Newsletter 88 May 2007
Contents
Malpractice Filings Against
Health Care Providers, Jan 2001 – Mar 2007
Southern Nevada Health Officer Report
Installation Dinner Announcement
President’s Message
Faith Steps in
By
I have just returned from my Spring Break with my family and friends. It is always a time of reflection, rest, meditation and recreation. It is a time when I heal after too many months of too much work and too little rest. Also, more importantly, it is a time when I am inspired by springtime, by new life everywhere. We have faith that spring will come and when it arrives we are filled with hope for a better world and feel ourselves, if we would permit it, surrounded by love. Spring fills one with faith, hope and love for the world and humanity.
Just as the
planet has its seasons, so do we as humans. I was in the winter of discontent during the
malpractice crisis, and now I am in springtime again. I am almost through my year as president of
the Clark County Medical Society. I have
only three months left in my term.
During this last year, I have had a renewed faith in humanity, as I have
cultivated wonderful relationships with many of my colleagues, as we work
together side by side for better medicine in
Over the last months of my presidency, I will be sharing why I have faith in my colleagues and in medicine, hope for medicine in new legislative actions that are taking place and how love or charity is flowering in medicine in Nevada.
Whether we like it or not, we must let go of how medicine used to be or we will be eternally frustrated. We must recognize and accept what medicine is today, with its PPOs, its HMOs, its VIP practices, etc. Now, accepting this we must stop whining and start acting to preserve quality health care and the dignity of our profession. To many of us, medicine is like our religion, and we have lost our faith. We must separate the business of medicine and the art of medicine, and we will regain our faith in medicine.
What is faith?
It is not a mere belief. To believe in something is to acknowledge a fact, to have faith is to experience the reality. In medicine we go beyond facts and we develop relationships. The practice of good medicine must include developing good relationships between doctors and patients; between doctors and doctors; between doctors and our political representatives. Belief fixates but faith liberates. Beliefs are limiting and binding but faith is expanding and releasing.
During the malpractice crisis I lost faith, especially after a junk lawsuit. It was very difficult to trust a patient. I finally had to decide if I was going to continue living in fear of every patient or return to trusting the patient. It seems ridiculous now to look back and see I was struggling between fear and trust. It seems pretty obvious now.
The next challenge in medicine today is how to give quality care within the confines of PPO/HMO medicine. So I have learned to treat each patient as I would want to be treated for the 15 minutes that I have with them, then to reschedule. It is not what it used to be, but it is still a quality patient/doctor relationship, shorter but good medicine by a thoughtful caregiver. We must not allow our patients to become widgets. It is up to us to preserve the dignity of the doctor/patient relationship even though the system works against us. We can and must have faith in the patient and the patient/doctor relationship.
During the last year as president, my faith and my relationships with my fellow doctors has grown by a quantum leap. Each week and month as I attend various committee meetings and board meetings I am continually inspired by the selfless dedication and unwavering commitment by physician after physician to work together at the Society to improve the quality of medical care. It is a wonderful experience of sharing beliefs, ideals and values, of learning to have faith in one another.
Finally, I
would like to address relationships with our legislators. Of immeasurable value are the relationships
cultivated between our three physician legislators and the rest of the
legislature. Not only do they represent
medical interests, but also other important issues for their
constituencies. They are to be commended
for their words and actions. They have
done much to bridge the gap between physicians and the legislature. Never has physician and medical interest been
better represented or better understood in the history of
Faith is
about relationships. Faith in our
patients and our patient's faith in us is essential to
quality medicine. Faith between fellow
colleagues is essential to bringing a community of care to
Faith needs to have four attitudes to work: humility, hunger, meekness and sincerity. We must be humble before our patients, before each other and within the political process. We must be hungry enough to foster a proper environment for quality medical care through each of our relationships. We must be meek by always being open to learning from each other, from our patients, from the larger environment, and we must be sincere in our faith in ourselves to always do what is right by our patients.
As I reflect on this last year of presidency it has been a wonderful experience of faith. My faith in my patients, colleagues and legislators has never been greater, and continues to grow.
