For the last few years I have been a member of the CCMS Community Health/Community Relations Committee. Our primary goal has been to investigate different agencies which would be good avenues for physicians to volunteer or serve the medically uninsured people of our community.

There have been some very good agencies such as Access Health which offers discounted health care to the uninsured. Undoubtedly, one of the most exciting organizations reviewed by us was Volunteers in Medicine Incorporated (“VIMI”).

VIMI is a national solution to Americans who are uninsured, "one community at a time." Since 1992 VIMI, a 501(c)3 corporation, has been helping communities set up free clinics in their respective cities. The clinics have been very successful in treating the uninsured. Remember that the number of uninsured has grown to over 80 million Americans. We have a huge issue of uninsured in Nevada. VIMI has adopted a "culture of caring," which is the heart and soul of the clinic. VIMI observes that the people, volunteer physicians and nurses who help have found that in treating the needy it has been very therapeutic for the caregivers.

VIMI provides a plan to develop, operate and sustain a model VIMI clinic. To establish a free health clinic, first we must locate others in the community who share this vision.

There is no doubt that Southern Nevada has a genuine need for such a free clinic. There is no doubt the medical community is concerned about access to health care for the uninsured. There is no doubt, our politicians are equally concerned about this issue. There is no doubt that the time has come for everyone to get together and work hard to make such a clinic become a reality.

Recently, at a meeting of the Transition Health Care Team on Uninsured, Garn Mabey, one of our physician legislators, suggested the idea of a volunteer free clinic, which was accepted and embraced by the Committee. It was included in the list of recommendations sent to the Governor that this free clinic be part of the solution to help the uninsured. The clinic would be a partnership between government and the volunteers. Since the clinics are free clinics, physicians working there would come under the federal protection act.

Although physicians can always be sued, they are less likely to be sued in this situation. This will allow us to volunteer without significant fear of being sued. In such a climate, everyone volunteers, physicians, nurses, even housekeeping. Everyone shares in the vision of helping bring needed health care to the uninsured. The clinic is a celebration of giving and receiving.

The time is now for us to step up and be leaders, and to establish our volunteers in medicine, VIMI clinic for our uninsured. Please join me in this great adventure! Send in your name to CCMS and you will be contacted to gather for our first meeting. It will take a little time to develop, but once it is set up I anticipate most people will serve one half to one day a month. I know that patient and medical providers will be equally blessed in this venture. I look forward to your response and thank you, in advance, for caring and giving of your precious time.

It is true that no person is an island; we are all connected and we need each other. We have been given a great gift and we are blessed as we bless others. We only truly discover ourselves as we reach outwards into the larger community in altruistic service. Thank you again for your thoughtful consideration.

Proposed Member Benefit

You should have received information in the mail introducing the opportunity to be a part of a new Medical Insurance Plan designed for Nevada physician groups. It has been specially designed for the Clark County Medical Society members and their employees (and the families of the physicians and their employees) by Saint Mary's Health Plans in Northern Nevada and is being made available to CCMS members in Southern Nevada. It offers significantly reduced rates for all CCMS members who enroll at the time of the Open Enrollment, which could be available as soon as April or May of 2007.

What you would need to do to get an initial rate for the CCMS membership would be to complete group enrollment information applications for all physicians and employees that would be participating. Once Saint Mary's reviews the applications, rates will be obtained and final enrollment into the plan may be achieved. (WCMS members in Northern Nevada report that their medical insurance rates are substantially below what are otherwise available in the Northern Nevada area.)

Please note that completing the applications does not obligate you to take the insurance plan, nor does it guarantee that the plan will ultimately be offered. It only counts you and your employees as prospective members of the plan. You will make the final decision about participating in the plan during the Open Enrollment period that will be established in early 2007.

If you have any questions, please feel free to contact Valerie Clark or Sarah Poehland at Clark and Associates in Reno, NV at 775-828-7420.

