Newsletter 74 March 06
Malpractice Filings Against Health Care Providers, Jan 2001 – Jan 2006
Nominating Committee’s Slate of
Candidates 2006-07
Clark County Health District
Report
Nevada
State Medical Association’s 102nd Annual Meeting and Scientific Session
Clark County Health District
Disease Statistics – January 2006
By Ron Kline, MD,
2005-2006
The
Last Spring, just before my term of office began, Mayor
Oscar Goodman unveiled plans for a government subsidized University of
Pittsburgh Medical Center (UPMC). It was
the talk of the medical community. The
RJ was full of articles telling us how UPMC surgeons would bring cutting edge
medical care to our community, and how they would train our local physicians in
the ways of lofty
The reasons that a metropolitan area the size of
UPMC was a lively topic of our board meetings in the summer
and fall of last year. Clearly, the fact
that UNSOM was under the authority of the President of UNR was a significant
problem, impairing its development in southern
Even though activity may not seem apparent to those not involved in the conversations, active discussions are taking place at multiple levels. Legislators are talking about an Academic Medical Center (AMC) in the Senate and Assembly Interim Health committees and the Board of Regents has formed a committee, along with an advisory body that I will chair, to review the biomedical research and education programs of the NSHE and to recommend ways in which these programs can be improved.
A consultant hired by UNSOM is making the rounds. He has discussed an AMC with city officials and hospital executives, but curiously, few if any physicians. Speaking with community physicians was clearly an afterthought for UNSOM and its consultant, since they did not schedule any meetings with us until after they were told by multiple people they interviewed that they should. This was reinforced when I finally received an email from the consultant asking me to meet with him. The attached introductory letter had a proposed list of dates that had already passed! He then cancelled his meeting with me without bothering to reschedule. Only when I asked about our meeting did he agree to a phone interview. Talk about no respect!
The work of this consultant is still in progress, but I can
tell you that Chancellor Jim Rogers told the UNR President Search Committee
that the preliminary report of the consultant indicates that UNSOM is 35 years
behind its comparable medical schools in
One of the physicians actively involved in these discussions
has pointed out that it is not that the leadership of UNSOM either likes or
dislikes the medical community in
TALK ABOUT OVERPLAYING YOUR HAND!
Most UNSOM residency programs could not meet their accreditation requirements were it not for the unpaid clinical faculty that makes their time available to teach students and residents. If you think I am exaggerating, go to http://meded2.med.unr.edu/electives and view the electives available to medical students in your field of specialty. The vast majority are provided by community physicians volunteering their time to work with UNSOM students and residents. This is the same medical school that views us as irrelevant to the discussion about an AMC. I guess in their minds, they will hire all of the faculty in all of the specialties of medicine, making us superfluous. I hope they have shared those funding expectations with the legislature!
We need to remember this moment if and when a UNSOM sponsored AMC is ever built and the leadership that once thought us irrelevant comes to us encouraging us to refer our patients to their faculty and to place our patients in their hospital. As I recently pointed out to some regents that I have spoken with, physicians may not be terribly relevant when it comes to contributing money for construction funds and providing the physical location for residency programs, but we are critical to the successful functioning of a hospital after it is built and the education of those residents once they have a place to see patients. We are the ones who decide where our patients are treated. We are the ones who, in large part, educate those medical students and residents. This brings me to the next part of my column.
While a great deal of attention has been focused on UNSOM,
and our continued frustration with a school that has taken us for granted for
thirty years, a new medical school has opened its doors in Clark County. The Touro University School of Osteopathic
Medicine began operations here one and a half years ago. It currently has a freshman class of 102
students, with a planned increase to 125 students in the next freshman
class. This compares to 52 students in
the current UNSOM class, with a planned increase to 62 in the next two
years. In addition to its medical
school, it also has an advanced degree nursing program, a physician's assistant
program and an occupational therapist program.
