As mentioned in last month's newsletter, there are three bill draft requests pending which would provide for formation of a fund to subsidize, for a limited period of time, physicians overwhelmed by exorbitant medical malpractice premiums. Senator Titus has suggested that strip clubs be taxed on a square foot basis as one source of funds for such a subsidy. CCMS member John Nowins, MD, president of the Clark County OBGYN Society, was quoted in the Las Vegas Review-Journal as opposing such a source of funding a medical malpractice subsidy program. John somehow misunderstood the proposal and thought that OBs would be involved in that funding source. On the day when John Nowins puts on a G-string and dances around a pole at a strip club, all will realize the medmal crisis has sunk to unimaginably awful levels of despair. The CCMS staff opines that we should have our digital camera ready to memoralize this astounding event in about six months, assuming no ameliorative action by the Legislature.

Attempts at tasteless mirth aside, Senator Ann O'Connell has proposed using some of the several million in surplus cash accumulated in the accounts of the NBME to help fund a medical malpractice subsidy. More than one NBME board member has suggested the board needs the money "in case of a lawsuit" against them. Such reasoning appears baseless since, as a "political subdivision" of the state government, the board is limited to a $50,000 sovereign immunity exception to civil damages. Individual board members and staff are immune from civil actions against them for any of their actions done in good faith and without malicious intent. See NRS 630.364. Both the Nevada Supreme Court and the Federal 9th Circuit Court of Appeals has sustained the immunity from civil actions against board members, except in "ministerial" (administrative) malicious conduct. Thus, absent proof of malicious conduct, the board members and staff are immune from civil actions in the performance of their functions.

Senator O'Connell’s proposal would require physicians to pay $200 per year to help support such a proposed temporary subsidy. Other states which have promulgated similar subsidies have required physicians annual contributions of $200 or $250. Some states have had the BME collect the money, others have required professional liability carriers to collect the money by adding that amount to the health care providers' annual premium. CCMS recently polled all 2500 physicians in Clark County on their willingness to pay $200 per year for two years for such a purpose. Fax returns totalled 47 in favor and 59 opposed. One could reasonably conclude that the vast majority of Clark County physicians just don't care one way or the other about a $200 annual contribution to help fund a temporary subsidy.

STATE OF NEVADA

LEGISLATIVE COUNSEL BUREAU

February 28, 2003

Senator Ann O'Connell

Senate Chambers

Dear Senator O'Connell:

You have asked several questions relating to the money which is collected by the Board of Medical Examiners in the course of regulating the practice of medicine pursuant to chapter 630 of NRS. First, you have asked whether the Legislature has the power to enact legislation which changes the authority of the Board to expend the money that it has collected pursuant to chapter 630 of NRS, including any money which the Board has collected before the effective date of the legislation but which the Board has not yet expended pursuant to law. Second, you have asked whether the Legislature may require the Board to expend the money which it has collected pursuant to chapter 630 of NRS to fund a program to assist physicians in paying premiums for malpractice insurance.

BACKGROUND

The Board of Medical Examiners is charged with the statutory responsibility to regulate the practice of medicine. NRS 630.130. As part of that regulation, the Board issues licenses to and regulates physicians, physician assistants and practitioners of respiratory care. NRS 630.160, 630.275 and 630.279. To carry out its regulatory functions, the Board is authorized to collect fees from physicians, physician assistants and practitioners of respiratory care. NRS 630.268. The Board is required to use those fees to pay the expenses of the Board, and no part of the expenses of the Board maybe paid out of the State General Fund. NRS 630.110.

According to the information provided to this office, the revenue collected by the Board through fees currently exceeds the expenses of the Board and, therefore, the Board has a surplus on hand. In light of this surplus, you have proposed legislation that would require the Board to use a portion of its surplus to fund a program to assist physicians in paying premiums for malpractice insurance. With this background in mind, we turn now to your specific questions.

DISCUSSION

I. Does the Legislature have the power to enact legislation which changes the authority of the Board of Medical Examiners to expend the money that it has collected pursuant to chapter 630 of NRS, including any money which the Board has collected before the effective date of the legislation but which the Board has not yet expended pursuant to law?

The Nevada Supreme Court has held that the power of the Legislature is extremely broad and "except where limited by Federal or State Constitutional provisions, that power is practically absolute." Galloway v. Truesdell, 83 Nev. 13, 20 (1967). With regard to the use of money collected by the state, the Nevada Supreme Court has held that "the power of controlling the public purse lies within legislative, not executive authority." State of Nev. Employees Ass'n v. Daines, 108 Nev. 15, 21 (1992). Thus, an administrative agency has no power to disregard a legislative act that requires the agency to expend public money for a particular purpose. Id. at 20-23.

