Text of NV SB 124 (2019)

S.B. 124 - *SB124* SENATE BILL NO. 124–SENATOR PARKS PREFILED JANUARY 31, 2019 ____________ Referred to Committee on Commerce and Labor SUMMARY—Establishes conditions for the performance of certain surgical procedures. (BDR 54-294) FISCAL NOTE: Effect on Local Government: No. Effect on the State: No. ~ EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. AN ACT relating to health care; establishing conditions for the performance on a child of any surgical procedure to assign anatomical sex; providing for disciplinary action against certain providers of health care for any violation of those conditions; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Section 1 of this bill generally prohibits a provider of health care from 1 performing or assisting in the performance of any surgical procedure to assign the 2 sex of a child unless the provider or another qualified professional has first 3 conducted an assessment of the child to ensure that the child understands the nature 4 and risks of the procedure and assents to the procedure. An exception is provided if 5 the provider of health care determines that delaying the procedure is likely to 6 endanger the life of the child. If the child has not been emancipated, section 1 7 further provides that compliance with the requirements of the section does not 8 relieve the provider of the duty to obtain the consent of the parents or guardians of 9 the child. Sections 2-4 of this bill authorize an occupational licensing board to take 10 disciplinary action against a physician, physician assistant or nurse who violates the 11 provisions of section 1. The Division of Public and Behavioral Health of the 12 Department of Health and Human Services is authorized under existing law to deny 13 an application for a license as a medical facility or suspend or revoke the license of 14 a medical facility for aiding, abetting or permitting a provider of health care to 15 violate those provisions. (NRS 449.160) 16 – 2 – - *SB124* THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. Chapter 629 of NRS is hereby amended by adding 1 thereto a new section to read as follows: 2 1. Except as otherwise provided in subsection 2, a provider of 3 health care shall not perform or assist in the performance of any 4 surgical procedure to assign anatomical sex, including, without 5 limitation, surgery to relocate the urethral meatus, of a child 6 under 18 years of age unless the provider of health care or 7 another qualified professional has first conducted an assessment 8 of the child and confirmed that the child: 9 (a) Is capable of assenting to the procedure; 10 (b) Understands the nature and risks of the procedure and any 11 available alternatives to the procedure; and 12 (c) Assents to the procedure. 13 2. The assessment and assent of a child to a procedure 14 described in subsection 1 are not required if the provider of health 15 care determines that delaying the procedure is likely to endanger 16 the life of the child. 17 3. If a child has not been emancipated, nothing contained in 18 this section relieves a provider of health care of the duty to obtain 19 the informed consent of the parents or guardians of the child to a 20 procedure described in subsection 1. 21 Sec. 2. NRS 630.306 is hereby amended to read as follows: 22 630.306 1. The following acts, among others, constitute 23 grounds for initiating disciplinary action or denying licensure: 24 (a) Inability to practice medicine with reasonable skill and safety 25 because of illness, a mental or physical condition or the use of 26 alcohol, drugs, narcotics or any other substance. 27 (b) Engaging in any conduct: 28 (1) Which is intended to deceive; 29 (2) Which the Board has determined is a violation of the 30 standards of practice established by regulation of the Board; or 31 (3) Which is in violation of a regulation adopted by the State 32 Board of Pharmacy. 33 (c) Administering, dispensing or prescribing any controlled 34 substance, or any dangerous drug as defined in chapter 454 of NRS, 35 to or for himself or herself or to others except as authorized by law. 36 (d) Performing, assisting or advising the injection of any 37 substance containing liquid silicone into the human body, except for 38 the use of silicone oil to repair a retinal detachment. 39 (e) Practicing or offering to practice beyond the scope permitted 40 by law or performing services which the licensee knows or has 41 – 3 – - *SB124* reason to know that he or she is not competent to perform or which 1 are beyond the scope of his or her training. 2 (f) Performing, without first obtaining the informed consent of 3 the patient or the patient’s family, any procedure or prescribing any 4 therapy which by the current standards of the practice of medicine is 5 experimental. 