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An invitation for you from the NSMA President, Dr. Wayne Hardewick

The NSMA Legislative Core Group will meet weekly during the Legislative Session. All NSMA/CCMS and Alliance members are welcome. The Core Group is composed of the NSMA Council and the NSMA Commission on Governmental Affairs. I would also encourage the Clark County Medical Society and Washoe County Medical Society Governmental Affairs Committees to attend as well. All Medical Specialty Societies are invited to designate a representative who would be responsible to report to and from the specialties. In the event that an action requires a vote and to avoid quorum issues or delays because of the time constraints of Legislative actions, a majority vote of the NSMA Executive Committee members will be required. The meetings will be held at the CCMS headquarters at 6:00pm, every Wednesday or the first Thursday of each month.

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Clark County District Court Medical Malpractice Filings

Against Health Care Providers, Jan 2001 –Jan 2007

2001 2002 2003 2004 2005 2006 2007

Jan 39 33 108 61 41 50 109

Feb 20 14 98 72 63 61

Mar 35 30 169 123 64 38

Apr 37 34 111 81 70 58

May 37 35 126 65 14 71

Jun 27 24 103 90 65 83

Jul 19 100 114 45 66 74

Aug 54 51 76 67 33 82

Sep 20 65 105 79 36 51

Oct 37 83 110 59 26 74

Nov 38 184 59 78 68 50

Dec 9 170 67 47 30 28

Sum 372 823 1246 867 581 720 109

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Member News

Congratulations and Welcome to the Clark County Medical Society New Members – January 2007

· Judy M Jackson, MD - Radiation Oncology, 1176 Vegas Valley, Las Vegas, NV 89109

· Sikisam A Magoyag, MD - Internal Medicine, 10640 Aire Dr, Las Vegas, NV 89144

· Paul J Michaels, MD – Pathology, 3059 S Maryland Pkwy #100, Las Vegas, NV 89109

· Sanket L Patel, MD - Internal Medicine, 5380 S Rainbow Blvd #306, Las Vegas, NV 89118

· Ronald A Shockley, MD - Internal Medicine, 1700 Bearden Dr, Las Vegas, NV 89106

Reinstated Member

· Daniel M Sabry, MD - Internal Medicine

Applicants to Go Before Credentialing Committee

· Ronald J Knoblock, MD - Anatonmic/Clinical Pathology

If you have any pertinent information about these membership candidates, please contact: Clark County Medical Society, 2590 E. Russell Rd., Las Vegas, NV 89120

For information on becoming a member of the Clark County Medical Society, call Janiceanne Poblete at 739-9989.

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Attention All Members: The Clark County Medical Society will pay you to be a Delegate!

$500

Delegates must be present for roll call at the meetings on both Saturday and Sunday to qualify for the $500.

Call the Medical Society at 739-9989 to sign up.

The annual Nevada State Medical Association meeting will be held in Sparks, Nevada at John Ascuaga's Nugget from

April 27-29, 2007.

Why attend?

· To interact with the people who deal with tort reform, who coordinate efforts for all legislative medicine-related issues and who deal with the regulatory issues that affect us every day

· To voice your opinions about the mission and purpose of our organization. Do you see a need for change? Now's your time to be heard

· To exchange ideas with physicians from throughout the state and from many specialties about many topics - from problems with hospitals or insurance companies, to public health issues

· To participate in CME which will cover

several different timely topics

· To have fun! There are many events for members and spouses or guests to enjoy

To find out more, call Nancy Sommer at the Society, 739-9989, or any board member.

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Feature of the Month: Transparency

By Robert W Shreck MD, MMM, FAAFP, VPMA HealthInsight, QIO

For the first time in history, healthcare providers are voluntarily submitting performance information in publicly available reports that reveal the good and the not-so-good data about patient care. HealthInsight, the Quality Improvement organization for the state of Nevada, has been a catalyst in effecting this significant change. Publicly disclosing performance information has an enormous impact on both consumers and healthcare organizations alike. How? The information enables consumers to ask informed questions about their health care, and it also holds healthcare providers accountable for the health care they provide and for demonstrating improved outcomes.