Furthermore, an administrative agency is wholly a

creature of the state, and it derives its existence and all of its executive powers solely from legislative enactments. As a result, an administrative agency does not have any general or common law powers, but only such powers as the Legislature has conferred on the agency by express statutory provision or by implication from other statutory provisions. Andrews v. Nevada State Bd. of Cosmetology, 86 Nev. 207, 208 (1970); Clark County v. State, 107 Nev. 489, 492 (1991). Thus, if the Legislature enacts a statute that requires an administrative agency to perform an act in a particular manner, the administrative agency does not have any discretion to deviate from the method or procedure prescribed by the Legislature. Cf. State ex rel. Fall v. Kelso, 46 Nev. 128, 130-32 (1922).

Finally, public money is all money raised by operation of law for the support of the government or for the discharge governmental duties or obligations. 63C Am. Jur. 2d Public Funds § 1 (1997). Public money includes all money raised from taxation, fees, duties and any other form of governmental assessment. Id. "The fact that the government has taken possession of moneys pursuant to law is sufficient to constitute them government funds, even though they are held for a special purpose." Id. Thus, when a public agency collects money pursuant to law, that money becomes public money whose ownership is vested in the state. 63C Am. Jur. 2d Public Funds § 2 (1997).

As noted previously, the Board of Medical Examiners is authorized by chapter 630 of NRS to collect fees from physicians, physician assistants and practitioners of respiratory care. Because the Board is collecting such fees pursuant to law, the fees become public money upon collection, even though the fees are collected by the Board for a special purpose and are not deposited in the State General Fund. Once the fees become public money, the Legislature has the power to enact legislation to control the expenditure of those fees by the Board, and the Board is completely without power to disregard the mandates of the Legislature. See State of Nev. Employees Ass'n v. Daines, 108 Nev. 15, 20-23 (1992).

Furthermore, the Nevada Supreme Court has recognized that the Legislature has the power to enact legislation which changes the purposes for which public money is to be spent, even if that legislation applies to public money collected before the effective date of the legislative act. In City of Reno v. Stoddard, 40 Nev. 537 (1917), the case involved two legislative acts enacted in 1915 and 1917. In the 1915 Act, the Legislature authorized the City of Reno to levy a municipal tax, and the Legislature required the city to set aside a portion of the tax in a special fund to provide for a sewage disposal system for the city. In the 1917 Act, the Legislature eliminated the special fund for the sewage disposal system and authorized the city to transfer the money from the special fund to the general fund of the city. The auditor and the treasurer of the city refused to transfer the money from the special fund to the general fund on the ground that the money was designated for the special fund by the 1915 Act and that the money could not be transferred pursuant to the later legislative enactment.

In reviewing the case, the Nevada Supreme Court recognized that a municipality is wholly a creature of the state, and that it derives its existence and most of its powers from the Legislature. Id. at 542. The court further recognized that, even if the Legislature has authorized public money to be used for one public purpose, the Legislature may, by later legislative enactment, require the public money to be used for a different public purpose so long as the Legislature does not violate any constitutional limitations. Id. Because the court found that the Legislature did not violate any constitutional limitations in enacting the 1917 Act, the court concluded that the auditor and treasurer had a statutory duty to transfer the money from the special fund to the general fund. Id. at 542-44.

Like the money at issue in the Stoddard case, the money collected by the Board pursuant to chapter 630 of NRS has been designated by law to be used for a specific public purpose. However, that money remains subject to the overriding power of the Legislature to enact subsequent legislation which requires the Board to expend the money for a different public purpose, so long as the Legislature does not violate any constitutional limitations. Based on the information provided to this office, we do not have any facts to suggest that the Legislature would be violating any constitutional limitations if it changed the authority of the Board to expend the money which it has collected pursuant to chapter 630 of NRS. In the absence of any constitutional limitations, we believe that a court would most likely find that the Legislature has the power to enact legislation which requires the Board to expend the money it has collected for a different public purpose. Therefore, it is the opinion of this office that the Legislature has the power to enact legislation which changes the authority of the Board to expend the money which it has collected pursuant to chapter 630 of NRS, including any money which the Board has collected before the effective date of the legislation but which the Board has not yet expended pursuant to law.

II. May the Legislature require the Board of Medical Examiners to expend the money which it has collected pursuant to chapter 630 of NRS to fund a program to assist physicians in paying premiums for malpractice insurance?

Although the power of the Legislature to control the expenditure of public money is practically absolute, the Nevada Supreme Court has held that the Legislature may authorize the expenditure of public money only for a public purpose. See State ex rel. Brennan v. Bowman, 89 Nev. 330, 332-33 (1973); State ex rel. Moody v. Williams, 43 Nev. 290, 295 (1919). The question that remains, therefore, is whether a program that uses public money to assist physicians in paying premiums for malpractice insurance qualifies as the expenditure of public money for a public purpose.

As a general rule, a public purpose is any governmental purpose that "inures to the public benefit." State ex rel. Brennan v. Bowman, 89 Nev. 330, 333 (1973). Typically, if the object of the legislation is to preserve or promote the public health, safety or general welfare of the residents of the state, the Nevada Supreme Court will find that the legislation carries out a valid public purpose and constitutes an appropriate expenditure of public money. See id.; McLaughlin v. Housing Auth., 68 Nev. 84, 93 (1951); Washoe County Water Conservation Dist. v. Beemer, 56 Nev. 104, 114-15 (1935). Furthermore, the Nevada Supreme Court has long recognized that the question of whether legislation is enacted for a public purpose is generally a question for the Legislature and that, in most instances, deference should be given to the Legislature's finding of a public purpose unless that finding is clearly erroneous and without reasonable foundation. McLaughlin v. Housing Auth., 68 Nev. 84, 93 (1951).