It will begin sending its third year students into the medical community
this fall and is currently in discussions with the
It is time for us to return that embrace and view Touro as an institution worthy of our support.
For thirty years we have complained that UNSOM has not
treated southern
None of us can predict what the future holds. Perhaps with entrenched presidents at both UNR and UNLV no longer holding back the process, an independent president of health sciences is a real possibility. This would remove the structural impediment that prevents UNSOM from becoming a true statewide institution. Perhaps after all the "sturm und drang" at UNSOM, it will evolve into a medical school that truly values the community physicians that support it, and includes them in its process of shared governance. I am hopeful (perhaps I am naïve) that this new Regent's committee and its advisory body, will bring together the disparate voices and interests in the state, allowing us to come together to build an AMC. If we can accomplish our goal, we will cease to be the only state in the US with a medical school but without an AMC, and join our peers in the rest of the United States (both richer and poorer than us) who believe that medical research, education, and cutting edge clinical programs are valuable to both the quality of life and the economic development of a state.
PS: I have struggled for many months debating about whether to publish this column or not. Various permutations have been on my computer since November. Each month I have delayed, waiting for a sign from UNSOM indicating change. It is finally time to say what we all know is true. Although I am optimistic that the Regent's committee will result in change, hopes for the future cannot change the actions of the past.
2001 2002 2003
2004 2005 2006
Jan 39 33 108 61 41 50
Feb 20 14 98 72 63
Mar 35 30 169 123 64
Apr 37 34 111 81 70
May 37 35 126 65 14
Jun 27 24 103 90 65
Aug 54 51 76 67 33
Oct 37 83 110 59 26
Nov 38 184 59 78 68
Sum
372 823
1246 867 581
Congratulations
and Welcome to the
January 2006
Applicants to Go Before Credentialing Committee
If you have any pertinent information about
the following membership candidates, please contact:
For information on becoming a member of the
***New Member Special*** $390 New members
can join for half price their first year.
By Weldon (Don) Havins, M.D., Esq., CEO, Special Counsel
PROPOSED ETHICS REGULATIONS OF THE BOARD OF MEDICAL
EXAMINERS
The Nevada
Board of Medical Examiners (NBME) has proposed amending
The full
text of the proposed Ethical Code of Conduct regulations can be viewed and
downloaded from the
The
The
proposed ethical regulations were written by Dr. Robert Barnett of
The enabling statute authorizing the adoption of a code of ethics is NRS 630.301(9) which provides: "the following acts, among others, constitute grounds for initiating disciplinary action or denying licensure:
9. The engaging in conduct that brings the medical profession into disrepute, including, without limitation, conduct that violates any provision of a code of ethics adopted by the Board by regulation based on a national code of ethics."
By the language of this statute, a violation of an adopted code of ethics "brings the medical profession into dispute". This general contention is arguable, at a minimum.
Code of Conduct
I. The Physician-Patient Relationship
1. A physician is free to choose whom to serve, except in an emergency. Once a physician patient relationship has been established, there is an obligation to provide care as long as that relationship exists.
The first sentence of the proposed ethics regulation violates the "Ethical Foundations" which precede the enumerated proposed regulations. "The welfare of the patient should always be the physician foremost consideration in the formation of medical judgments and decisions (primum non nocere). This always involves the duty to act in the best interest of the patient (beneficence)." The proposed ethics regulation would create a duty in the licensee to treat "in an emergency" without regard to whether the person is a patient and regardless of the competence of the physician to address the emergency. This regulation, would violate the fundamental ethical principal of medicine: "primum non noncere" - above all do no harm. At a minimum, the phrase "except in an emergency" should be removed.
The second sentence in the proposed regulation is already law - see NRS 630.304(7).
2. A physician has a duty to ensure that patients (or their surrogates) have received and understand the necessary information to make an informed decision. This should include an assurance that the patient has been presented with appropriate and understandable information on the goal, risks, benefits, possible complications, prognosis and alternatives. Patients (or their surrogates) have the right to refuse treatment.