Transparency also means that the methodology for measuring quality is revealed to anyone and made available in the public report. The methodology is like a blueprint and describes how a measure is constructed. It specifies which diagnoses are counted in the measure and how many patients must be included; it accounts for how sick the patients are and what other medical complications the patients may have; it specifies how the information and processes around patient care are collected and how it is reported. When the methodology is transparent, you can be assured the results are reliable and comparable across all the reporting health care providers on an "apples to apples" basis.

There are other healthcare quality reports published by commercial for-profit enterprises and widely marketed to consumers and purchasers. Although some of these reports are extensive and use "scores" or "grades," the methodology behind the measures is not revealed. Therefore, it is not always possible to determine how much difference there is between a high score or low score, or more importantly, how the measure was constructed. These are important details for healthcare providers to know in reconstructing their processes to produce better patient outcomes. Without the methodology, it is harder to hold them accountable for improvement.

Transparency is what makes a public report on healthcare quality performance trustworthy. HealthInsight is committed to transparency in the quality measures they collect and report.

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Southern Nevada Health District Report

Community-Associated Methicillin-Resistant Staphylococcus aureus: Strategies for Clinical Management

By Donald S. Kwalick, MD, MPH, Chief Health Officer

Lawrence Sands, DO, MPH, Assistant Chief Health Officer

Past and continuing disease surveillance activities by the Southern Nevada Health District for methicillin-resistant Staphylococcus aureus have indicated that community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is common in Clark County¹.

The health district conducts routine surveillance of CA-MRSA using the following case definition developed by the Centers for Disease Control and Prevention (CDC):

A culture positive diagnosis of MRSA made in the outpatient setting or within 48 hours after admission to the hospital
No medical history in the past year of:

MRSA infection
Hospitalization or surgery
Residence in a long-term care facility
End-stage renal disease and/or dialysis
Permanent indwelling catheters or percutaneous medical devices
Employment in the health care profession

To help guide physicians and other health professionals in the diagnosis and management of MRSA in the community the CDC has developed as a reference “Strategies for Clinical Management of MRSA in the Community with a Focus on Skin and Soft Tissue Infections (SSTIs)²^.”The following is a brief synopsis of the major recommendations found in this document:

Consider MRSA in:

Differential diagnosis of SSTIs
Other syndromes compatible with SA infection

Collect appropriate clinical specimens for C&S from patients with abscesses or purulent skin lesions, particularly those with:

Severe local infections
Systemic signs of infection
History suggestion connection to a cluster or outbreak of epidemiologically linked individuals

Appropriate clinical specimens include:

Fluid from a purulent lesion or abscess cavity
Respiratory secretions (e.g., sputum, tracheal aspirations)
Blood from a moderately or severely ill patient with signs and symptoms of systemic infection
Other specimens from a normally sterile site suspected in an infection focus

Perform incision and drainage (I&D) as primary therapy for furuncles, other abscesses, and septic joints.

If unsure of pus presence, aspirate fluid from lesion with 16-18 gauge needle and 10 cc syringe
Use moist heat for small furuncles not amenable to I&D to promote drainage

Consider empiric therapy when purulent skin lesions present with:

Cellulitis
Signs and symptoms of systemic illness
Co-morbidities or immunosuppression
Age extremes
Location of abscess in a difficult to drain/clean area
Lack or response to I&D alone

Consider prescribing the following beta-lactam alternatives if in accordance with local susceptibilities

Clindamycin (D-test if erythromycin resistant)
Tetracyclines

Doxycycline
Minocycline

TMP-SMX
Rifampin (only in combination with other AMs)
Linezolid (only in combination with an infectious diseases consultant)

Avoid using antimicrobials that have a potential for rapidly developing resistance such as:

Fluoroquinolones
Macrolides

And finally, it is important to educate patients on how to prevent infecting others.

Given the current status of antimicrobial resistance in the community the ideal course of action is for providers to obtain specimens for culture and sensitivity when considering treatment options. For more information on CA-MRSA, including strategies for clinical management, contact the health district Office of Epidemiology at (702) 759-1300.