It is well-documented that Nevada has been experiencing a crisis relating to malpractice insurance and that the crisis is affecting the public health, safety and general welfare of the residents of the state. In particular, the cost of malpractice insurance for physicians practicing in Nevada has risen to the point where many physicians have restricted the scope of their practice in Nevada or have considered ceasing their practice in Nevada. Indeed, some physicians have actually departed the state because of the high cost of malpractice insurance. Because the crisis has had such a detrimental impact on the public health, safety and general welfare, the Governor recently called the Legislature into special session for the purpose of addressing the crisis. During the special session, the Legislature received extensive evidence of the detrimental effects that the crisis is having on the availability and quality of health care in the state.

In light of the crisis in Nevada relating to malpractice insurance and the adverse effects that the crisis is having on the public health, safety and general welfare of the residents of the state, the Legislature could reasonably conclude that the use of public money to fund a program to assist physicians in paying premiums for malpractice insurance would preserve and promote the availability and quality of health care in the state and would inure to the public benefit. We believe that a court would most likely defer to the Legislature's judgment and find that a program which uses public money to assist physicians in paying premiums for malpractice insurance would qualify as the expenditure of public money for a public purpose. Therefore, it is the opinion of this office that the Legislature may require the Board of Medical Examiners to expend the money which it has collected pursuant to chapter 630 of NRS to fund a program to assist physicians in paying premiums for malpractice insurance and that such a program would qualify as the expenditure of public money for a public purpose.

CONCLUSION

It is the opinion of this office that the Legislature has the power to enact legislation which changes the authority of the Board of Medical Examiners to expend the money which it has collected pursuant to chapter 630 of NRS, including any money which the Board has collected before the effective date of the legislation but which the Board has not yet expended pursuant to law. It is also the opinion of this office that the Legislature may require the Board of Medical Examiners to expend the money which it has collected pursuant to chapter 630 of NRS to fund a program to assist physicians in paying premiums for malpractice insurance and that such a program would qualify as the expenditure of public money for a public purpose.

If you have any further questions regarding this matter, please do not hesitate to contact this office.

Very truly yours,

Brenda J. Erdoes

Legislative Counsel,

et al

JCB:dtm Encl.

Ref No. 0301101247

File No. OP O'Conne1103022172214

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President’s Message

By Warren Evins, M.D., PhD, 2002-2003 CCMS President

Initiative Petition Fails in NV Legislature

The Nevada State Legislature failed to enact the Keep Our Doctors in Nevada Initiative petition. They had forty days from the beginning of the legislative session on February 3 (until March 14) to act. The initiative will now appear on the November 2004 general election ballot. The legislature could approve an alternate ballot measure to compete with the initiative. The Senate Judiciary committee held two days of hearings on the initiative, but did not report it out of committee.

SB 97 in Hearings

Senate Bill 97, introduced by Senator Ann O'Connell, is an amendable form of the Keep Our Doctors in Nevada Initiative petition. The Senate Judiciary Committee, chaired by Senator Mark Amodei (Capitol Senate district), is also hearing testimony on this bill. SB 97 has until April 11 to be passed by the Senate Judiciary committee. It must then pass in the Senate and be forwarded to the Assembly or it dies. Representatives of CCMS and NSMA have attended hearings and testified for both the initiative petition and SB 97. Testimony from physicians (but not lawyers) was extremely limited by the committees. Many physician supporters attended the hearings. Several thousand citizens have called the Keep Our Doctors in Nevada toll-free legislative telephone number at 1-800-784-4730 to voice support for medical liability reform. If SB 97 passes, it likely will be heavily amended. Many more calls are needed.

SB 97 proposes (as unamended):

1. Limit Runaway Lawyer Fees

2. Stop "Double Dipping" - expenses covered by others

3. Extend Payments - installments

4. Stop Exceptions - applies the 'non-economic damages only limit' to each incident or injury

5. Create "Fair Share" Liability -not joint and several

NV State Board of Medical Examiners

Dr. Evins, Dr. Havins, and Dot Freel, office manager, represented CCMS at the March 7 meeting in Las Vegas and spoke with some of the BME physician members. Only one other Las Vegas physician - not reporting to the BME or present for their personal licensing matters - attended. The BME had not met in Las Vegas for about two years. The Las Vegas meeting was a trial to see if there would be significant attendance by Las Vegas licensees or the public. Some physician BME members were disappointed that so few Las Vegans attended. We do not know if any future meetings will be held outside of the BME's offices in Reno.

CCMS continues to pay a court reporter to provide minutes of the public portion of the BME meeting. We post the minutes on our web site: http://www.clarkcountymedical.org.