6 (g) Continual failure to exercise the skill or diligence or use the 7 methods ordinarily exercised under the same circumstances by 8 physicians in good standing practicing in the same specialty or field. 9 (h) Habitual intoxication from alcohol or dependency on 10 controlled substances. 11 (i) Making or filing a report which the licensee or applicant 12 knows to be false or failing to file a record or report as required by 13 law or regulation. 14 (j) Failing to comply with the requirements of NRS 630.254. 15 (k) Failure by a licensee or applicant to report in writing, within 16 30 days, any disciplinary action taken against the licensee or 17 applicant by another state, the Federal Government or a foreign 18 country, including, without limitation, the revocation, suspension or 19 surrender of a license to practice medicine in another jurisdiction. 20 (l) Failure by a licensee or applicant to report in writing, within 21 30 days, any criminal action taken or conviction obtained against the 22 licensee or applicant, other than a minor traffic violation, in this 23 State or any other state or by the Federal Government, a branch of 24 the Armed Forces of the United States or any local or federal 25 jurisdiction of a foreign country. 26 (m) Failure to be found competent to practice medicine as a 27 result of an examination to determine medical competency pursuant 28 to NRS 630.318. 29 (n) Operation of a medical facility at any time during which: 30 (1) The license of the facility is suspended or revoked; or 31 (2) An act or omission occurs which results in the suspension 32 or revocation of the license pursuant to NRS 449.160. 33  This paragraph applies to an owner or other principal responsible 34 for the operation of the facility. 35 (o) Failure to comply with the requirements of NRS 630.373. 36 (p) Engaging in any act that is unsafe or unprofessional conduct 37 in accordance with regulations adopted by the Board. 38 (q) Knowingly or willfully procuring or administering a 39 controlled substance or a dangerous drug as defined in chapter 454 40 of NRS that is not approved by the United States Food and Drug 41 Administration, unless the unapproved controlled substance or 42 dangerous drug: 43 (1) Was procured through a retail pharmacy licensed 44 pursuant to chapter 639 of NRS; 45 – 4 – - *SB124* (2) Was procured through a Canadian pharmacy which is 1 licensed pursuant to chapter 639 of NRS and which has been 2 recommended by the State Board of Pharmacy pursuant to 3 subsection 4 of NRS 639.2328; 4 (3) Is marijuana being used for medical purposes in 5 accordance with chapter 453A of NRS; or 6 (4) Is an investigational drug or biological product prescribed 7 to a patient pursuant to NRS 630.3735 or 633.6945. 8 (r) Failure to supervise adequately a medical assistant pursuant 9 to the regulations of the Board. 10 (s) Failure to comply with the provisions of NRS 630.3745. 11 (t) Failure to obtain any training required by the Board pursuant 12 to NRS 630.2535. 13 (u) Failure to comply with the provisions of NRS 454.217 or 14 629.086. 15 (v) Engaging in any act prohibited by section 1 of this act. 16 2. As used in this section, “investigational drug or biological 17 product” has the meaning ascribed to it in NRS 454.351. 18 Sec. 3. NRS 632.347 is hereby amended to read as follows: 19 632.347 1. The Board may deny, revoke or suspend any 20 license or certificate applied for or issued pursuant to this chapter, or 21 take other disciplinary action against a licensee or holder of a 22 certificate, upon determining that the licensee or certificate holder: 23 (a) Is guilty of fraud or deceit in procuring or attempting to 24 procure a license or certificate pursuant to this chapter. 25 (b) Is guilty of any offense: 26 (1) Involving moral turpitude; or 27 (2) Related to the qualifications, functions or duties of a 28 licensee or holder of a certificate, 29  in which case the record of conviction is conclusive evidence 30 thereof. 31 (c) Has been convicted of violating any of the provisions of 32 NRS 616D.200, 616D.220, 616D.240 or 616D.300 to 616D.440, 33 inclusive. 34 (d) Is unfit or incompetent by reason of gross negligence or 35 recklessness in carrying out usual nursing functions. 36 (e) Uses any controlled substance, dangerous drug as defined in 37 chapter 454 of NRS, or intoxicating liquor to an extent or in a 38 manner which is dangerous or injurious to any other person or 39 which impairs his or her ability to conduct the practice authorized 40 by the license or certificate. 41 (f) Is a person with mental incompetence. 42 (g) Is guilty of unprofessional conduct, which includes, but is 43 not limited to, the following: 44 – 5 – - *SB124* (1) Conviction of practicing medicine without a license in 1 violation of chapter 630 of NRS, in which case the record of 2 conviction is conclusive evidence thereof. 