References:

1. Antibiogram of Organisms Commonly Isolated from Outpatient Urinary Tract Specimens in Clark County, Nevada – January 2004 through March 2006http://www.southernnevadahealthdistrict.org/physician/download/newsletter_06_jul.pdf

2. Gorowitz, RJ, Jernigan, DB, Powers, JH, Jernigan JA. “Strategies for Clinical Management of MRSA in the Community: Summary of an Experts’ Meeting Convened by the Centers for Disease Control and Prevention. March 2006. http://www.cdc.gov/ncidod/dhqp/pdf/ar/CAMRSA_ExpMtgStrategeis.pdf

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Alliance Message

By Pauline Lee & Andrea Yu, 2006-07 CCMS Alliance Co-Presidents

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Across

1 Bone that’s broken in Colle's fracture

4 Abdomen has a greater & lesser one

7 CN responsible for gag reflex afferents

8 A collection of tissues

12 Involuntary facial muscle contraction

13 Fetus messer-upper

14 "First do no ______"

15 Not well

17 CHF marker

19 Vitamin deficient in pellagra

21 Problem caused by a defect in LES

22 XY chromosome carrier

23 This element causes problems in Wilson's disease

24 Opening to the cervix

25 Brand name for metoprolol

27 Same as 24 across

28 Not po, pr, IV or SQ

29 2nd letter in Greek alphabet

30 Thousands & thousands within 23

33 Otolaryngologist to a lay person

35 Compound that binds hemoglobin 200 times better than oxygen

37 Best CXR view to see heart

40 Have bucket & pump handle motions

42 CN responsible for gag reflex efferents (full name)

43 Possible DVT sequela

44 Ocular condition seen in MS

46 Recent coronavirus caused epidemic

48 Human parasite that has pig as intermediate host

51 CN responsible for sight

52 OSHA says these should never be recapped

54 Lateral rectus innervator

55 Government suggested intake amount of vitamins

56 Palsy resulting from delivery in shoulder dystocia

Down

2 Ductus arteriosus allows blood flow b/w pulm arteries & this

3 Longest forearm bone

4 Final electron acceptor in electron transport chain

5 A potent vasodilator

6 Specialized cells that monitor urine Na concentration

9 Activated lymph nodes have this type of center

10 Upper limb, to a layperson

11 Test that's positive in SLE

12 Forearm extensor

14 Fe containing molecule

16 The back parts of skulls

17 Same as 17 across

18 The "P" in BP

19 Sodium, to a chemist

20 In the eye, to an ophthalmologist

22 Dura + pia + arachnoid

24 Space bounded by lacrimal, frontal, sphenoid ethmoid & zygomatic bones

26 Endolypmh containing organs

27 A parasympathetic ganglion in the head

31 Openings to nasal cavity

32 Hormone secreted by adrenal medulla

34 What the Babinski test should be in a normal adult

36 Pressure d/t proteins & other com pounds

38 Foramen through which CN V3 passes

39 Place where inguinal ligament & sartorius attach

41 Your relative to whom dad donates an X chromosome

45 Diaphysis & metaphysis containing organ

47 Disease often treated w/ amphetamine salts

49 Anatomical problem that may lead to paradoxical embolus

50 O2 has a 21% concentration in this

53 Sildenafil requiring problem

(answers at the end)

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Minutes

CLARK COUNTY MEDICAL SOCIETY BOARD OF TRUSTEES MEETING BOARD OF TRUSTEES MEETING

MINUTES SYNOPSIS

Tuesday, November 21, 2006; 6:00 P.M.

Minutes (October 2006)

The minutes were approved unanimously.

Financial Report

Using revenue for a new building or renovating the current building was discussed. Dr. Steinberg volunteered to attend the next building committee meeting.

Membership Report

Marlaina Burns reported there were 586 dues-paid members; last year at this time there were 586 paid members. Total including dues exempt members was 711.

Credentials Committee

The following members were approved for active membership: Atoya B Adams, MD - Internal Medicine; Shanker N Dixit, MD - Neurology; Timothy J Eichenlaub, DO - Family Practice; Donna M Miller, MD - OB-Gyn;

Wilson T Watanabe, MD - Internal Medicine; and Charmaine G Yap, MD - Endocrinology.

Medpac Committee

Dr. Evins, president of MedPac, discussed the election outcomes.