The BME approved a resolution to require all MDs to have competency certification before the 2005 relicensure and every ten years thereafter. Proposed means of certifying competency include: 1. ABMS certification or re-certification every ten years or less, 2. Certification of active staff members by hospital peer review committee chart reviews, 3. SPEX or other exams, 4. Office chart reviews by approved reviewers, paid by the licensee. The number of charts to be reviewed will be determined. Public hearings will occur. Physicians should submit written comments and/or testimony at the hearings if they suggest changes.

Medical Society Elections

Ballots will be mailed to you at the end of April. Be sure to return your ballot for CCMS officers and Board of Trustee members. The original ballot (on CCMS letterhead) must be received by CCMS no later than the closing of the polls at 5 p.m., Friday, May 16. PLEASE VOTE.

CME

CCMS continues to offer free CME courses to our paid members about twice a month.

Membership Directory

You will receive a printout of your profile from CCMS’s database along with your voting ballot. Please personally review this information so we can ensure the most accurate information about you and your practice is published in our 2003 Directory.

NSMA Annual House of Delegates Meeting

This year the NSMA will meet at the Atlantis Hotel in Reno on Friday 16 through Sunday morning, May 18. CCMS members are needed to represent us there. There will be a Friday morning CME program.

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Malpractice Filings

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New Members for February 2003

Congratulations and Welcome to the Clark County Medical Society

John S Davis, MD, General Surgery, 700 Shadow Ln #370, Las Vegas, NV 89106
Arthur D Del Rosario, MD, Pathology, 4320 Burnham Ave, Las Vegas, NV 89119
Gregory A Linderer, MD, Anesthesiology, 129 W Lake Mead Dr #B, Henderson, NV 89012

Reinstated Members

Ivan Karabachev, MD, Otolaryngology, 3201 S Maryland Pkwy #500, Las Vegas, NV 89109
Mitch Keamy, MD, Anesthesiology, 3010 W Charleston Blvd #150, Las Vegas, NV 89102
Steven Winkler, MD, Internal Medicine, 10001 S Eastern Ave #101, Henderson, NV 89052

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Membership Applicants To Go Before Credentialing Committee

If you have any pertinent information about the following membership candidates, please contact:

Clark County Medical Society, 2590 E. Russell Rd., Las Vegas, NV 89120

Christina A Dixon, MD, Internal Medicine
Michael L Fishell, MD, Anesthesiology/Pain Mgt.
Jason E Garber, MD, Neurosurgery
Karen R Goodman, MD, Family Practice
David E Slattery, MD, Emergency Medicine

For information on becoming a member of the Clark County Medical Society, call Marlaina Burns at 739-9989

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In Memorium

The Clark County Medical Society is saddened to announce the passing of Dr. Thomas Armour, Jr. Dr. Armour, General Surgeon, died Sunday, March 2, 2003 in Henderson. He was born October 19, 1921 and was a member of the Clark County Medical Society for 39 years.

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Calendar of Events

April 15 - Deadline for Write-In Nominations to be included on CCMS Election Ballot.
May 1 - CCMS Election Ballots mailed to members, with closing of the polls at 5 p.m. on May 16.
May 15-18 - Nevada State Medical Association Annual Meeting at the Atlantis Casino Resort in Reno.
May 31 - CCMS Installation Dinner at Green Valley Ranch Station Casino, Registration and cocktails at 6 p.m., dinner at 7 p.m.

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Referral Tallies

The following referrals were provided to CCMS members in the first quarter of 2003 (through March 15)

Specialty Referrals

Addiction Medicine 0

Allergy 1

Anesthesiology 4

Cardiology 9

Cardiovascular Surgery 1

Colon & Rectal Surgery 2

Dermatology 7

Diagnostic Radiology 0

Endocrinology 8

Family Practice 22

Gastroenterology 5

General Surgery 3

Geriatrics 1

Gynecologic Oncology 0

Hematology 3

Infectious Medicine 0

Internal Medicine 23

Nephrology 0

Neurology 12

Neurosurgery 3

Ob-Gyn 15

Oncology 4

Ophthalmology 7

Oral/Maxillofacial Surg. 0

Orthopaedic Surgery 13

Otolaryngology 5

Pain Management 8

Pathology 0

Pediatrics 4

Ped. Psychiatry 1

Ped. Surgery 0

Physical Med/Rehab 4

Plastic Surgery 15

Preventative Medicine 0

Psychiatry 10

Pulmonology 4

Radiology 1

Rheumatology 9

Urology 5

Vascular Surgery 0

Totals 209

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CEO Editorial

By Weldon (Don) Havins, M.D., J.D., CCMS CEO and Special Counsel

Physician Reporting Requirements When Sued For Medical Malpractice

In addition of having the requirement to report to the Nevada Board of Medical Examiners or the Nevada Board of Osteopathic Medicine, A.B. 1 amended NRS 630.3067 to provide for licensure discipline against any NBME licensee who does not report a claim for medical malpractice within 30 days of the claim being filed in District Court. This A.B. 1 added provision sounds reasonable unless one realizes that Nevada Rules of Civil Procedure, Rule 4, permits up to 120 days to serve a complaint and summons for a civil lawsuit. The physician must report within 30 days of filing of the lawsuit, but may not learn of the lawsuit for another 90 days. Nevertheless, as the law stands, that physician is clearly in violation of NRS 630.3067 and is subject to licensure discipline up to and including revocation of the physician's license to practice medicine (once guilty of a violation of a provision of NRS 630, all the licensure discipline punishments are available to the board).

