 4, eff. 9-15-80]
NAC 633.210 Interview required for license without examination. (NRS 633.291, 633.361)
1. Each applicant must appear before the Board for a personal interview at the time his application is considered, and may be required to pass an oral examination.
2. An application for a license without examination is ineffective if the applicant fails to appear at the time and place scheduled for a personal interview by the Board. The applicant must refile his application before the Board will schedule another interview. The Board will reschedule a personal interview within 1 year after it receives a request for rescheduling which sets forth sufficient reasons for the applicant’s prior inability to attend.
[Bd. of Osteopathic Med., Art. VII § 1, eff. 9-15-80]
NAC 633.220 Special licenses: Application; issuance; period of validity; renewal. (NRS 633.291, 633.401, 633.411)
1. The Board may issue a special license to any person designated in subsection 1 of NRS 633.401 and in subsection 1 of NRS 633.411 who applies for a special license and includes with his application a letter from the regulatory authority of the jurisdiction where he is licensed to practice osteopathic medicine which verifies that the applicant holds a current license.
2. In addition to the letter required by subsection 1, an applicant under NRS 633.411 must submit a letter from any one of the following persons requesting that he be given a special license:
(a) The chief of staff or the medical director of the hospital or institution where the applicant proposes to practice osteopathic medicine. The letter must also specify the members of the medical staff under whose supervision the applicant will practice. Any special license issued to the applicant will limit his practice to that hospital or institution.
(b) The chief of the medical agency proposing to employ the applicant to practice osteopathic medicine. The letter must also describe the scope of the services proposed to be performed by the applicant and the medical licensees under whose supervision the applicant will be employed. Any special license issued will limit the scope of the applicant’s practice to those described in the letter and indicate the person under whose medical supervision the applicant will be employed.
(c) The osteopathic physician with whom the applicant proposes to associate. The letter must also state the specific period, not to exceed 1 year, and the specific purpose for which he proposes to associate the applicant, and must verify that the osteopathic physician will retain primary responsibility for the care of all patients seen by the applicant. Any special license issued to the applicant will specify the period of association, the services to be performed by the applicant and the osteopathic physician with whom the applicant is associated.
3. No special license issued by the Board is valid for a period longer than 1 year following the date of issuance.
4. A special license may be renewed from year to year by the Board upon receipt of an application which meets the requirements of NAC 633.250, is accompanied by the appropriate fee prescribed by NRS 633.501 and is received no later than 90 days before the expiration of the then current special license.
[Bd. of Osteopathic Med., Art. XI §§ 1 & 3, eff. 9-15-80]—(NAC A by R057-02, 10-24-2002)
NAC 633.230 Special licenses: Suspension or revocation. (NRS 633.291, 633.401, 633.411) If the license of the physician under whose supervision a special licensee is required to practice, or with whom a special licensee is associated, is suspended or revoked, the special licensee’s privilege to practice osteopathic medicine is suspended or revoked. The special licensee may apply for a new special license if the revocation or suspension did not arise from his conduct.
[Bd. of Osteopathic Med., Art. XI § 2, eff. 9-15-80]
NAC 633.240 Special licensees not to charge fees to patients. (NRS 633.291, 633.401, 633.411) A special licensee may not charge or receive fees for his services from patients, but he may receive a salary paid by his employer.
[Bd. of Osteopathic Med., Art. XI § 4, eff. 9-15-80]
NAC 633.250 Continuing education required for renewal of license. (NRS 633.291, 633.471)
1. Each licensee applying for renewal of his license shall furnish the Board proof that he has attended during the preceding year at least 35 hours of continuing education courses or programs approved by the Board, at least 10 hours of which are category 1A courses.
2. As used in this section, “category 1A course” means a course of continuing medical education that is offered by a sponsor accredited to offer such a course by the American Osteopathic Association or the Accreditation Council for Continuing Medical Education.
[Bd. of Osteopathic Med., Art. X § 1, eff. 9-15-80]—(NAC A by R057-02, 10-24-2002)
NAC 633.255 Revocation of suspended license upon failure to renew. (NRS 633.291, 633.481) A license that the Board has suspended will be revoked pursuant to NRS 633.481 if:
1. The license expires during the period of suspension; and
2. The licensee fails to renew the license as set forth in NRS 633.471.
(Added to NAC by Bd. of Osteopathic Med. by R057-02, eff. 10-24-2002)
NAC 633.260 Licensees to file addresses with Board. (NRS 633.291) Each person who holds a license to practice osteopathic medicine in this State shall file with the Board his proper and current mailing address and report immediately to the Board any change of address, giving both his old and his new address.