Informed consent is addressed in NRS 41A.110. The whole notion of informed consent is based on the elementary principle that a patient may refuse treatment if they do not wish to accept the risks of which they have been informed.
3. The physician must respect both the rights and privacy of patients. Confidentiality is a fundamental tenet that facilitates patient freedom and discussion. Confidentiality will always be respected by the physician and only overridden when required by law or when the risk of harm to an identifiable third party outweighs the duty to the patient.
Confidentiality is addressed in NRS 49.225 and in NRS 449.720.
4. It is unethical to receive compensation for, provide, or prescribe therapies that are known to be of no benefit or are unnecessary.
Providing therapies of no known benefit is medical malpractice under NRS 630.301(4). It also may be criminal fraud under our criminal statutes.
5. The physician has an obligation to inform patients, or their surrogates, about their medical condition truthfully and in clear and understandable language.
Mandating
the physician explain in the patient’s own
"clear and understandable language" creates a duty upon
physicians that contrasts with federal law.
The Office of Civil Rights of the Centers for Medicare and Medicaid
Services, in August 2003, issued a revised Policy Guidance regarding the
provision of interpreters. The revised
Policy Guidance recognized the financial burden imposed upon small
providers. The Policy distinguished
between Part A Medicare providers (such as hospitals, nursing homes, and home
health agencies) and Part B Medicare providers, including most physicians in
private practice. The Guidance states
that the onerous rules mandating the provision of interpreters would not apply
to private practice physicians for office visits. Thus, the duty and financial burden to provide
interpreters to explain a patient's medical condition does not fall on the
office based physician. In practice,
patients must supply their own interpreters in office visit settings. This proposed code of ethics provision would
reverse that ruling and require physicians to bear the burden of providing
interpreters to ensure their obligation to "inform patients, or their
surrogates, about their medical condition … in clear and understandable
language". For the public’s
convenience, the Clark County Medical Society maintains a database of languages
in which particular physicians are fluent.
Any person can call
6. The physician shall acknowledge that the patient has a right to the information in the patient 's medical record and will provide the patient access to the information.
This is addressed in NRS 629.061 and is limited by some of the provisions of 45 CFR 164 (the HIPAA Privacy regulations)
7. The physician, as the patient 's advocate, should serve and exercise all reasonable means to ensure that the most appropriate care is provided to the patient.
This is addressed in NRS 630.301(8) and NRS 630.304(6).
8. Sexual relationships between a health professional and a patient involve an abuse of professional power and a violation of patient trust and are prohibited.
This is addressed in NRS 630.301(5), NRS 630.301(10), and NRS 530.304(5).
9. The physician should always be respectful of differences in values and priorities and must not discriminate against patients based on race, color, national origin, gender, sexual orientation or religion.
This is addressed, among other laws, by the Civil Rights Act of 1964, as amended in 1991. The U.S. Supreme Court has also repeatedly held that such discrimination violates the 14th Amendment.
II. Physician Conduct and Practice.
Section II of the proposed ethics code regulations, numbers 1, 3, 4, 6, 7, and 8, use the word "should". "Should" is advisory and intended to induce specific conduct. In the law, words like "should" are known as "precatory" language - "a word expressing a desire for action, but they are non-binding". Black's Law Dictionary, 7th edition. Use of the precatory "should" is inconsistent with the enforceability of the definitive "shall" and "will" found in statutory and regulatory mandates. Thus, these proposed ethics regulations are inappropriately worded and would be unenforceable.
Many of the ethical concepts in Section II would serve as excellent aspirational principles of a code of ethics adopted by a medical association. They are inappropriate and ambiguous as regulatory law.
1. The physician should respect all laws, uphold the dignity and honor of the profession and accept the discipline of the profession.