This is not just theoretical. In the first few days of March, Dr. Joel Lubritz, a member of the Nevada Board of Medical Examiners, called the CCMS office and requested the raw data on healthcare providers having medical malpractice claims filed against them in Clark County District Court. CCMS' staff has been accumulating this data from January 2001, utilizing public information available on the Clark County District Court Clerk's web site: www.co.clark.nv.us. CCMS has been following these filings to determine the effect on frequency of elimination of the Medical Dental Screening Panel in A.B. 1 which occurred on October 1, 2002. (The graph and chart of frequency of filings, through the middle of March, is included in this issue of the newsletter). As mentioned in the last month's newsletter, any CCMS member is welcome to a copy of this CCMS work product. I faxed all 33 pages of this information to Dr. Lubritz as he requested.

On March 7, the NBME met for a board meeting in Las Vegas. Among others, CCMS President Dr. Warren Evins, CCMS Office Manager Dot Freel, and I attended that meeting. In response to the data provided to Dr. Lubritz, the board's general counsel Mr. Richard Legarza said he intends to write every licensee who had a claim filed against him or her since October 1, 2002, inquiring why they have not yet informed the NBME. Ms. Charlotte Bible, the Assistant Attorney General confirmed to the board members that NRCP 4 permits 120 days (or longer upon approval of the court) for serving notice of the complaint to a defendant. Thus, these letters from the NBME may be the first indication to some doctors that they have been sued for medical malpractice.

CCMS has requested several legislators to amend NRS 630.3067 such that licensees would be required to contact the NBME within 30 days of service of summons and complaint for medical malpractice (eliminating "within 30 days of filing" of the claim).

The NBME's web site: www.state.nv.us/medical

The NBME's web site contains interesting information for the public inquiring about a licensee physician. The web site contains information regarding dispositions of medical malpractice claims including the subject matter of allegations against the licensee. The vast majority of "successful" medical malpractice disputes are concluded by a settlement. Settlements almost invariably contain a "disclaimer of negligence" or a "no admission of wrongdoing" or a "no admission of negligence" statement. It seems inappropriate, then, to place on the web site allegations of negligence without at least the defenses or answer to those allegations. One could reason that since there was no admission of negligence, the web site should simply indicate the case of disputed medical malpractice was settled for XX amount. Likewise, in jury trials, juries generally just determine if medical negligence occurred without specifying what precisely constituted the malpractice. It would appear reasonable for the web site to state the jury verdict of medical negligence, amount of jury award XX, without indicating the allegations. In the very rare trial in which the jury was asked to make specific findings, only then would it be appropriate to indicate the specific medmal allegations found by the jury to be true. The NBME's link for this information is labeled "Search for a Medical Doctor" ….

Until very recently, and for the past several months, the web site indicated that reports were sourced from the National Practitioner Data Bank (NPDB). Any member of the public, for 60 cents a page, could obtain copies of the reports sent to the NBME from insurers and from the NPDB. The NPDB reports contained essentially the same information as the insurers' reports with at least two important exceptions. The NPDB reports contain the social security number and the DEA number of the physician. Any person requesting this intensely private information, and willing to pay the 60 cents, was able to access the NPDB reports. In this age of identity theft, desperate drug addicts, and other assorted criminals, such information for 60 cents a page constitutes a phenomenal bargain. CCMS indirectly inquired as to this apparent violation of federal law. CCMS was told that the board "has a legal opinion" that making such information available was permissible. Looking on the web site on 3-14-03, it appears the NPDB reports, as a source of medical negligence disposition information, has been removed. It is unknown if the NPDB reports are still supplied to any willing purchaser.

Absent from the web site apparently are hospital peer review actions. One can argue that peer review actions, rather than actions taken by a plaintiff attorney in the form of medical malpractice allegations, are a superior source of information about a licensee. Unless recently added, this valuable information, reported by law to the NBME, has not found its way onto the board's web site.

Competency Testing

At the board's March 7 & 8 meeting, the board approved a regulation for workshop comment. This proposed regulation mandates competency testing for re-licensure. No other state has implemented competency testing for re-licensure. ABMS boards have all been directed to develop continuing competency programs. The American Board of Ophthalmology, working with the American Academy of Ophthalmology, estimates their non-punitive continuing competency program will be available within 18 months. Why, then, the hurry?