Community Health/Relations Committee

The committee met the directors of "Helping Kids". They are looking for items for donation for vision and hearing testing. They provide free physicals for children to go to camp and athletic activities. Dr. Jones requested any assistance, especially from pediatric physicians.

Health District Report

Dr. Kwalick was unable to attend but provided a written report to the Board on current Health District concerns. Dr. Jameson commented on the monumental achievement of the Clean Air Act.

UNSOM Report

Dr. Lenhart explained to the board how residency programs might be divided among hospitals with the help of ECG consulting. He stated that he would be bringing the board continual updates and the next meeting would be December 5th, 2006.

Touro University College of Osteopathic Medicine Report

Dr. Kalekas explained the college's relationship with Valley Hospital and that Valley chooses all of their residencies. He explained about dually accredited training programs. He stated that Touro University is looking at dually approved post graduate training programs.

Alliance Report

Pauline Lee spoke about the greeting card event. She also mentioned the passing of question five and thanked the Alliance for all their help. Pauline Lee mentioned the upcoming fashion show on Friday March 23rd at the Four Seasons Hotel benefiting the American Heart Association and the American Stroke Association. She also requested the donation of items for the silent auction.

Scholarship Fund Report

Dr. Ellerton stated that he was planning to have a scholarship meeting in December to discuss a different way to fund the scholarships besides going through the foundations. He stated that he needed to get the outside people on the board (Irene Correr and Dr. Nawaz Qureshi) invited to the meeting. He reported that the task of reincorporating the scholarship fund was in process.

NSMA Report

Larry Matheis discussed the implications of the proposed Medicare cuts. Dr. Jameson requested that an ad be placed in the Senior Spectrum to alert the public about those cuts. Dr. Jones stated that OB/Gyn Society would like to contribute to the ad, the Clark County Medical Society would pay $500 and Dr. Jameson said she would pay the remaining balance.

AMA Report

Dr. Horne spoke about some topics that were covered at the conference such as; the governments "pay for performance" initiatives, utilizing preventive Medicare services, housing medical records, post operative care of Medicare patients, and many other issues. There also was some discussion on the ethical concerns of reporting patients who are illegal immigrants.

NBME Report

Dr. Rodriguez stated the NBME would be meeting on Dec 1st and 2nd. Dr. Havins asked about an agenda item that limited public comments to five minutes. He explained that this was necessary due to a previous incident.

Presidents Report

Dr. Jameson restated her position on the proposed Medicare cuts.

New Business

There was discussion about the possibility of providing health insurance to members. A question was raised regarding the possibility of Medical Liability Association of Nevada providing an insurance discount for Clark County Medical Society members. Dr. Teijeiro reminded the board about providing resolutions for the upcoming delegates meetings.

Old Business

Vaccination Rates were discussed.

Future Meetings

The next monthly meeting for the BOT Executive Council will occur on December 19th, 2006 at 6:00pm.

Adjournment

There being no further business, the meeting was adjourned at 7:40 p.m.

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Southern Nevada Health District Disease Statistics* - November 2006

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Classifieds

southern nevada lab services: is a newly established clinical laboratory providing accurate and timely results using leading edge equipments. We specialize in home health agencies and assisted living facilities, offering PICC line draws and onsite PT/INR testing. Call us @ 437-5227.

for lease: 2600 sq ft on W Charleston between Rancho and Campbell. Immediate occupancy, brand new, exam rooms furnished. Available 4000(+/-) sq ft needs some build out, one story bldg, lots of parking. Also have 6500 sq ft on Charleston, call for availability dates. Call cell #232-3344 or 804-4736.

Practice & Equipment for Sale: Family Practice, mostly Medicare and contracted FFS. Equipment includes surgical instruments, business machines, computers, chairs, stools and exam tables. Call 733-8803 if interested.

Need Internist or Family Physician: will provide new office/full staff support, EMR, X-rays. Set your own hours, full or part time. Email resumes at staff@childrensurgentcare.com or call at 898-6400.

FOR LEASE: 4000(+/-) sq.ft. W. Charleston frontage, one story, ample parking, Close proximity to VALLEY & UMC hospitals and freeways. Build to suit. Call cell #702-232-3344.

