Newsletter 94 November 2007
Contents
Health Insurance Enrollment Opportunity at
CCMS Headquarters
Malpractice Filings Against Health Care Providers, Jan 2001 – Sep 2007
The Estimated Contributions of 2007
Primary Care Graduates
Southern Nevada
Health Officer Report
BOT Minutes for September
18, 2007
Resolution
Regarding Medical Schools in Nevada
Health
Insurance Enrollment Opportunity at CCMS
Headquarters
By Valerie Clark of Clark & Associates of NV, Inc
and Maureen Henkes of Saint Mary’s Health Plans
Clark County Medical Society has teamed up with Clark & Associates of Nevada, Inc. and Saint Mary’s Health Plans to bring your practice an exciting opportunity to save valuable premium dollars on your group health plan!
Saint Mary’s Health Plans, a member of Catholic HealthCare West, is committed to providing high-quality, affordable health care to the community. Above all else we value:
- Dignity – Respecting the inherent value and worth of each person.
- Collaboration – Working together with people who support common values and vision to achieve shared goals.
- Justice – Advocating for social change and acting in ways that promote respect for all persons and demonstrate compassion for our sisters and brothers who are powerless.
- Stewardship – Cultivating the resources entrusted to us to promote healing and wholeness.
- Excellence – Exceeding expectations through teamwork and innovation.
Saint Mary’s Health Plans has
utilized the Preferred Health Care Network (PHCN) since 1993. PHCN’s statewide network provides access to over 4,000
physicians, 21 hospitals and over 200 ancillary facilities throughout
The Saint Mary’s Health Plan endorsed by the Clark County Medical Society began on June 1, 2007 with great success – many of your peers saved 15% to as much as 60% in premium dollars! Due to the extensive response received, there will be a one time, mid-year open enrollment effective February 1, 2008. Enrollment will begin November 1, 2007 and end December 31, 2007. The plan will renew June 1, 2008 and then renew every June thereafter.
Clark & Associates is
available to provide you with a personalized quote for your practice and answer
any of your questions. We invite you to
join the 185 practices that have requested a quote for the health plan by
contacting them at (888) 505-1261 or www.clarkandassoc.com.
You are also invited to join them at the
Five plan options are available to meet your needs: 3 traditional PPO plans with varying deductibles and copays, as well as 2 High Deductible Health Plans that can be coupled with a Health Savings Account. Eligible practices must have a minimum of 2 eligible employees.
Don’t miss out on this exciting plan opportunity!
President’s Message - November
IS MEDICAL TORT REFORM
"WORKING" IN
By Weldon (Don)
This next
Legislative session will be the first opportunity for legislators to amend the
Ballot Question 3 medical tort reform initiative which was implemented into
To
determine the effectiveness of current medical tort reform, it is necessary to
review where we were before the implementation of the current medical tort
reform statutes. This graph demonstrates
that jury medical malpractice awards were skyrocketing.
In fact,
the sum of
In
February, 2002, the
Problems at
the
The
Governor called a Special Session of the Legislature July 31, 2002. To the chagrin of many physicians and PLI
insurers, the Legislature passed AB 1 on August 3. AB 1 eliminated the Medical Dental Screening
Panel. It capped non-economic damages at
$350,000 to each defendant in an action for medical malpractice, but provided
that the trial judge could determine by clear and convincing evidence that an
award in excess of the $350,000 was justified because of exceptional
circumstances. The non-economic damages
award could not exceed the defendant's policy limits if the defendant
maintained at least $1 million/$3 million coverage. AB 1 eliminated joint liability ("deep
pockets") for non-economic damages and made each defendant liable for
non-economic damages only to the extent of fault. The statute of limitations was shortened from
4 years to 3 years, or 2 years after the plaintiff discovered or should have
discovered the injury. AB 1 provided for
a $50,000 cap on damages for emergency care when the patient entered the
hospital through the emergency room or trauma center. This cap applied to physicians and dentists,
hospitals, and employees of hospitals, but applied only to care rendered as
part of the traumatic injury. For cases
filed between October 1, 2002, and October 1, 2005, the case must be dismissed
if not brought to trial within 3 years of filing. Cases filed after October, 1, 2005, were to
be dismissed if not brought to trial within 2 years. Trial judges were to have special training in
medical malpractice. Expert medical
testimony in the form of an affidavit was required to file a case. The medical expert was to practice or have
practiced in the same or substantially similar field as the defendant. While some of the provisions were welcomed,
the elimination of the Medical Dental Screening Panel without creating a firm
cap on non-economic damages doomed AB 1 as an instrument to ameliorate the PLI
insurance crisis.