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Open Letter to Nevada Board of Medical Examiners

March 7, 2003

Subject: Physician Competency Testing

Dear Dr. Hug-English,

The issue here is not really testing for competency, it is an attempt to identify physicians who are incompetent. We are not really concerned with the 2995 physicians who are competent, we want to know and weed out the 5 who are or may provide poor patient care or actually harm patients. How do we do that?

We cannot do that through academic testing. For example, I personally know of two physicians who practiced in Las Vegas who have left the state due to repeated lawsuits and disciplinary actions. They were both intellectually brilliant and could pass any academic competency test you administered to them with top marks. Their problem was not intelligence, it was poor judgment and behavior. They both had personality disorders and thought they were just invincible and behaved accordingly, unfortunately.

If we really want to test for clinical competency, then behavior and judgment must be assessed, the bottom line being detecting bad behavior and judgment leading to adverse incidents. That requires observation and reporting. An aviation-like system, with anonymous, no-fault reporting of incidents is necessary. The recommendation by Dr. Baepler for observation and reporting of adverse incidences of behavior or patient care by physicians to the Board is appropriate.

Sincerely,

Edson O. Parker, MD

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Minutes Synopsis

(Members can receive a full copy of meeting minutes by calling 739-9989.)

CLARK COUNTY MEDICAL SOCIETY BOARD OF TRUSTEES MEETING

Tuesday, February 18, 2003; 6:00 P.M.

Action Items

The minutes from the January 21 Board meeting were approved.
Revenue is down about $40,000 compared to the revenue last year at this time, but expenses are down $81,000 compared to the expenses last year at this time. Every category of expense is down this year compared to last year, except for utilities. The financial report was approved unanimously.

Committee Reports

Dr. Hyer reported the Community Relations/ Community Health Committee recommendation to have the Board write a letter to the Clark County School District requesting they look into improving the physical activity level of elementary school children. Several Board members requested more detailed information. Dr. Hyer asked to table the issue until after his committee could discuss it further.
Three applicants were approved for membership: John S Davis, MD; Arthur Del Rosario, MD; and Gregory A. Linderer, MD.
Dr. Jones moved to establish a fee for Associate Members at half of the amount for Active Member dues, $370. The motion passed unanimously.
Dr. Bernstein discussed targeting the Governor and Lt. Governor for the Mini-Internship program which is planned to repeat in the fall.
Dr. Evins reported Karen Schroeder relinquished her office as Treasurer of MedPac. Dr. Evins was elected to replace her as the new Med Pac Treasurer.
Dr. Evins reported the KODIN task force is in the process of sending Initiative information kits to every licensed physician in Nevada, commercials are running throughout the state and targeted district mailings have started
Dr. Evins reported the Governmental Affairs Committee met recently. Dr. Colletti felt the committee was a waste of time and that it is non-functional. Dr. Evins suggested the Committee try to organize physicians and spouses to participate in the issues of the Legislature. Dr. Havins stated the Alliance is already doing this.
Dr. Evins informed the Board of the candidates selected by the Nominating Committee.

Alliance Report

CCMSA President Karen Schroeder reported the Alliance had its member recognition dinner recently, which included a 50-year member. They reported more than 50% of their memberships have been members more than 15 years.

President's Report

KODIN, NSMA and CCMS were planning to have 3 days in Carson City where physicians and spouses will be asked to testify in front of committees on malpractice.

Administrative Report

The Executive Director of the Southern Nevada Area Health Education Center (AHEC) asked for a letter of support from CCMS for a program which benefits disadvantaged youth and to recruit physicians and other health care professionals to act as mentors. The motion passed unanimously.
CCMS has begun to have difficulty receiving public information from NBME regarding meeting minutes and financial reports. CCMS Office Manager Dot Freel had traveled to their Reno office and has personally hired an attorney in an attempt to receive the public records.
There was much discussion regarding KVBC's three-part news report on the NBME. Dr. Ellerton discussed a bill which puts the Attorney General's Office, instead of the NBME, as the responsible party to handle investigations against physicians.

Old Business

The letters requesting the hospitals not require $1 million/ $3 million liability for staff privileges was mailed to the CEOs and the Chiefs of Staff of the hospitals. Two CEO's, Summerlin and Desert Springs, have responded with regrets that they cannot drop the limit requirements.
The nursing shortage was discussed and Dr. Colletti again asked the Board to consider forming a committee to look at the nursing shortage, which he was willing to head. Dr. Havins stated a bill to double nursing enrollment has been submitted to the Legislature. Dr. Jones volunteered to talk to the Board of Regents member, Thalia Dondero, to inquire how best the Medical Society can support this Bill in the Legislature.

New Business

Dr. Evins discussed what is needed for the CCMS Delegation to submit nominees for the Distinguished Physician and Community Service Awards.
Dr. Chanderraj addressed the community crisis regarding orthopedic care, moving that CCMS mediate between the hospitals and the orthopedic surgeons. The motion died for lack of a second.

The next meeting will be Tuesday, March 18, 2003 at 6 PM. The Delegate meeting will be held directly following the Board meeting.

There being no further business, the meeting was adjourned by Dr. Evins at 8:00 pm.