[Bd. of Osteopathic Med., Art. I § 4, eff. 9-15-80]
NAC 633.270 Review of and action on application; burden of proof. (NRS 633.291, 633.321)
1. The Executive Director of the Board or his designee:
(a) Shall review the application and accompanying materials submitted by an applicant to determine if there may be grounds for rejecting the application or grounds for denying the issuance of a license to the applicant; and
(b) May request the applicant to submit such additional evidence of the mental, physical, medical or other qualifications of the applicant as the Executive Director or his designee believes the Board may require.
2. Upon the completion of the review of an application by the Executive Director or his designee, the Executive Director shall:
(a) Schedule a hearing on the application at a meeting of the Board.
(b) Send written notice of the hearing to the applicant at least 21 days before the meeting. The notice must conform to subsection 2 of NRS 233B.121, be given by certified mail, postage prepaid, and be addressed to the last address furnished by the applicant. If the Executive Director has reason to believe that there are grounds for denying the issuance of a license to the applicant, the notice must include a short and plain statement that specifies each such ground.
(c) Provide a copy of the notice to each member of the Board.
3. The Board will deny the issuance of a license only after:
(a) Notice to the applicant specifying the precise grounds upon which the denial is proposed; and
(b) A hearing before the Board at which the applicant is given an opportunity to respond to each ground specified in the notice.
4. An applicant bears the burden of proving to the Board that issuing a license to him is in the best interest of the public health and safety and the general welfare of the people of this State.
5. As used in this section, “grounds for denying the issuance of a license” includes, without limitation:
(a) Any grounds authorized by a specific statute;
(b) Failure to fulfill any applicable statutory requirement;
(c) Submitting an application or accompanying material which is incomplete, incorrect or inconsistent, or which has been obtained by fraud, misrepresentation or mistake; and
(d) Engaging in any conduct that would, if committed by a licensee, be grounds for initiating disciplinary action pursuant to NRS 633.511.
[Bd. of Osteopathic Med., Art. VIII § 1, eff. 9-15-80]—(NAC A by R057-02, 10-24-2002)
OSTEOPATHIC PHYSICIANS’ ASSISTANTS
NAC 633.290 Application to employ assistant. (NRS 633.291, 633.441) An application to employ an osteopathic physician’s assistant must, in addition to meeting the requirements of NRS 633.441:
1. Contain evidence showing that the proposed assistant meets the qualifications set forth in NAC 633.295.
2. Contain evidence establishing the professional background and specialty of the applying physician; and
3. Include a certificate signed under oath by the applying physician that the assistant, if permitted, will be employed to perform professional services only on direct orders of the employing physician in the city, town or county in which the employing physician resides or in a geographical location that is approved in writing by the Board.
[Bd. of Osteopathic Med., Art. XII § 1, eff. 9-15-80]—(NAC A 9-6-96)
NAC 633.292 Procedure following receipt of application. (NRS 633.291, 633.451)
1. After completing an application to employ an osteopathic physician’s assistant pursuant to NAC 633.290, the employing osteopathic physician and the proposed assistant shall appear before the Board at its next regularly scheduled meeting for examination.
2. The Board will examine the proposed assistant to determine whether the proposed assistant meets the minimum qualifications to provide assistance to the employing physician in his practice.
3. The format of the examination may include, without limitation, written questions, oral questions, a practical examination or any combination of these methods that the Board determines to be appropriate.
(Added to NAC by Bd. of Osteopathic Med., eff. 9-6-96)
NAC 633.295 Required qualifications for approval of application. (NRS 633.291, 633.451) To qualify as an osteopathic physician’s assistant pursuant to NRS 633.451, a person must:
1. Possess the level of skill and knowledge required to assist the employing physician for whom he will be employed;
2. Possess good moral character and a good reputation;
3. Communicate in the English language orally and in writing with the level of skill necessary to carry out his duties as an assistant;
4. Have graduated from high school or have received an equivalent degree;
5. Have satisfactorily completed a program of training approved by the Board; and
6. Except as otherwise provided in NAC 633.297, be certified by the National Commission on Certification of Physician Assistants.