I encourage
you to exercise your faith. Join
CCMS. Join a committee. I encourage to you to cultivate better
relationships. Instead of feeling doubt;
allow your faith to conquer your feelings of despair. Faith is capable of stepping in and seeing us
through to a new era of quality medical care.
Watch your own faith grow. If we
each give a little of our time, as little as two hours a month, to a committee,
to volunteer work, you will experience the same expansive, liberating quality
that faith brings. Share your time and
your wisdom. It will help organized medicine,
and medicine in
Call CCMS
and join a committee of your choice. In June, my final article, I shall reflect
on the quality of medical charity that is growing within CCMS and in
Clark County District Court Medical Malpractice Filings
Against Health Care Providers, Jan 2001 –Feb 2007
2001 2002 2003
2004 2005 2006 2007
Jan 39 33 108 61 41 50 109
Feb 20 14 98 72 63 61 41
Mar 35 30 169 123 64 38 70
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 867 581 720 220
Member News
Congratulations and Welcome to the
·
Ronald J Knoblock, MD - Anatomic & Clinical Pathology, 3059 S Maryland
Pkwy, #100, Las Vegas, NV 89109
Applicants to Go Before Credentialing Committee
·
Andrew M Cash, MD
- Orthopaedic Spine Surgery
If you have any pertinent information about this
membership candidate, please contact:
For information on becoming a member of the
CME CALENDAR
Bechtel
NV
Chapter
Pri-Med Institute (877) 4PRI-
Sierra
Health Services 242-7735
May 10 - “MRSA the Growing Dilemma: Treatment
Protocols”
June 14 - “The Management of Rectal Bleeding”
Southwest
Medical Associates 242-7735
May 10 - “Physician -Patient Communications”
1 Medical Ethics Credit
May 12 - “Cultural Awareness and Tolerance”
2 Medical Ethics Credits
May 19 - “The Public Health Ethics and
Disease Reporting for Medical Professionals”
1 Medical Ethics Credit
May 19 - “Physician -Patient Communications”
2 Medical Ethics Credits
May 4 - “Common Problems in Pediatric
Surgery”
May 9 - “Updates in Heart Failure Care”
May 11 - “Small Cell Lung Cancer”
July 27-28 - “Advanced Life Support in
Obstetrics”
Education
Opportunities for Practice Managers, Call the NV Medical Group Management
Association:
697-5471
ext 134
Only
Executive Director Article
PHARMACOGENOMICS AND
By Weldon (Don) Havins, M.D., Esq.
President-Elect,
Executive Director, and Special Counsel
Pharmacogenomics anchors the evolving medical science which
is becoming known as "personalized medicine." New developments in this field of pharmacogenomics are introducing targeted drug therapies
for individuals with specific genetic predisposition. With genetic information, specific
medications and specific dosage regimes can be selected to maximize therapeutic
effect with minimal adverse side effects.
While this science has proceeded beyond its embryonic stage,
The response to pharmacologic
therapy of a particular disease can vary among patients depending on many
factors, such as unique genetic constitution, nutrition, diet, and
environment. Nutrition, diet and
environment can be known and controlled.
Personal genetic information is relatively in its infancy, but
constitutes a growing field of discovery.
As a practical matter, physicians often engage in trying several
different medications to obtain the optimal therapeutic benefit with the least
undesirable side effects. This multiple
trial approach is necessitated by the current FDA regulatory approval process
which requires drug safety and efficacy be established for a large general
population pool. In the foreseeable
future, knowledge of a portion of a patient's genome, in the form of
biomarkers, will permit individualized pharmacologic therapy to maximize drug benefits
while minimizing the likelihood of adverse reactions.