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Alliance Message

By Karen Schroeder, 2002-2003 CCMS Alliance President

As we move into April we are looking at next year and filling the remaining open positions. Positions on the executive board include president-elect, 2nd Vice President in charge of luncheons, and assistant treasurer. We also need members on several committees including Community Health, Fashion Show Luncheon Benefit for 2004, and on the Holiday Greeting Card Project. Interested members should contact past President Debbie Chino or president-elect Annette Mohs.

Our third annual Fashion Show Luncheon Benefit will be held on March 18th in the beautiful Monet Room at the Bellagio. Members from the community will join Alliance members as we view gorgeous spring fashions of Giorgio Armani. Many silent auction items will be available for bidding from spa treatments, interior designs, weekend getaways, a Tiffany necklace, and even a mini Mercedes-Benz. Raffle prizes are also plentiful and include coffee packages, sport club membership, laser hair removal treatments, dinners, and many others. All proceeds from the benefit will help F.E.A.T. (Families for Effective Autism Treatment) and student scholarships at New Horizons Academy.

Would you be able to spare three or four hours? The Alliance will be "working" the food booth on Saturday May 3rd during the Susan G. Komen Race for the Cure. The work involves replenishing food and cutting oranges. All interested participants should contact Karen Schroeder at 898-2595. We will need thirty people and welcome physicians, spouses, and adult friends.

As we wind down our year (only two luncheons remain) remember we are still collecting new and used books for pre-school to grade four readers. Bring the books to any Alliance function or you may drop them off at the Medical Society office on Russell Road. They will be taken to the Spread the Word Kids to Kids project coordinator. Let's see if we can break 500 books donated. Have you done your part?

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CME Calendar

Cardiovascular Consultants 691-9154

4/29 - “End of Life Dilemmas: Ethical Considerations of Aggressive Treatments at the End of Life,” 5:30 - 8 p.m.

Clark County Medical Society 739-9989

4/5 - “Bioterrorism Awareness, Preparedness and Surveillance,” 8:45 - 11 a.m., 2 CME hours (also approved for EMS and Nursing continuing education)

Future Programs Planned

May - “Ophthalmology,” “Expert Witness”

June - “End of Life”

July - “Medical Legislative Update”

August - “Patient Consent and Rights”

Nevada Educational Associates for Diabetes 243-8476

4/5 - “Which Weigh to Go - Strategies for Weight Management,” 7:30 a.m. - 12:30 p.m., 4 CME hours

St. Rose Hospital 616-5832

Southwest Medical Associates 242-7347

4/10 - “Podiatry in Primary Care,” 7:30 - 8:30 a.m.
4/16 - “Domestic Violence and Medical Ethics: The Patient, The Practicioner and The Law,” 6 - 8 p.m.

Sunrise Hospital 731-8210

UMC 383-2604

4/25 - “Pathology Reports and Ethical Issues,” 7:30 - 9:30 a.m., 2 CME hours

Valley Hospital 388-4847

4/8 - “Alzheimer’s Disease Update,” noon
4/22 - “PET/CT Scan: The New Synergy, noon
5/13 - “Ocular Trauma and Corrective Surgery,” noon
5/27 - “Hepatitis C,” noon

*Special Note: CCMS members can receive free CME courses on the internet with World Medical Leaders.

To have your CME courses listed on our calendar, please contact Deborah Barton at 739-9989 prior to the deadline of the 12th each month.

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CLARK COUNTY HEALTH DISTRICT DISEASE STATISTICS* - FEBRUARY 2003

DISEASE CASES REPORTED YEAR TO DATE

2/02 2/03 2002 2003

VACCINE PREVENTABLE DISEASES

DIPTHERIA 0 0 0 0

HAEMOPHILUS INFLUENZA 1 1 1 2

(invasive)

HEPATITIS A 3 2 6 3

HEPATITIS B 0 6 3 10

INFLUENZA 23 4 24 12

MEASLES 0 0 0 0

MUMPS 0 0 0 0

PERTUSSIS 0 0 0 1

RUBELLA 0 0 0 0

TETANUS 0 0 0 0

SEXUALLY TRANSMITTED DISEASES

AIDS 16 10 34 33

CHLAMYDIA 336 379 732 758

GONORRHEA 110 141 257 283

HIV 14 7 22 33

SYPHILIS 0 1 0 1

(Primary & Secondary)

SYPHILIS (Early Latent) 1 3 1 4

ENTERICS

AMEBIASIS 2 1 3 3

BOTULISM-INTESTINAL 0 0 0 0

CAMPYLOBACTERIOSIS 9 8 16 14

CHOLERA 0 0 0 0

CRYPTOSPORIDIOSIS 0 0 1 0

E. COLI O157:H7 1 0 1 0

GIARDIASIS 8 5 20 14

ROTAVIRUS 65 100 127 184

SALMONELLOSIS 16 1 30 11

SHIGELLOSIS 0 0 0 1

TYPHOID FEVER 0 0 0 0

YERSINIOSIS 0 0 0 0

OTHER

ANTHRAX 0 0 0 0

BOTULISM INTOXIFICATION 0 0 0 0

BRUCELLOSIS 0 0 0 0

COCCIDIOIDOMYCOSIS 0 4 3 7

ENCEPHALITIS 0 0 0 0

HANTAVIRUS 0 0 0 0

HEMOLYTIC UREMIC 0 0 0 0

SYNDROME (HUS)