(Added to NAC by Bd. of Osteopathic Med., eff. 9-6-96)
NAC 633.297 Employment of assistant not yet certified. (NRS 633.291, 633.441, 633.451)
1. An osteopathic physician may submit an application to employ a person as an osteopathic physician’s assistant who is not certified by the National Commission on Certification of Physician Assistants as required pursuant to subsection 6 of NAC 633.295 if:
(a) The proposed assistant is scheduled to take the next examination for certification given by the Commission; and
(b) The proposed assistant satisfies all other qualifications for becoming an assistant.
2. After an application has been submitted to the Board pursuant to subsection 1 and the proposed assistant has successfully completed the examination administered by the Board pursuant to NAC 633.292, the Board may issue a temporary letter of permission to the employing physician and a temporary certificate to the proposed assistant. The temporary letter of permission and certificate become invalid if the assistant fails to:
(a) Take the next examination for certification administered by the Commission; or
(b) Become certified within the time specified on the temporary certificate.
(Added to NAC by Bd. of Osteopathic Med., eff. 9-6-96)
NAC 633.300 Board to issue letter of permission; denial. (NRS 633.291, 633.451)
1. The permission of the Board to a licensed osteopathic physician to employ a named person as an osteopathic physician’s assistant in his practice will be in the form of a letter of permission which will be dated and signed by the President and Secretary-Treasurer of the Board only upon the unanimous vote of the members of the Board at a regular meeting.
2. A letter of permission is not effective unless it:
(a) Names the osteopathic physician’s assistant permitted to perform services;
(b) Names the osteopathic physician for whom the services may be performed;
(c) States the city, town or county in which the assistant may perform services;
(d) Describes the specific professional services which the assistant may perform;
(e) Lists the specific type and amount of any controlled substance, poison, dangerous drug or device which the assistant may possess, administer, dispense or prescribe in or out of the presence of the employing physician; and
(f) Sets forth any other limitation or requirement on the practice of the assistant which the Board determines to be necessary.
3. The Board will not grant a letter of permission to an osteopathic physician if:
(a) The proposed assistant does not pass the examination administered by the Board pursuant to NAC 633.292;
(b) The proposed assistant does not meet the qualifications set forth in NAC 633.295;
(c) Any credential of the proposed assistant which is provided to the Board is false;
(d) The application submitted by the physician is incomplete, was provided to the Board in an improper format, or is otherwise insufficient; or
(e) The Board determines that the proposed assistant has conducted himself while outside the State of Nevada in a manner which would have resulted in the denial of a letter of permission had the act occurred within this State.
[Bd. of Osteopathic Med., Art. XII § 2, eff. 9-15-80]—(NAC A 9-6-96)
NAC 633.302 Issuance of certificate; renewal of certificate. (NRS 633.291, 633.451)
1. After a letter of permission is granted pursuant to NAC 633.300 and the appropriate fees are paid, the Board will issue a certificate to the osteopathic physician’s assistant named in the letter of permission.
2. The certificate must be renewed each year on or before December 31.
(Added to NAC by Bd. of Osteopathic Med., eff. 9-6-96)
NAC 633.305 Change in information included in application; notification regarding termination of employment. (NRS 633.291, 633.441)
1. An employing osteopathic physician shall notify the Board within 30 days after he becomes aware of a change in the information included in the application which he filed with the Board pursuant to NAC 633.290.
2. When an assistant is no longer employed by the employing physician, the physician and the assistant shall submit to the Board a summary of the reasons for and circumstances of the termination of employment within 30 days after the date on which the employment was terminated.
(Added to NAC by Bd. of Osteopathic Med., eff. 9-6-96)
NAC 633.310 Renewal of letter of permission. (NRS 633.291, 633.441, 633.451)
1. Each letter of permission concerning a physician’s assistant expires on the third anniversary of the date appearing on the letter of permission.
2. Renewal of permission to employ a physician’s assistant must be requested in the same manner as the original permission was requested.
3. No letter of permission will be issued to a physician who continues to employ a physician’s assistant after the letter of permission to employ the assistant has expired.
[Bd. of Osteopathic Med., Art. XII § 3, eff. 9-15-80]
NAC 633.315 Amendment to letter of permission. (NRS 633.291, 633.441, 633.451)
1. An employing osteopathic physician may propose an amendment to a letter of permission by submitting a written proposal to the Board. The Board will either make a determination and issue a letter approving or denying the proposed amendment or will request the employing osteopathic physician, the osteopathic physician’s assistant, or both, to appear before the Board at its next regular meeting for a determination regarding the amendment.
2. If a proposed amendment to the letter of permission includes changing the named employing osteopathic physician to a different osteopathic physician, the Executive Director may approve the amendment as a temporary change if no other information is changed and the proposed employing osteopathic physician submits:
(a) A statement agreeing to the terms of the original letter of permission; and
(b) An application pursuant to NAC 633.290 to employ the named assistant.