Under the direction of the FDA, a
Consortium (the Predictive Safety Testing Consortium) of major pharmaceutical
companies (Bristol-Myers Squibb, GlaxoSmithKline, Johnson & Johnson
Pharmaceutical Research & Development, Merck, Novartis, Pfizer, Roche Palo
Alto, and Schering Plough) has been tasked with sharing and validating
laboratory methods to predict the safety of new treatments. Pharmaceutical companies are sharing
knowledge to expedite the development of genetic biomarkers. An example of success in the research is the
FDA approved AmpliChip Cytochrome
p450 Genotyping Screening Test. This
test detects variations in two cytochrome p450 genes
from DNA extracted from a patient's blood.
Some known mutations in this gene are identified with abnormally rapid
metabolism of pharmaceuticals. Other
mutations have been found to be associated with abnormally slow metabolism of
the same pharmaceuticals. The pharmaceuticals
affected by cytochrome p450 system metabolize more
than 25% of all prescription drugs. This
AmpliChip screening test is the first of what is to
be many laboratory tests permitting physicians to use genetic information to
maximize the therapeutic benefit of a pharmaceutical agent while minimizing
potential risks to a specific patient.
Another example of pharmacogenomic guided
therapy involves the use of Trastuzumab (Herceptin) in the treatment of specific breast cancers
where the cell surface protein HER2 (human epidermal growth factor receptor 2)
has mutated and is over expressed. HER2
protein levels or gene copy numbers can now be measured (biomarkers) informing
the oncologist of the likelihood of successful treatment with this
pharmacologic therapeutic.
Driving the research and development
of this science are studies exemplified by a 1997 JAMA article propounding that
adverse drug reactions in hospitalized patients cost about $2,400 per patient
and cause an average 2 day extension in hospitalization. Many of these drug reactions are caused by
variations in genetic coding for enzymes which impact drug metabolism. Conceivably, testing for these genetic
variations could prevent many of the adverse drug reactions.
In practice, however, most FDA
approved medications have a wide safety profile and will continue to be used
without the need for genetic testing.
Acute diseases responding efficiently to standardized therapy will not
permit time for diagnostic testing.
Nevertheless, the development of genetic biomarkers for chronic diseases
which require long term pharmacologic therapy will be an important part of our
future.
It is a misdemeanor to retain
genetic information that identifies a person without first obtaining the
informed consent of the person or the person's legal guardian, with very
limited exceptions: criminal investigation, court order, or retention of a
medical record at a medical facility as defined in NRS 449.0151. This statute does not include a medical
clinic or a medical office as a medical facility which may retain genetic
information without specific written authorization of the individual. A person who has authorized another person
(physician) to retain his genetic information may request that genetic
information be destroyed. Failure to
destroy the genetic information, except in the rare circumstances noted above,
is a criminal misdemeanor violation under
Physicians should be aware that
violation of any provisions of state law regarding genetic testing and
information (NRS 629.151, 629.161, or 629.171) is a criminal misdemeanor. NRS 629.201 provides that a person who
suffers an injury as a result of the disclosure of his genetic information by
another person may bring a civil action for recovery of his actual damages,
including costs and attorney fees. In
addition, an injured party may also bring another action for medical
malpractice against a health care provider if the unauthorized disclosure of
the genetic information violates the standard of care of ordinary physicians in
similar circumstances. The promise of benefits
of genetic testing and use must be tempered with the mandates in
Southern Nevada Health District Report
By
Southern Nevada Health
District
My 20 years of experience in public health, preventive medicine, and health planning and administration have left me with a broad understanding and a healthy respect for the challenges public health agencies and health care professionals must overcome in order to meet the expanding needs of the communities we serve.
It is because of this understanding that in my new role as Chief Health Officer, my top priorities will be to continue to meet the current and emerging public health needs of our community through innovative programs and to provide leadership by serving as a catalyst for raising awareness and empowering the public to improve their individual health and the health of their community.
Our biggest challenge as we address these priorities will be to use our limited resources as effectively and efficiently as possible. As a public health agency we have to focus our efforts and resources on issues that have the most impact on disease, illness and injury in our community. With this in mind, sometimes difficult decisions must be made to allow our staff to refocus scarce resources to areas of highest need.