Without more definition, how would a physician violate "the dignity and honor of the profession"? This phrase is ambiguous and arguable. Would NBME Board members use their own discretion to determine this ambiguity on a subjective case-by-case basis? Does "accept the discipline of the profession" mean that a physician would be subject to licensure discipline for utilizing his or her right to judicial review of adverse NBME discipline? The proposed ethics regulation ambiguity likely would render it invalid when challenged. And the use of the precatory "should" renders this proposed regulation unenforceable.
2. Physicians will treat their medical colleagues and other health care professionals and workers with respect, integrity and honesty. They will do so regardless of the race, religion, ethnicity, nationality, gender, sexual orientation, age or disability of the individuals.
What constitutes a violation of the mandate to treat "medical colleagues and other health care professionals with respect, integrity and honesty"? Disruptive behavior is addressed in NRS 630.301(6). Treating a colleague with sufficient "respect", "integrity", and "honesty" are relative and subjective terms suggesting, without further definition, unenforceable ambiguity. The prohibition against discrimination of constitutionally protected groups has been previously discussed.
3. Physicians should communicate and cooperate with their medical colleagues and other health care professionals with the goal of meeting the primary commitment to the patient's welfare and best interest.
The precatory "should" renders this proposed ethics regulation unenforceable.
4. Physicians should recognize the boundaries of their practice and must provide only those services and use only those techniques for which he or she is qualified by education, training and experience.
This proposed ethics regulation is addressed in NRS 630.306(5).
5. Physicians will remain current in the scientific and professional knowledge relevant to the medical services they provide.
How will physicians be determined to be "current in the scientific and professional knowledge relevant to the medical services they provide"? This proposed ethics regulation appears addressed in 20 hours of CME required in the field of practice of the licensee, as mandated by NAC 630.153 (the mandatory CME requirements).
6. Appropriate consultations will be obtained when medically appropriate or when requested by the patient.
This proposed ethics regulation is addressed in NRS 630.301(8) and NRS 630.304(6).
7. Physicians should not publicize or represent themselves to patients, colleagues or the public with unsubstantiated, untruthful, misleading or deceptive statements.
This is addressed in NAC 630.190 which delineates "prohibited advertising". This NAC regulation is specific and detailed. The precatory "should" would render this proposed ethics regulation unenforceable.
8. Physicians should not practice medicine while impaired by alcohol or drugs. If they are physically or mentally disabled, they should refrain from assuming patient responsibilities that they cannot discharge safely or effectively.
This proposed ethics regulation is addressed in NRS 630.306(1) and NAC 630.230(c).
9. Physicians must be conscious of all potential conflicts of interest and not engage in practices that either influence, or appear to influence, the care of patients and result, or potentially result, in personal financial gain. Financial interests that might conflict with appropriate medical care should be disclosed to the patient.
This is addressed in NRS 630.301(7) and NRS 630.305(g).
10. A physician is ethically obligated to report fraud, professional misconduct, incompetence or abandonment of a patient by another physician.
This is addressed in NRS 630.3062(6).
III. Societal Responsibilities
The NBME is charged with licensing and regulating medical doctors, physician assistants and respiratory therapists. To expand that mandate to include "societal responsibilities" exceeds the scope of the NBME's activities.
1. The physician has a responsibility to society as a whole, should support activities that enhance the community and should respect the laws of society.
The precatory "should" renders this proposed ethics regulation unenforceable. It is difficult to imagine how the Board would determine a licensee’s insufficient "community enhancement".
2. The medical profession has a collective responsibility to work to see that suitable medical care is available for those in need.
The NBME does not have authority to discipline "the medical profession." The medical professions' obligation to "work to see that suitable medical care is available for those in need" seems best addressed by the Nevada Legislature. In sum, these proposed ethical regulations are redundant and unnecessary notwithstanding their good intent.