3 (2) Impersonating any applicant or acting as proxy for an 4 applicant in any examination required pursuant to this chapter for 5 the issuance of a license or certificate. 6 (3) Impersonating another licensed practitioner or holder of a 7 certificate. 8 (4) Permitting or allowing another person to use his or her 9 license or certificate to practice as a licensed practical nurse, 10 registered nurse, nursing assistant or medication aide - certified. 11 (5) Repeated malpractice, which may be evidenced by claims 12 of malpractice settled against the licensee or certificate holder. 13 (6) Physical, verbal or psychological abuse of a patient. 14 (7) Conviction for the use or unlawful possession of a 15 controlled substance or dangerous drug as defined in chapter 454 of 16 NRS. 17 (h) Has willfully or repeatedly violated the provisions of this 18 chapter. The voluntary surrender of a license or certificate issued 19 pursuant to this chapter is prima facie evidence that the licensee or 20 certificate holder has committed or expects to commit a violation of 21 this chapter. 22 (i) Is guilty of aiding or abetting any person in a violation of this 23 chapter. 24 (j) Has falsified an entry on a patient’s medical chart concerning 25 a controlled substance. 26 (k) Has falsified information which was given to a physician, 27 pharmacist, podiatric physician or dentist to obtain a controlled 28 substance. 29 (l) Has knowingly procured or administered a controlled 30 substance or a dangerous drug as defined in chapter 454 of NRS that 31 is not approved by the United States Food and Drug Administration, 32 unless the unapproved controlled substance or dangerous drug: 33 (1) Was procured through a retail pharmacy licensed 34 pursuant to chapter 639 of NRS; 35 (2) Was procured through a Canadian pharmacy which is 36 licensed pursuant to chapter 639 of NRS and which has been 37 recommended by the State Board of Pharmacy pursuant to 38 subsection 4 of NRS 639.2328; 39 (3) Is marijuana being used for medical purposes in 40 accordance with chapter 453A of NRS; or 41 (4) Is an investigational drug or biological product prescribed 42 to a patient pursuant to NRS 630.3735 or 633.6945. 43 (m) Has been disciplined in another state in connection with a 44 license to practice nursing or a certificate to practice as a nursing 45 – 6 – - *SB124* assistant or medication aide - certified, or has committed an act in 1 another state which would constitute a violation of this chapter. 2 (n) Has engaged in conduct likely to deceive, defraud or 3 endanger a patient or the general public. 4 (o) Has willfully failed to comply with a regulation, subpoena or 5 order of the Board. 6 (p) Has operated a medical facility at any time during which: 7 (1) The license of the facility was suspended or revoked; or 8 (2) An act or omission occurred which resulted in the 9 suspension or revocation of the license pursuant to NRS 449.160. 10  This paragraph applies to an owner or other principal responsible 11 for the operation of the facility. 12 (q) Is an advanced practice registered nurse who has failed 13 to obtain any training required by the Board pursuant to 14 NRS 632.2375. 15 (r) Is an advanced practice registered nurse who has failed to 16 comply with the provisions of NRS 453.163, 453.164, 453.226, 17 639.23507, 639.2391 to 639.23916, inclusive, and any regulations 18 adopted by the State Board of Pharmacy pursuant thereto. 19 (s) Has engaged in the fraudulent, illegal, unauthorized or 20 otherwise inappropriate prescribing, administering or dispensing of 21 a controlled substance listed in schedule II, III or IV. 22 (t) Has violated the provisions of NRS 454.217 or 629.086. 23 (u) Has engaged in any act prohibited by section 1 of this act. 24 2. For the purposes of this section, a plea or verdict of guilty or 25 guilty but mentally ill or a plea of nolo contendere constitutes a 26 conviction of an offense. The Board may take disciplinary action 27 pending the appeal of a conviction. 28 3. A licensee or certificate holder is not subject to disciplinary 29 action solely for administering auto-injectable epinephrine pursuant 30 to a valid order issued pursuant to NRS 630.374 or 633.707. 31 4. As used in this section, “investigational drug or biological 32 product” has the meaning ascribed to it in NRS 454.351. 33 Sec. 4. NRS 633.511 is hereby amended to read as follows: 34 633.511 1. The grounds for initiating disciplinary action 35 pursuant to this chapter are: 36 (a) Unprofessional conduct. 