3. The temporary change of an employing osteopathic physician pursuant to subsection 2 is valid until the next regular meeting of the Board at which time the Board will act on the application submitted by the new employing osteopathic physician for a letter of permission.
(Added to NAC by Bd. of Osteopathic Med., eff. 9-6-96)
NAC 633.320 Employment by more than one physician prohibited; exceptions. (NRS 633.291, 633.441, 633.451)
1. An osteopathic physician’s assistant may not perform services for more than one osteopathic physician at the same time, except that he may perform services for all members of a medical corporation or firm who are licensed osteopathic physicians if the letter of permission from the Board so specifies.
2. Except as otherwise provided in NAC 633.315, upon receipt of an application for permission to employ a physician’s assistant with respect to whom a letter of permission is in effect, the letter of permission which is in effect will be cancelled by the Board, unless the applying physician is the same physician, or a member of the same medical corporation or firm, as the physician, corporation or firm named in the letter of permission which is then in effect and the provisions of the letter of permission remain unchanged.
[Bd. of Osteopathic Med., Art. XII § 4, eff. 9-15-80]—(NAC A 9-6-96)
NAC 633.330 Prohibited acts; revocation of letter of permission; act or omission of assistant responsibility of employing physician; disciplinary action after termination of employment. (NRS 633.291)
1. A person who holds a license to practice osteopathic medicine in this State shall not:
(a) Employ an osteopathic physician’s assistant without a letter of permission from the Board;
(b) Misrepresent any fact in connection with an application for permission to employ a physician’s assistant;
(c) Authorize an osteopathic physician’s assistant to work outside the geographic area described in the letter of permission, unless specifically authorized by the Board;
(d) Employ an osteopathic physician’s assistant after the expiration of a letter of permission from the Board;
(e) Employ an osteopathic physician’s assistant for any professional service not specified in the letter of permission respecting him; or
(f) Employ an osteopathic physician’s assistant after the Board or a court of competent jurisdiction issues an order suspending, revoking or limiting a license in a manner which prohibits employment of an osteopathic physician’s assistant.
2. The Board will consider the question of the revocation of any letter of permission to employ an osteopathic physician’s assistant at the time it considers the revocation, suspension or limitation of the license of any osteopathic physician without the necessity of a separate notice to the physician or the assistant, and at the same hearing.
3. The act or omission of any osteopathic physician’s assistant shall be deemed for the purpose of this chapter, unless contrary intent appears herein, the act or omission of the employing osteopathic physician.
4. An osteopathic physician’s assistant may be subject to disciplinary action after his employment as an assistant has been terminated for any complaint filed against him related to an act or omission during his employment as an osteopathic assistant.
[Bd. of Osteopathic Med., Art. XII § 5, eff. 9-15-80]—(NAC A 9-6-96)
STANDARDS OF PRACTICE
NAC 633.340 Prohibited procedures and substances. (NRS 633.131, 633.291)
1. A licensee shall not engage in any of the following procedures or use any of the following substances in his practice:
(a) The prescribing or dispensing of oral amphetamines, except for the treatment of exogenous obesity for a period of less than 30 days;
(b) The prescribing or dispensing of any injectable amphetamine; or
(c) The prescribing or dispensing of Disodium Ethylene Diamine Tetra Acetic Acid (EDTA) or the use of Chelation Therapy, except that the substance or the procedure, or both, may be used for the treatment of proven heavy metal poisoning or any other unusual or infrequent condition which the Board finds warrants its use.
Ę The use of any procedure or substance which is prohibited by this subsection is harmful to the public, detrimental to the public health, safety and morals and constitutes unprofessional conduct.
2. The use of Human Chorionic Gonadotropin (HCG) in programs for the reduction of weight constitutes the practice of experimental medicine and must not be used in a clinical practice. HCG may be used only in a bona fide research program which is approved by the Board.