1Dr. Havins appreciates the input of former Clark County Chief District Judge Gene T. Porter who's recommended edits of this article have been incorporated. Mr. Porter concurs with the substance and conclusions of this article.
Your
President-Elect – Weldon E. Havins, MD
Secretary – Jerry Jones, MD
Delegate Chair – Annette Teijeiro, MD
Treasurer – David Steinberg, MD
Trustees - Howard Baron, MD;
Keith Brill, MD;
Mark
Doubrava, MD;
J.
Parker Kurlinski, MD;
Donald
Mohs, MD
Nominating
Committee – Frank Nemec,
MD;
Ronald Slaughter, MD;
Carol Van der Harten, MD;
Michael Verni, MD
The bylaws state any member may nominate an additional
candidate for any of the positions subject to the following:
·
The additional nominees must be
voting members with two or more year’s consecutive membership in the Society.
·
Each nomination must bear the
signature endorsement of four members in good standing.
·
All nominations must be submitted
in writing before April 15th.
By
Dear Colleagues:
It seems
like the battles in the last Legislative session, the fight "to the
death" over Ballot Question 3 tort reform, and the war to turn back the
trial lawyers Questions 4 and 5 were just yesterday. However, the next Legislative election is
already upon us. Excellent Legislators
who support medicine and access to quality medical care are formulating
strategies for their re-election.
Candidates who are pro-medicine are now asking for and need our
financial support. This is the first
Legislative session where the provisions of
There is
already talk among some plaintiff trial lawyers of pushing for the passage of a
medical "three strikes law" - that is, three findings of medical
malpractice against a physician and the physician's license is revoked. Ridiculous you say? It is the law in
Physicians
must support those who supported us during the last Legislative session, and
support those who will support our Legislative concerns in the next Legislative
session - incumbent or candidate. To be
successful, we must have your contribution.
Political contributions are now just a fact of life in the practice of
medicine. You can contribute a
reasonable amount now, or you can pay a whole lot more in the foreseeable
future. Or you can move to
Because of
the tremendous effort of the health care community,
Please send your $300.00 check NOW to:
MEDPAC
Reprinted with permission from www.jama.com
By Catherine D. DeAngelis, M.D., M.P.H.
The
unthinkable tragedy of
Consider the following:
· Cal Ripken was hailed as a hero by adoring crowds because he played in 2,130 consecutive baseball games3. While I admire and respect him, how many men and women work at least that many consecutive workdays for a salary far less than that of the average professional baseball player?
The true heroes of September 11 were
the firefighters, police officers, emergency response workers, and other
individuals who remained in the
Ten months later, in Somerset, Pa, just 10 miles from the crash site of Flight 93, 9 coal miner heroes helped each other through 77 harrowing hours in cold darkness to be rescued by other heroes. Within 10 miles and 10 months, heroes fell from the sky and heroes were lifted from beneath the ground. The miners were amazed by the national interest in their plight and that they were considered heroes. They were "ordinary" people, not CEOs, politicians, or movie stars or sports stars. Like the heroes of September 11, they were merely doing what noble, courageous people do. They were heroes expecting no reward.
If there is anything positive about September 11, it is that Americans now know what true heroism is. Many of us have allowed our common sense and hearts to define it. The CEOs with the million-dollar compensations are cast in a much different light. Sports fans are now reacting to the greed of both team owners and players in a way that just might lead to rational salaries for the players and owners. Wouldn't it be wonderful for a family to again be able to attend a major sports event for less than several days' salary for the average working person?
So what does all this have to do with medicine? Everything. All of us who are involved, directly or indirectly, in the care of patients are potential heroes. Each of us needs to remember the noble and courageous reasons we had for becoming a physician. Many of the heroes of the past millennium were physicians. We can emulate them by ensuring that we bring to medicine the same professionalism they displayed. Do we now have the courage to force policy makers to pass legislation that will benefit patients with no consideration for how big business will support them for re-election? We have the potential for great political influence if we let go of our selfish interests. Do we now have the nobility to refuse the use of our names, reputations, or treatment deicisions for financial gain? Do we strive to use the best possible treatment for patients, rather than the latest and most heavily promoted? Can we give up those "free" lunches and dinners, reimbursements for attending continuing medical education programs sponsored by industry, and honoraria for using our names on promotional papers authored by individuals who work for industry?