To this end, and after much consideration, the health district recently informed area health care providers we could no longer accept referrals to our community health nursing program for maternal child health issues from private hospitals, effective May 1, 2007. This decision was made after a careful review of the referral program, including the number of referrals received from private hospitals, the outcome of these referrals and the use of staff time.
During this past year we have received more than 2,900 referrals to our maternal child health program, and while approximately 20 percent of these referrals were from private hospitals they account for a higher rate of cases where families were not locatable for initial contact or follow up services.
It is unfortunate that we must cut back on our services due to a lack of resources. However, by narrowing our client base we will be able to better provide services to those clients who are most in need of our services which in turn will allow our public health nurses to follow through with all aspects of their care and to see clients through to a favorable outcome with long-term results.
Our nursing staff is dedicated to continuing to work with our health care partners to identify resources that better meet the needs of their patients and to assess these services and provide assistance when appropriate.
The health district is committed to working to secure needed resources and to collaborating with partner agencies and organizations with common goals to pool resources in order to maximize the impact on our community's health and the well-being of the constituents we serve.
I look forward to addressing our common goals through ongoing partnerships, and to successfully fulfilling the essential role the health district plays with both the public and private sector of ensuring the viability of our community from the perspective health plays in sustaining the local economy and promoting our overall quality of life.
Alliance
By Pauline Lee & Andrea Yu, 2006-07
CCMS
Minutes
MINUTES SYNOPSIS February 20, 2007
A. Minutes from the
B. Financial report was presented by Dr.
Havins:
§
Employee
Expenses - increased due to salary increases and employee turnover.
o
Dr.
Havins re-introduced Janice Poblete as the Membership Coordinator, and
introduced Nancy Sommer as the new Office Manager.
§
Overall,
revenues exceeded our expenses. The bank
balance for the end of January was $538,517.95 compared to $410,974.81 last
year at this time.
III. Committee Reports
A.
As of
B.
New Member Applicants were
presented to the board and were unanimously approved:
Applicant
Name Specialty
Lin-Chi
Chen, MD Internal Medicine
Camille
Falkner, MD OB/GYN
Husain
Abid, MD Internal Medicine
C.
Community Health/Community Relations
Committee
Dr.
Jones presented the report. The
Committee is:
§
Continuing
with the service opportunity project and identifying/posting community services
on the website.
§
Looking
at a contest whereby one service provider will be featured each month on our CCMS website home
page.
§
To continue to
be in contact with Healthy Families,
§
Planning to tour
Child Haven this Friday at
§
Working on the
“Ask The Doctor” column which is proceeding well, thanks to Dr. George
Alexander.
Dr. Jameson
provided an update regarding the “Purple Bus”.
§
The bus became
cost prohibitive and the care provided did not meet the needs of the
program. Therefore, a clinic was
established and is having great success.
§
The bus is now
available to CCMS, if we can use it as a clinic.
§
The bus would be
driven and parked at an agreed location, such as across the street from
Juvenile Justice Services, and would act as a self-contained mobile clinic for
children.
Dr.
Foreman advised there is a double-wide trailer set up at
A
grant has been requested to expand care to the homeless, making it a community
based project, through Carl Heard’s group (Nevada Health Centers).
§
Medical students
assist the physicians and see a large volume of patients.
IV.
§
Dr.
Jameson stated she was impressed with the
§
Dr.
Jameson stated that the
§
The
CCMS Alliance members are to be commended for their work with regard to the
passage of the tobacco free environment initiative.
V.
County Health Officer Report (in packets)
§
The
Board will read the District Health Report, provided in the meeting packets, at
their leisure.
VI.
Dr.
Lenhart presented the UNSOM Report.
§
UNSOM
is engaged in the Legislative sessions.
§
Many
items are “on the table”, including $110,000,000 proposed for “bricks &
mortar” in
§
The
current Governor’s budget does not include any monies for operations (faculty,
etc).
§
UNSOM
has asked for $14,000,000 to support admin faculty, residents and
fellowships.
§
Class size will be 62 this year (last year
was 57). The medical school application
process is going quite well.