HEPATITIS C 0 0 0 0

LEGIONELLOSIS 0 0 0 0

LEPROSY (HANSEN'S DISEASE) 0 0 0 0

LEPTOSPIROSIS 0 0 0 0

LISTERIOSIS 0 0 0 0

LYME DISEASE 0 0 0 1

MALARIA 0 0 1 0

MENINGITIS, 5 4 9 6

ASEPTIC/VIRAL

MENINGITIS, BACTERIAL 3 2 5 4

MENINGOCOCCAL DISEASE 2 2 5 2

PLAGUE 0 0 0 0

RABIES (HUMAN) 0 0 0 0

RELAPSING FEVER 0 0 0 0

RSV (RESPIRATORY 590 419 891 784

SYNCYTIAL VIRUS)

ROCKY MOUNTAIN 0 0 0 0

SPOTTED FEVER

TOXIC SHOCK SYNDROME 0 0 0 0

TUBERCULOSIS 5 4 8 13

TULAREMIA 0 0 0 0

*Numbers include confirmed and probable cases

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Classifieds

· medical executive suite for rent Medical executive suite by 1/2 day, full day, or monthly. Office space with 3800 square feet. Phones, utilities, front reception included. Valley View & Sahara area. Call 384-3207.

· immediate opportunity for bc/be Internist, Las Vegas - Busy, growing, multi-specialty practice seeking BC/BE Internist for staff position. Excellent, competitive benefits package; will negotiate terms. J1 candidates may apply. Fax resume with references/credentials to 702-307-1095.

· lake mead weekend getaway Mobile home for sale on shores of Lake Mead between two marinas, space for boat. 14X67, 2BD 2BA. All the conveniences of home. 180 day/yr occupancy limit. $27,500. Also available fully furnished. 362-8368.

· FOR SALE: 3375 SQ FT MEDICAL OFFICE building, 3115 South Eastern Avenue, May be used by one, two or three physicians ... eight to nine exam rooms. Currently fully equipped. Will sell with or without medical equipment. Call 378-0620 noon to ten PM.

· VIP OFFICE SPACE FOR NON-PCP: In Green Valley by Anthem/Seven Hills. Office & exam rooms at affordable cost -- in truly elegant setting. Ideal for new practice, practice expansion to Green Valley, or to lower overhead costs. Call 419-8256.

· ESTABLISHED INTERNAL MEDICINE Practice for sale. Call 204-8109.

· NEEDED: PART-TIME PEDIATRICIAN Call 804-4736, leave message - and Office Space For Lease on W. Charleston between Rancho & Campbell. Call 232-3344.

· FOR SALE: BEAUTIFUL 5000 SQ FT HOME in gated community near UMC and Valley Hospital. 5 or 6 bedrooms, 3 full baths, 2 3/4 baths. Huge backyard with pool and tiled patio. Indoor jacuzzi and sauna. $460,000. Call 258-1987.

· MEDICAL OFFICES FOR RENT 2280 E. Calvada Blvd., Pahrump, NV. From 1,000 to 3,000 sq. ft., configurable to your specifications. Rent and tenant improvements negotiable. Call Jim Read at (877) 673-0782 (toll free).

· WANT TO ADVERTISE? CALL 739-9989 for advertising information. CCMS Members can receive a free 40-word ad in County Line (an $85 value) up to 3 times per year. Display advertising rates are also available. Call Today!

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County Line Advertisers

Bank of Commerce 949-9800 www.bankofcommerce-nevada.com

Jan Bernard Realty 838-0333

Clark County Credit Union 228-2228 www.ccculv.org

Colonial Bank 304-3770 www.colonialbank.com

Comprehensive Cancer Centers of Nevada 952-3400

Desert Radiologists 598-1006 www.desertrad.com

Hutchison & Steffen, Attorneys 385-2500 www.hsnvlaw.com

KUNV 91.5 FM 869-6623

Longford Medical Center 737-8000 www.longfordmedical.com

McCormick & Schmick’s Seafood Restaurant 836-9000

Medical Association of Billers 240-8519 www.e-medbill.com

Nevada State Bank 855-4540 www.nsbank.com

Nevada State Psychological Association 454-0500

Paradise Development Holdings 804-4736 info@nicaraguaparadise.com

Raymond James Financial Services 383-5092 www.financialprudence.com

Red Rock Radiology 731-2888 www.redrockradiology.com

Shred-it 25-SHRED (257-4733) www.shredit.com

Wybtrak 382-5858 ext. 230 www.wybtrak.com

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Contents

Utilizing the BME's Surplus Cash: Legal Opinion of the Legislative Counsel Bureau