None of this would involve risking our lives or livelihood. All it would take is finding the potential hero inside each of us. What greater gift could we offer patients? What better way to honor the heroes of September 11?
References
1
Random House Webster's Unabridged Dictionary. 2nd ed.
Author Affiliation: Dr. DeAngelis is Editor, JAMA.
Corresponding
Author: Catherine D. DeAngelis, MD, MPH,
JAMA,
By Donald Kwalick,
MD, MPH, Chief Health Officer
Mental health patients
continue to impact emergency departments
The Clark
County Health District continues to work with our community partners to address
emergency room overcrowding and related issues. Our community has struggled
with this issue for many years and the situation became critical on
At the time of the declaration there were 103 mental health beds at Southern Nevada Adult Mental Health Services (SNAMHS). By the end of 2004 emergency funding allowed an additional 28 beds to be added and during the last legislative session increased funding lead to an additional 50 beds by the close of 2005.
The new SNAMHS facility will increase the capacity to a total of 217 beds by August 2006. Unfortunately, these increases result in only short term reductions of the mental health patients holding in emergency rooms. It has become apparent that additional beds, while needed, provide only temporary reductions to mental health holds in emergency departments.
The adverse
impact of these mental health patients also has a tremendous affect on
Emergency Medical Services (EMS). Over a twelve month period, our emergency
departments had more than 553,000 visits. Emergency Medical Services (EMS) data
shows that
In December
of 2005,
In order to address this issue the health district recommended several strategies designed to alleviate the situation:
· Enforcement of the General Patient Care Protocol section that allows EMS providers to place certain low acuity patients in the waiting room if they have been unable to transfer care within 20 minutes.
· Utilization of the "First-Watch" software to track the number of ambulances en-route to hospitals and waiting to off-load at area hospitals, and informing patients of the potential wait-time at the hospital they are requesting.
· Mandating crews to immediately return to service after they have released patients.
·
Enabling
1. Make every effort to give a verbal report of the patient's condition.
2. Leave a completed patient care report with the patient.
3. Physically transfer the patient to an appropriate hospital location and/or equipment.
This policy
allows
We are
working with our partners to identify ways to reduce the number of individuals
transported by
It is
imperative we find a solution. There are approximately 325-345 emergency room
beds in the
Mental health patients stay in emergency rooms on an average for 72 hours waiting for transfer to SNAMHS. This is equivalent to 16 emergency patients and therefore equates to over 1,200 emergency department patient visits that are potentially impacted by mental health patients. To put it another way, mental health patient's utilization of area hospital resources is equivalent to 400 emergency department visits every day.
This
further demonstrates that any solutions involving
The only
strategy that will benefit
By Shanila Choudhury,
2005-06
The
5th Annual Spring Fashion Show
"Think Pink"
Benefiting the
Susan G. Komen Breast Cancer Foundation
Special Guest Paula Francis
Silent Auction
And other Surprises
On Tuesday, March 14, 2006
At
At
Cost
$100 Charitable Donation
This is a Pre-paid event.
Please buy your tickets
As soon as possible.
For tickets and more information contact
Shanila Choudhury at
(702) 355-2019
or email Choud@aol.com
for more information
go to out website www.ccmsa-lv.org
For those of you, who would like to advertise in our program book, please contact Estela Hansen for more details at 240-3149 or 496-0456 cell. We are expecting 300 to 500 people. This is an event open to the public and a chance for us to let the community know the physicians and their families are making a difference here in the Las Vegas Community.
Mark Your Calendars!