[Bd. of Osteopathic Med., Art. XIII § 1, eff. 9-15-80]
NAC 633.350 Unethical conduct. (NRS 633.131, 633.291) For the purposes of this chapter and chapter 633 of NRS, a licensee engages in unethical conduct if he:
1. Engages in sexual misconduct with a patient;
2. Abandons a patient;
3. Willfully makes and files false reports, records or claims in the licensee’s practice;
4. Willfully fails to file or record a medical report required by law, willfully impedes or obstructs the filing or recording of such a report, or willfully induces another person to fail to file or record such a report;
5. Fails to generate or create medical records relating to the diagnosis, treatment and care of a patient;
6. Prescribes a controlled substance in a manner or an amount that the Board determines is excessive;
7. Fails to comply with the terms of an agreement with a diversion program approved by the Board;
8. Fails to comply with an order of the Board; or
9. Engages in any other conduct that the Board determines constitutes unfitness to practice osteopathic medicine.
(Added to NAC by Bd. of Osteopathic Med. by R057-02, eff. 10-24-2002)
NAC 633.360 Advertisement of practice. (NRS 633.131, 633.291)
1. A licensee shall not advertise the practice of osteopathic medicine in a manner that is:
(a) False; or
(b) Intended or has a tendency to:
(1) Deceive or mislead the public; or
(2) Create unrealistic expectations in any particular case.
2. Proof of actual injury is not necessary to establish a violation of subsection 1.
(Added to NAC by Bd. of Osteopathic Med. by R057-02, eff. 10-24-2002)
NAC 633.370 Rebuttable presumption of professional incompetence. (NRS 633.291, 633.561, 633.571) For the purposes of this chapter and chapter 633 of NRS, if a mental or physical examination or a medical competency examination determines that a licensee is not competent to practice osteopathic medicine with reasonable skill and safety to patients, the Board will consider that determination to constitute a rebuttable presumption of professional incompetence with regard to the licensee.
(Added to NAC by Bd. of Osteopathic Med. by R057-02, eff. 10-24-2002)
REPORTS
NAC 633.380 Reports of certain information concerning surgeries: Submission; failure to comply with requirements. (NRS 633.291, 633.524)
1. A licensee shall, on or before January 31 of each year, submit to the Board, on a form to be provided by the Board, the report required pursuant to NRS 633.524.
2. Failure to comply with the requirements of this section or NRS 633.524 may subject the licensee to disciplinary action as provided by law.
(Added to NAC by Bd. of Osteopathic Med. by R208-05, eff. 2-23-2006)
ADMINISTRATIVE PROCEEDINGS
General Provisions
NAC 633.400 Conduct and record of hearings. (NRS 633.291)
1. Each hearing of a contested case will be conducted in accordance with the provisions of this chapter and chapter 233B of NRS and, if the hearing concerns a disciplinary proceeding, chapter 622A of NRS and NRS 633.509 to 633.681, inclusive.
2. Except as otherwise provided in subsection 3, the President, or a member of the Board designated by him, will preside over the hearing.
3. If the hearing concerns a disciplinary proceeding, the Board or a hearing officer or panel designated by the Board will preside over the hearing.
4. An electronic or stenographic record will be made of all contested hearings before the Board.
[Bd. of Osteopathic Med., Art. IX §§ 1-4, eff. 9-15-80]—(NAC A by R057-02, 10-24-2002; R208-05, 2-23-2006)
NAC 633.410 Rulings on preliminary matters. (NRS 633.291)
1. The Board, the President or the member of the Board, the hearing officer or the panel designated to preside over a hearing may issue rulings on all preliminary matters, including, without limitation, scheduling matters, protective orders, the admissibility of evidence, and other procedural or prehearing matters.
2. A ruling by the President, member of the Board, hearing officer or panel on a preliminary matter is subject to reconsideration by the entire Board upon the request of a Board member or the motion of a party.
3. The failure of a party who is affected by a ruling on a preliminary matter to move for reconsideration of the ruling does not constitute:
(a) Consent to the ruling; or
(b) Waiver of any objection previously made to the ruling.
4. For the purposes of this section, a matter is preliminary if it is not dispositive of a disciplinary proceeding or other contested case or a substantive issue therein.
(Added to NAC by Bd. of Osteopathic Med. by R057-02, eff. 10-24-2002; A by R208-05, 2-23-2006)
NAC 633.420 Appearance and representation of parties. (NRS 633.291)
1. Except as otherwise provided in subsection 2, a party may appear at a hearing in person or by an attorney.
2. If the hearing concerns a contested case other than a disciplinary proceeding governed by chapter 622A of NRS, a party shall attend the hearing on the merits in person unless the President or presiding officer waives the requirement of the attendance of the party.
