The Las Vegas IV industry has grown quite considerably in the last six 6 years. Unfortunately, many people are not very well educated on what the regulatory requirements are for doing an IV hydration treatment or for doing a house call for IV hydration.
The key issue is that a Prescribing Provider (P2) which is a Nurse Practitioner, Physician, or Physician Assistant must be physically involved in the process of handling the medications and administering the medications.
A P2 must go to every house call where new patients receive medications. In addition, a P2 must be at any clinic where new patients are receiving medications.
A P2 has a DEA license, which allows them to posses prescription medications. An RN cannot possess prescription medications without a valid prescription for a specific patient. Therefore, an RN cannot keep a duffel bag of saline and Zofran at their house. Nor can a medical assistant.
It is illegal for an RN and medical assistant to do an IV hydration treatment on their own. It is a Class D felony punishable by up to 5 years in jail and the various people involved could lose their nursing or medical license.
A bag of saline, botox, and a B12 shot are all prescription medications and require a P2-Patient relationship.
Currently, numerous clinics in Las Vegas, their staff, and owners are under active investigation by the:
- Nevada Medical Board
- Nevada Board of Nursing
- Nevada Board of Pharmacy
- Nevada Attorney General
For sending out RNs and Paramedics to treat patients with IV fluids, IV vitamins, IV medications, Botox, and other prescription medications who have not been seen by a “P2 – Prescribing Provider” (Physician, Nurse Practitioner, or Physician Assistant.) This is illegal, punishable as a D felony with up to 5 years in prison. It constitutes “Practicing Medicine without a license.”
“Conspiracy to Practice Medicine without a license” is also a felony and loops in everybody at a medical clinic that is involved in supporting the illegal activity.
A “Medical Director” is only relevant to patients that are treated by a Licensed Ambulance Unit, such as AMR, Medic West, Fire Department, or Community Ambulance. If you are not “On Duty” which means “clocked-in” for a Licensed Ambulance Unit, you cannot practice your EMS scope of practice. See SNHD regulations 500.022, 500.024, and 500.026.
In any medical clinic, every patient who receives a prescription for a medication must have a face-to-face or bona fide telemedicine (audio/video) consult with a P2. Otherwise, this constitutes “Practicing Medicine Without a License” which is a felony.
A Paramedic is only able to practice their scope of practice while “on duty” for a licensed ambulance unit. Once they are off duty, they function as a medical assistant and must be directly (eyes-on) supervised by the physician or PA.
Contact your respective Board to make sure you are working under the correct regulatory conditions or you could be in legal trouble and possibly lose your nursing license or National Registry certification. Being arrested is grounds for the National Registry canceling your certification.
Important Regulatory Points:
- Southern Nevada Health District Regulations 500.022, 500.024, and 500.026 state that EMS personnel are only able to practice their scope of practice when “On Duty” for a licensed ambulance unit, such as AMR, Medic West, etc. Once you “clock out” from AMR or the fire department, you are working for a medical clinic as a “medical assistant.” It is illegal for a medical assistant to treat patients unless the Physician or PA-C is in the building.
- NRS 454.316 – RNs are not allowed to possess prescription medications without a valid prescription from a P2 for that medication for a specific patient. This means that an RN cannot have a duffel bag of IV fluids, Zofran, etc in their trunk or at their house. This is a class D felony.
- NRS 454.221 – Prescription medications cannot be given to patients without a valid prescription. Normal saline is a prescription medication. A P2 has to establish a P2-patient relationship either with a face-to-face consult or via telemedicine.
- NRS 629.515 describes the legality of telemedicine in Nevada. It specifically excludes phone calls, faxes, and emails as legal telemedicine consults. It states that telemedicine has to be audio and visual. Not doing a valid telemedicine consult puts the RN at risk for “practicing medicine” without a license. There are also other security and documentation issues related to telemedicine. Facetime is not 100% compliant for Nevada telemedicine consults.
- Currently, the Nevada Board of Pharmacy does not allow an RN to take prescription medications to a medical house call after a P2 has done a valid telemedicine consult. The only way telemedicine can work for an IV House call might be for the RN to pick up the ordered prescription medications from a licensed pharmacy and then take those exact medications to the house call. Contact Brett Kandt or David Wuest at the Board of Pharmacy for more information on this issue.
- The Nevada Board of Pharmacy requires that a P2 be present at any medical clinic where new patients are receiving prescription medications. The P2 must order the medications and give them to the RN to then give to the patient. As an example, chemotherapy centers are able to function without a P2 being present at all times, as all of their patients have been evaluated by a P2 in the last 6 months and orders have been written for each patient’s chemotherapy which an RN can then administer at the chemotherapy center. The Nevada Board of Pharmacy requires every patient who receives prescription medications to be evaluated either face to face or a bona fide telemedicine consult by a P2 every six months.
Contact information for the various regulatory boards is below. The Nevada Board of Pharmacy, Board of Medicine, and Board of Nursing are investigating various IV, aesthetic, and wellness companies in Clark County. In addition, the Nevada Attorney General is involved in the investigatory proceedings. A few of these NRS violations are misdemeanors, but most are Class D or C felonies and can carry jail time of one year or more.
Furthermore, even being charged with a Class E felony with no jail time will likely result in loss of one’s nursing license or National Registry Certification.
Currently, the only model for doing IV hydration medical house calls is for a P2 to go on the house call with the RN or MA.
Contact info for regulatory Boards
All of the people listed below are very accessible. They are much more interested in helping people get their regulatory deficiencies corrected versus throwing people in jail. But, many wellness and aesthetic clinics in Las Vegas have already received letters from various regulatory boards and continuing to operate illegally will likely be met with more severe penalties.
Please see the included case information on Dr. Braunstein who was investigated by the Nevada Medical Board for similar issues. He could have lost his medical license for what he did with Spa Dorin Clinic here in Las Vegas. This is all public record available to everybody.
Nevada Board of Pharmacy
David Wuest, PharmD
Deputy Director, Nevada Board of Pharmacy
dwuest at pharmacy.nv.gov
Brett Kandt, JD
Nevada State Board of Pharmacy
Dena McClish – Senior Investigator
Nevada State Board of Pharmacy
1050 E Flamingo Rd Ste E-217
Las Vegas, NV, 89119
Office: 702.486.6420 ext 154
E-mail: dmcclish at pharmacy.nv.gov
Web Page: www.bop.nv.gov
Nevada Board of Medicine
Kim Friedman – Senior investigator
Sr. Investigator, CMBI
Nevada State Board of Medical Examiners
6010 S. Rainbow Blvd. Bld. A, Suite 2
Las Vegas, NV 89118
Office Phone: 702-486-3339
Kfriedman at medboard.nv.gov
Nevada Board of Nursing
Kim Arguello, Esq
General Counsel, Nevada Board of Nursing
Sam McCord, BSN, RN
Director of Nursing Practice and Investigations
Nevada State Board of Nursing
smccord at nsbn.state.nv.us
Southern Nevada Health District
SNHD EMS and Trauma System Manager
Hammond at snhdmail.org
Nevada Attorney General’s Office
555 E Washington Ave # 3900
Las Vegas, NV 89101