§
UNSOM,
Touro & 5 of the large hospitals in
§
It is becoming more of a challenge for the
various institutions to support a central body to oversee all of the medical
education working within a single model.
IX. NSMA Report
Warren
Evins presented the NSMA Legislative Core Group Report.
§
Dr. Evins explained the purpose of the
meeting is to give direction to our lobbyists and report issues to the medical society, including decisions to be made
that are not yet part of the
legislative strategy.
XI. NBME Report
§
Next
meeting of the NSME is March 16-17.
§
Discussion
occurred regarding the Bill to have the Board of Pharmacy disbanded and their
duties transferred to the Board of Medical Examiners. Discussion also ensued
regarding the Bill to mandate CME for Gerontology for all practitioners.
XII. President’s Report
A.
The
passing of Eugene Eisenman, MD, a member since 1981, was
recognized by Dr. Jameson.
XIII.
Administrative Report
Dr.
Havins presented the Administrative Report.
A.
Expiring
Terms for Trustees
Dr.
Havins stated five Board of Trustee members terms are expiring:
§
If
any of these members are interested in running again for a Trustee position,
please ask them to contact a member of the Nominating Committee, who will be
meeting Thursday.
§
Dr.
Havins advised there are openings for President-Elect, Delegate Chair, Secretary and for five Trustee positions. Dr. Colleti and Dr.
Kline have expressed an interest in running for a Trustee position.
B.
St.
Mary’s Health Insurance
Letters were sent to entire
membership advising them of the opportunity to obtain a quote for health
insurance through the same type of program as enjoyed by Washoe Medical
Society.
C.
Performance
Appraisals were discussed.
XIV.
New Business
A.
MD
News (Presented by Dr. Jameson)
§
Ingrid
Edelman, publisher of MD News, presented an opportunity for MD News to publish
a special CCMS edition. Ms Edelman
stated it is a good opportunity to promote CCMS throughout the medical
community. In return, MD News would
obtain CCMS’s list (database) of advertisers.
§
After
discussion, the Board approved a motion permitting CCMS to send a letter to our
own advertisers asking our advertisers about their interest in supporting the
special CCMS edition publication. CCMS
will send the list of positive responses to that letter to MD News for further
action.
B.
UNSOM
Class of 2007 Yearbook Ad
§
A
½ page ad for $500 was unanimously approved.
C.
Dr.
Frei, Honorary Membership (Presented by Dr. Jameson)
§
Senator
Barbara Cegavske has previously contacted CCMS requesting an honorary
recognition for Dr. Frei, a world renowned
oncologist, who has retired and now resides in
§
Dr.
Ellerton stated he has known Dr. Frei for 25 years
and knows his work. Dr. Ellerton gave high praise to Dr. Frei.
§
After
discussion, it was unanimously approved to award Dr. Frei
an Honorary CCMS Membership.
§
CCMS
will provide a plaque and present it to Dr. Frei.
Classifieds
FULL-TIME FACULTY MEMBER NEEDED: UNSOM Dept of
Family Med., join at the rank of Asst or
Assoc Professor. Tenure is negotiable. Position will be providing patient care
(90% of time) in outpatient clinical setting and secondary role of student
& resident education (10% of time). In
Ophthalmologist, ENT physicians Needed: Nevada Eye & Ear is offering a unique opportunity for a BC/BE Ophthalmologist or ENT physician to join an established practice with its new office now open in the Southwest. Offering full or part time positions. E-mail your CV to jduncan@nee-nv.com or call Dr. Rudy Manthei at 702-492-6928
OFFICE SPACE AVAILABLE: 2400 sf commercial now available for build-out in the
OFFICE SPACE AVAILABLE: 1500 sf build-out, first floor, utilities included. Central location at Sahara/Rancho, older building, ample parking, I-15
access. Other short term, month to month leases available. Contact Melba at 702-384-1494.
Equipment
for
for
seeking a retired/semi-retired MD wanting to earn good
pay with a part-time, flexible schedule.
Needs current
for
lease: 2600 sq ft on W Charleston between Rancho and
Installation Dinner Announcement
County
Line
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