3. If a party who is required pursuant to subsection 2 to attend a hearing in person fails to do so without having obtained a waiver of the requirement of his attendance pursuant to subsection 2, the Board may:
(a) Determine that his failure to attend the hearing in person shall be deemed:
(1) An admission of all matters and facts contained in the record with respect to the party; and
(2) A waiver of the right to an evidentiary hearing; and
(b) Take action based upon such admission or upon any other evidence, including affidavits, without any further notice or a hearing.
4. If a party retains an attorney to represent him before the Board, the attorney shall so notify the Board not later than 10 days after he is retained. Thereafter:
(a) The attorney shall sign all motions, oppositions, notices, requests and other papers, including requests for subpoenas; and
(b) The Board will serve all notices, motions, orders, decisions, and any other papers or pleadings upon the attorney.
5. An attorney appearing as counsel in any proceeding other than a disciplinary proceeding must be an attorney at law, admitted to practice and in good standing before the highest court of any state. If the attorney is not admitted and entitled to practice before the Supreme Court of Nevada, he must be associated with an attorney so admitted and entitled to practice.
6. An attorney appearing as counsel in a disciplinary proceeding shall comply with the provisions of NRS 622A.310.
(Added to NAC by Bd. of Osteopathic Med. by R057-02, eff. 10-24-2002; A by R208-05, 2-23-2006)
NAC 633.430 Procedure at hearings. (NRS 633.291)
1. In a hearing other than a hearing concerning a disciplinary proceeding, the President or presiding officer will call the hearing to order and proceed to take the appearances on behalf of the Board, the applicant or licensee. The legal counsel for the Board will present the evidence for the Board first and, if the Board allows closing arguments, will present the closing arguments for the Board first.
2. In a hearing concerning a disciplinary proceeding, the Board, hearing officer or panel shall conduct the hearing in accordance with the provisions of NRS 622A.380.
3. The notice of hearing, any petition, answer, response or written stipulation, and, if the hearing concerns a disciplinary proceeding, the complaint or any other responsive pleading, becomes a part of the record without being read into the record, unless a party requests that the document be read into the record.
4. The Board, President, presiding officer, hearing officer or panel may, at any time:
(a) Question a witness;
(b) Request or allow additional evidence, including additional rebuttal or documentary evidence;
(c) Make proposed opinions, findings of fact and conclusions of law;
(d) Issue appropriate interim orders;
(e) Recess the hearing as required; and
(f) Set reasonable limits of time for the presentation of testimony.
5. If closing briefs are permitted, the Board, President, presiding officer, hearing officer or panel shall establish a time frame for the submission of the closing briefs.
(Added to NAC by Bd. of Osteopathic Med. by R057-02, eff. 10-24-2002; A by R208-05, 2-23-2006)
NAC 633.440 Proposed findings of fact and conclusions of law. (NRS 633.291)
1. The Board, President, hearing officer, panel or a member of the Board designated to preside over and conduct a hearing may require a party in any disciplinary proceeding or other contested case to file proposed findings of fact and conclusions of law at the close of the proceeding. The Board, President, hearing officer, panel or member of the Board shall fix the period within which the proposed findings of fact and conclusions of law must be filed.
2. Each proposed finding of fact and conclusion of law must be clearly and concisely stated and numbered. Each proposed finding of fact must specifically show, by appropriate reference to the transcript, the testimony that supports the finding.
3. The proposed findings of fact and conclusions of law, accompanied by a certificate of service, must be filed by each party with the Board, President, hearing officer, panel or member of the Board, and one copy must be served upon each party to the proceeding.
(Added to NAC by Bd. of Osteopathic Med. by R208-05, eff. 2-23-2006)
Disciplinary Proceedings
NAC 633.450 Summary suspension of license by Board. (NRS 633.291, 633.651)
1. If a complaint has been filed against a licensee pursuant to NRS 633.531, the Board may order the summary suspension of the license of the licensee pending disciplinary proceedings.
2. The Board will issue such an order if it determines that:
(a) The licensee has violated a provision of this chapter or chapter 633 of NRS;
(b) The summary suspension of the license is necessary to prevent a further violation of this chapter or chapter 633 of NRS; and
(c) The public health, safety or general welfare imperatively requires the summary suspension of the license.
3. An order summarily suspending a license:
(a) Must:
(1) Comply with the applicable provisions of NRS 233B.127; and
(2) Set forth the grounds upon which the order is issued, including a statement of facts;
(b) Is effective upon service on the licensee of the order and complaint; and
(c) Remains in effect until the Board:
(1) Modifies or rescinds the order; or
(2) Issues its final order or decision on the underlying complaint.