Office space (1700 sq ft) available: for sublease in central location (2020 Goldring) near Valley/UMC. Currently seeing surgery patients half day 1-2x /wk. Call 688-1343.

OB/GYN Physician needed: Nevada Health Centers is recruiting for a Board Certified OB for its Las Vegas Clinic. This is an opportunity to join an experienced team and to work with a supportive staff. We offer a competitive compensation package with full benefits. Email your CV to sharders@nvrhc.org.

House for sale by owner: Play tennis in your own tennis court in your backyard; 5500 sq ft home, 5 bd 7ba, 1/2 acre, gated SW, pool. Call 702-289-2835.

Single family home for rent: in guard gated community. 4 bedrooms/3 ½ baths, large yard with pool and spa. Newly remodeled gourmet kitchen and fresh custom paint throughout. Partially furnished. Close to UMC and Valley Hospitals. $2900/mo. Available now. Call Ann @702-338-5335.

SEEKING BOARD CERTIFIED/ELIGIBLE MD OR DO: UNSOM's Family and Community Medicine in Las Vegas needs a FT family physician interested in Student Health. Must have Nevada license, eligible for malpractice. Apply online http://www.unrsearch.

OFFICE IN SOUTHWEST FOR LEASE: Rainbow-Quail Plaza, 5755 S Rainbow Blvd., 1609 sf. Rainbow frontage near 3 hospitals. Completely built out. Available immediately. Call 280-1003. RE/MAX One.

OFFICE FOR LEASE IN SOUTHWEST: Spanish Trail Business Park, near Spring Valley Hospital at Rainbow & Tropicana. 2500 sf available beginning January 2007. Building currently under construction. $1.50 NNN, TI allowance. Call 280-1003 or 222-0500. RE/MAX One.

Office space available: Desert Professional Plaza, 2225 E Flamingo Rd, 2 suites available - 1,200 sq ft and 1,100 sq ft can be combined for 2,300 sq ft. Completely built out - call 221-7000 for more information.

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CME CALENDAR

Bechtel Nevada 295-0208

NV Chapter AACE 434-8400

Pri-Med Institute (877) 4PRI-MED

Sierra Health Services 242-7735

Mar 8 - “Headaches”

Apr 12 - “Why Hospice”

Southern Nevada AHEC 318-8452

Southwest Medical Associates 242-7735

Summerlin Hospital 233-7572

Sunrise Hospital 731-8210

UMC 383-2604

Mar 2 - “Tourette Syndrome: Tackling a Noisy Tic Disorder”

Mar 9 - “Capacity to Make Medical Decisions”

Mar 14 - “Current Management of Community-Acquired Pneumonia in Adults”

Mar 23 - “Professionalism: Learn It, Teach It, Live It, Evaluate It” - 2 Hour Ethics Conference

Mar 30 - “Small Cell Lung Cancer”

Valley Hospital 388-4847

Education Opportunities for Practice Managers, Call the NV Medical Group Management Association:

697-5471 ext 134

Only CME Activities held at the Clark County Medical Society office are specifically endorsed by CCMS.

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County Line Advertisers

Colliers International…836-3756…….. www.lvcolliers.com

Commercial Specialists…..364-0909

Comprehensive Cancer Centers of NV ……952-3400

Ensemble Real Estate Services ….562-7595

Impress Communications …. 367-7771

Lee & Associates…………739-6222….. www.LeeLasVegas.com

Medical Group Management Association ….. 697-5471 ext. 134

MxSecure, Inc …..888-580-1010 …. www.mxsecure.com

Nevada Docs Support Association, Inc …….. 215-4894 …… www.nvdocs.com

Nevada Mutual Insurance Company ….. 798-6001 ….. www.nevadamutual.com

Premier Physicians Insurance Company…..860-6130 ... www.ppicmedmal.com

Protrans ….. 877-6333 ….. www.protranslv.com

The Firm……. 739-9933

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Answers

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Contents

Doctors have a prescription to help remedy Nevada's struggle against the medically uninsured