37 (b) Conviction of: 38 (1) A violation of any federal or state law regulating the 39 possession, distribution or use of any controlled substance or any 40 dangerous drug as defined in chapter 454 of NRS; 41 (2) A felony relating to the practice of osteopathic medicine 42 or practice as a physician assistant; 43 (3) A violation of any of the provisions of NRS 616D.200, 44 616D.220, 616D.240 or 616D.300 to 616D.440, inclusive; 45 – 7 – - *SB124* (4) Murder, voluntary manslaughter or mayhem; 1 (5) Any felony involving the use of a firearm or other deadly 2 weapon; 3 (6) Assault with intent to kill or to commit sexual assault or 4 mayhem; 5 (7) Sexual assault, statutory sexual seduction, incest, 6 lewdness, indecent exposure or any other sexually related crime; 7 (8) Abuse or neglect of a child or contributory delinquency; 8 or 9 (9) Any offense involving moral turpitude. 10 (c) The suspension of a license to practice osteopathic medicine 11 or to practice as a physician assistant by any other jurisdiction. 12 (d) Malpractice or gross malpractice, which may be evidenced 13 by a claim of malpractice settled against a licensee. 14 (e) Professional incompetence. 15 (f) Failure to comply with the requirements of NRS 633.527. 16 (g) Failure to comply with the requirements of subsection 3 of 17 NRS 633.471. 18 (h) Failure to comply with the provisions of NRS 633.694. 19 (i) Operation of a medical facility, as defined in NRS 449.0151, 20 at any time during which: 21 (1) The license of the facility is suspended or revoked; or 22 (2) An act or omission occurs which results in the suspension 23 or revocation of the license pursuant to NRS 449.160. 24  This paragraph applies to an owner or other principal responsible 25 for the operation of the facility. 26 (j) Failure to comply with the provisions of subsection 2 of 27 NRS 633.322. 28 (k) Signing a blank prescription form. 29 (l) Knowingly or willfully procuring or administering a 30 controlled substance or a dangerous drug as defined in chapter 454 31 of NRS that is not approved by the United States Food and Drug 32 Administration, unless the unapproved controlled substance or 33 dangerous drug: 34 (1) Was procured through a retail pharmacy licensed 35 pursuant to chapter 639 of NRS; 36 (2) Was procured through a Canadian pharmacy which is 37 licensed pursuant to chapter 639 of NRS and which has been 38 recommended by the State Board of Pharmacy pursuant to 39 subsection 4 of NRS 639.2328; 40 (3) Is marijuana being used for medical purposes in 41 accordance with chapter 453A of NRS; or 42 (4) Is an investigational drug or biological product prescribed 43 to a patient pursuant to NRS 630.3735 or 633.6945. 44 – 8 – - *SB124* (m) Attempting, directly or indirectly, by intimidation, coercion 1 or deception, to obtain or retain a patient or to discourage the use of 2 a second opinion. 3 (n) Terminating the medical care of a patient without adequate 4 notice or without making other arrangements for the continued care 5 of the patient. 6 (o) In addition to the provisions of subsection 3 of NRS 7 633.524, making or filing a report which the licensee knows to be 8 false, failing to file a record or report that is required by law or 9 knowingly or willfully obstructing or inducing another to obstruct 10 the making or filing of such a record or report. 11 (p) Failure to report any person the licensee knows, or has 12 reason to know, is in violation of the provisions of this chapter or 13 the regulations of the Board within 30 days after the date the 14 licensee knows or has reason to know of the violation. 15 (q) Failure by a licensee or applicant to report in writing, within 16 30 days, any criminal action taken or conviction obtained against the 17 licensee or applicant, other than a minor traffic violation, in this 18 State or any other state or by the Federal Government, a branch of 19 the Armed Forces of the United States or any local or federal 20 jurisdiction of a foreign country. 21 (r) Engaging in any act that is unsafe in accordance with 22 regulations adopted by the Board. 23 (s) Failure to comply with the provisions of NRS 629.515. 24 (t) Failure to supervise adequately a medical assistant pursuant 25 to the regulations of the Board. 26 (u) Failure to obtain any training required by the Board pursuant 27 to NRS 633.473. 28 (v) Failure to comply with the provisions of NRS 633.6955. 29 (w) Failure to comply with the provisions of NRS 453.163, 30 453.164, 453.226, 639.23507, 639.2391 to 639.23916, inclusive, 31 and any regulations adopted by the State Board of Pharmacy 32 pursuant thereto. 33 (x) Fraudulent, illegal, unauthorized or otherwise inappropriate 34 prescribing, administering or dispensing of a controlled substance 35 listed in schedule II, III or IV. 36 (y) Failure to comply with the provisions of NRS 454.217 or 37 629.086. 38 (z) Engaging in any act prohibited by section 1 of this act. 39 2. As used in this section, “investigational drug or biological 40 product” has the meaning ascribed to it in NRS 454.351. 41 Sec. 5. This act becomes effective on July 1, 2019. 42 H