4. A hearing on the complaint must be held within 60 days after the effective date of the suspension.
(Added to NAC by Bd. of Osteopathic Med. by R057-02, eff. 10-24-2002)
NAC 633.454 Hearing officer or panel: Authority of Board; duties; findings and recommendations. (NRS 633.291, 633.660)
1. The Board may appoint a hearing officer or panel to preside over and conduct a hearing concerning a disciplinary proceeding in the manner set forth in chapter 622A of NRS.
2. If the Board appoints a hearing officer or panel pursuant to subsection 1, the Board may:
(a) Revoke the appointment and assume responsibility for presiding over and conducting the hearing; or
(b) Designate another hearing officer or panel to preside over and conduct the hearing.
3. If a hearing officer or panel presides over and conducts a hearing concerning a disciplinary proceeding, the hearing officer or panel shall, after the close of all evidentiary hearings, file with the Board and serve on each party to the hearing written findings and recommendations that include, without limitation:
(a) A proposed order;
(b) The findings of fact and conclusions of law of the hearing officer or panel;
(c) The reasons and bases for its findings of fact and conclusions of law; and
(d) The recommendations of the hearing officer or panel.
4. Pursuant to NRS 622A.300, the written findings and recommendations of a hearing officer or panel are subject to review by the entire Board.
5. Upon review of the written findings and recommendations of a hearing officer or panel, the Board may, subject to the provisions of NRS 233B.124 and subsection 5 of NRS 622A.300, approve, reject or modify the written findings and recommendations, in whole or in part, and may take any other action that the Board deems appropriate to resolve the case.
(Added to NAC by Bd. of Osteopathic Med. by R208-05, eff. 2-23-2006)
NAC 633.457 Hearing officer or panel: Rulings regarding admissibility of evidence; referral of matter to Board. (NRS 633.291)
1. In a disciplinary proceeding, a ruling made by a hearing officer or panel presiding over and conducting a hearing concerning the disciplinary proceeding regarding the admissibility of evidence is subject to review by the Board.
2. In extraordinary circumstances, when a prompt decision by the Board is necessary to promote substantial justice, the hearing officer or panel shall refer the matter to the Board for a determination and may recess the hearing pending the determination.
(Added to NAC by Bd. of Osteopathic Med. by R208-05, eff. 2-23-2006)
NAC 633.460 Meeting or conference of parties before hearing. (NRS 633.291)
1. The parties to a disciplinary proceeding shall meet or confer, not later than 20 days before the hearing, and:
(a) Exchange copies of all documents that each party intends to offer as evidence in support of its case.
(b) Identify, describe or produce all tangible things, other than documents, that each party intends to offer as evidence in support of its case and, if requested, arrange for the opposing party to inspect, copy, test or sample such evidence under reasonable supervision.
(c) Exchange written lists of persons that each party intends to call as witnesses in support of its case. The list must identify each witness by name and position and, if known, business address. If no business address is available, the party intending to call the witness shall disclose the home address of the witness or make the witness available for service of process. The list must also include, for each witness, a summary of the proposed testimony and the purpose for which the witness will be called.
2. As used in this section, “parties to a disciplinary proceeding” includes:
(a) A licensee who has been served with a formal complaint alleging a disciplinary violation pursuant to NRS 633.541;
(b) The attorney, if any, representing the licensee; and
(c) The legal counsel for the Board.
(Added to NAC by Bd. of Osteopathic Med. by R057-02, eff. 10-24-2002; A by R208-05, 2-23-2006)
NAC 633.463 Prehearing conference. (NRS 633.291)
1. In a disciplinary proceeding, the Board, hearing officer or panel may, upon its own motion or a motion by a party, hold a prehearing conference not later than 10 days before a hearing concerning a disciplinary proceeding to:
(a) Formulate or simplify the issues involved in the proceeding;
(b) Obtain an admission of fact or stipulation of the parties;
(c) Arrange for the exchange of prefiled direct testimony of a witness ordered by the Board, hearing officer or panel;
(d) Limit the number of witnesses;
(e) Rule on any pending procedural motions, motions for discovery or motions for protective orders; or
(f) Establish any other procedure which may expedite the orderly conduct and disposition of the proceeding.
2. Notice of any prehearing conference must be provided to all parties to the disciplinary proceeding. Except as otherwise ordered for good cause shown, the failure of a party to attend a prehearing conference constitutes a waiver of any objection to the agreements reached or rulings made at the prehearing conference.