This is the first time in years that this meeting will be
held in
1. A half day Scientific Session
2. President’s Luncheon (usually has an interesting speaker)
3. Very Informative Governmental Affairs Meeting
4. Reference Committee meetings where resolutions are discussed and perfected to become policy
5. Dinner and Awards ceremony where the NSMA and NSMAA Presidents are inaugurated
This year the
Delegation Chair for
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UMC 383-2604
Only CME Activities held at the
CLARK
COUNTY HEALTH DISTRICT
DISEASE
STATISTICS* - January 2006
DISEASE
CASES REPORTED YEAR TO DATE
Jan
2005 Jan 2006 2005 2006
VACCINE
PREVENTABLE DISEASES
DIPTHERIA 0 0 0 0
HAEMOPHILUS
INFLUENZA 1 3 1 3
HEPATITIS A 0 2 0 2
HEPATITIS B 2 2 2 2
INFLUENZA 22 84 22 84
MEASLES 0 0 0 0
MUMPS 0 0 0 0
PERTUSSIS 2 5 2 5
POLIOMYELITIS 0 0 0 0
RUBELLA 0 0 0 0
TETANUS 0 0 0 0
SEXUALLY
TRANSMITTED DISEASES
AIDS 22 9 22 9
CHLAMYDIA 452 598 452 598
GONORRHEA 219 246 219 246
HIV 14 18 14 18
SYPHILIS
(Early Latent) 0 5 0 5
SYPHILIS (Primary
& Secondary) 3 11 3 11
ENTERICS
AMEBIASIS 2 0 2 0
BOTULISM-INTESTINAL
0 0 0 0
CAMPYLOBACTERIOSIS 4 5 4 5
CHOLERA 0 0 0 0
CRYPTOSPORIDIOSIS 2 0 2 0
E. COLI
O157:H7 0 1 0 1
GIARDIA 2 3 2 3
ROTAVIRUS 84 151 84 151
SALMONELLOSIS 14 14 14 14
SHIGELLOSIS 4 2 4 2
TYPHOID
FEVER 0 0 0 0
VIBRIO 0 0 0 0
YERSINIOSIS 0 0 0 0
OTHER
ANTHRAX 0 0 0 0
BOTULISM
INTOXICATION 0 0 0 0
BRUCELLOSIS 0 0 0 0
COCCIDIOIDOMYCOSIS 7 5 7 5
ENCEPHALITIS 1 0 1 0
HANTAVIRUS 0 0 0 0
HEMOLYTIC
UREMIC (HUS) 0 0 0 0
HEPATITIS C 0 0 0 0
HEPATITIS D 0 0 0 0
INVASIVE
STREPTOCOCCAL0 0 1 0 1
LEGIONELLOSIS 0 3 0 3
LEPROSY 0 0 0 0
LEPTOSPIROSIS 0 0 0 0
LISTERIOSIS 0 0 5 0
LYME
DISEASE 0 0 0 0
MALARIA 0 0 5 0
MENINGITIS,
ASEPTIC/VIRAL 4 3 4 3
MENINGITIS,
BACTERIAL 3 1 3 1
MENINGOCOCCAL
DISEASE 0 0 4 7
PLAGUE 0 0 0 0
PSITTACOSIS 0 0 0 0
Q FEVER 0 0 0 1
RABIES
(HUMAN) 0 0 0 0
RELAPSING
FEVER 0 0 0 0
ROCKY MTN
SPOTTED FEVER 0 0 0 0
RSV 432 427 432 427
TOXIC SHOCK
SYNDROME 0 12 0 12
TOXIC SHOCK
SYN 1 0 1 0
(STREPTOCOCCAL)
TUBERCULOSIS 7 5 7 5
TULAREMIA 0 0 0 0
UNUSUAL
ILLNESS 0 0 0 0
(ENCEPHALITIS)
*Numbers include confirmed and probable cases.
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