3. The actions taken and the agreements made at a prehearing conference:
(a) Must be made part of the record;
(b) Control the course of subsequent proceedings unless modified by the Board, hearing officer or panel; and
(c) Are binding upon the parties to the disciplinary proceeding and any person who subsequently becomes a party to the disciplinary proceeding.
(Added to NAC by Bd. of Osteopathic Med. by R208-05, eff. 2-23-2006)
NAC 633.466 Stipulations regarding facts in issue. (NRS 633.291)
1. With the approval of the Board, hearing officer or panel presiding over and conducting a hearing concerning a disciplinary proceeding, the parties to the disciplinary proceeding may stipulate as to any fact in issue, either by written stipulation introduced in evidence as an exhibit or by an oral statement made upon the record. The stipulation is binding only upon the parties so stipulating and is not binding upon the Board, hearing officer or panel.
2. A stipulation may be considered by the Board, hearing officer or panel as evidence at a hearing concerning the disciplinary proceeding. Notwithstanding the stipulation of the parties, the Board, hearing officer or panel may require proof of the facts stipulated to by independent evidence.
(Added to NAC by Bd. of Osteopathic Med. by R208-05, eff. 2-23-2006)
NAC 633.470 Action by Board after hearing. (NRS 633.291, 633.651) If the Board, after a hearing on the merits in a disciplinary proceeding, finds that the licensee is:
1. Not guilty as charged in the formal complaint, the Board will issue a final order dismissing the charges and notify the licensee that the charges have been dismissed.
2. Guilty as charged in the formal complaint, the Board may:
(a) Before agreeing on a punishment, consider all relevant factors, including, without limitation:
(1) The danger to the health or safety of the public from the violation;
(2) The economic benefit received by the licensee from the violation;
(3) Any mitigation or aggravation by the licensee of the effects of the violation;
(4) The extent to which the licensee demonstrates his good faith;
(5) Any previous history of violations by the licensee;
(6) Whether the licensee knew or, as a competent osteopathic physician, should have known that the action complained of violated a law, a regulation or a condition on his license;
(7) Whether the licensee has initiated remedial measures to prevent similar violations;
(8) The magnitude of penalties imposed on other licensees for similar violations;
(9) The proportionality of the penalty in relation to the misconduct; and
(10) If the licensee offered evidence of mitigating factors, all such evidence.
(b) Agree on punishment that may, in addition to any sanction authorized pursuant to subsection 1 of NRS 633.651, require the licensee to:
(1) Participate in a program, approved by the Board, to correct alcohol or drug dependence or any other impairment;
(2) Practice only under supervision approved by the Board and paid for by the licensee;
(3) Perform public service approved by the Board without compensation;
(4) Submit to a physical or mental examination or a medical competency examination for the purposes of determining his fitness to practice osteopathic medicine with reasonable skill and safety to patients;
(5) Fulfill certain training or educational requirements approved by the Board; and
(6) Pay all costs incurred by the Board relating to his disciplinary proceedings.
(c) Issue and serve on the licensee its final order.
(Added to NAC by Bd. of Osteopathic Med. by R057-02, eff. 10-24-2002)
NAC 633.480 Decision or order by Board. (NRS 633.291, 633.651)
1. A decision or order in a disciplinary proceeding adverse to a licensee must:
(a) Be in writing;
(b) Except as otherwise provided in subsection 5 of NRS 233B.121, include findings of fact and conclusions of law; and
(c) Specifically set forth the punishment imposed on the licensee.
2. Except as otherwise provided in NRS 633.671, an order of the Board is effective upon being served on the licensee.
(Added to NAC by Bd. of Osteopathic Med. by R057-02, eff. 10-24-2002)
NAC 633.490 Removal of limitation on or restoration of license. (NRS 633.291, 633.681)
1. If a person whose practice of osteopathic medicine has been limited, or whose license to practice osteopathic medicine has been suspended or revoked, applies to the Board pursuant to NRS 633.681 for the removal of the limitation or for the restoration of his license, the Board may require the person to submit to an examination testing his competence to practice osteopathic medicine.
2. The Board will not remove a limitation or restore a license unless:
(a) The applicant proves by clear and convincing evidence that the requirements for the removal of the limitation or for the restoration of the license have been met; and
(b) The applicant proves by evidence satisfactory to the Board that he:
(1) Has complied with all the terms and conditions set forth in the final order of the Board limiting his practice or suspending or revoking his license; and
(2) Is capable of practicing osteopathic medicine in a safe manner.
(Added to NAC by Bd. of Osteopathic Med. by R057-02, eff. 10-24-2002)