Over the
next several months, PLI insurance premiums continued to rise, physicians
increasingly left
Following
the passage of AB 1, it was immediately apparent to many physicians that the
PLI crisis would not be averted by this well intended, but inadequate,
legislation. The Keep Our Doctors in
The
severity of the crisis was reflected in the number of new licensees of the
Nevada Board of Medical Examiners with addresses in
Year Clark
1998 1907
1999 2023 116
2000 2153 130
2001 2314 161
2002 2321 7
2003 2366 45
2004 2578 212
2005 2729 151
2006 2885 156
Estimated
Ballot
Question 3 medical tort reforms were implemented on November 24, 2004 when the
election results were certified by the Nevada Supreme Court. The net gain in licensees in
The last
issue of the
A perusal
of the frequency of claims filed against health care providers, published in
each month of the
While the
numbers are less empirical, the severity of claims has been ameliorated by our
current medical tort reform. In 2001,
there was $ 21 million in jury verdicts.
In 2004, there were only three plaintiff medical malpractice verdicts in
In summary,
the competition among the increasing number of insurance carriers has made PLI
insurance more readily available with premiums more affordable.
Yes, the
medical tort reforms of Ballot Question 3 of the 2002 election are
"working" and will continue to do so if left intact by the
Legislature and by the Nevada Supreme Court.
Clark County District Court Medical Malpractice Filings
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
60
May 37 35 126 65 14 71
84
Jun 27 24 103 90 65 83
56
Jul 19 100 114 45 66 74
84
Aug 54 51 76 67 33 82
74
Sep 20 65 105 79 36 51
62
Oct 37 83 110 59 26 74
Nov 38 184 59 78 73 50
Dec 9 170 67 47 30 28
Sum 372 823 1246 867 581 720 640
Member News
Congratulations and Welcome to the
·
Bennett K Abe,
MD – Radiology, 2555 Montessouri St #C, Las Vegas, NV 89117
·
John S
Anderson, MD – Radiology,
·
John R Gosche, MD - General Surgery, 2040 W Charleston Blvd #601, Las Vegas, NV 89102
·
Stephen B
Horsley, MD - General Surgery, 9811 W
Charleston Blvd #2-389,
·
Matthew W
Schwartz, MD - Radiation Oncology, 10001
S Eastern Ave #108, Henderson, NV 89052
·
Scott G
Shipley, MD – Otolaryngology, 3131 La
Canada #241, Las Vegas, NV 89109
·
Michael J
Todd, MD – Radiology, 3201 S Maryland
Pkwy #300, Las Vegas, NV 89109
Congratulations and Welcome to the
All from
·
Linda Lay, OMS
·
Lindy Lay, OMS
·
Jonathan A
Santana, OMS
Applicants to Go Before Credentialing Committee
· Miriam E
Bar-on, MD - Pediatrics
· Rita B
Chuang, MD - Family Practice
· Elizabeth
Hamilton, MD - General Surgery
· William P
Jacks, MD - Family Practice
· Kenneth J
Mooney, MD - Internal Medicine
· Krystal H
Pham, MD - OB-Gyn
· Mary A
Thomas, MD - PhysMed/Rehabilitation
If you have any pertinent information about these
membership candidates, please contact:
For information
on becoming a member of the
The Estimated Contributions of 2007 Primary Care Graduates
By Robert C. Bowman, M.D. a workforce
researcher and the North American Editor for Rural and Remote Health. He
has practiced in a wide range from inner city to rural locations in 4 states
and trained a broad range of health professional students and residents. His
other workforce efforts can be found by Google at Physician Workforce Studies.
His current efforts are involved in the restoration of Infrastructure
I continue to hear from colleagues who are assaulted by various claims by various forms of primary care. Many of these claims involve reports of family physicians that are not able to provide services to all. Although Irfan Dhalla noted that "The plural of anecdote is policy" these anecdotes are not suitable for developing national, state, or local health policy. When nations decide about workforce they need national comparisons and realistic estimates based on the current policies and the most recent graduates. The process involved in the following comparisons is described using current literature and physician databases.
Each primary care form was considered across the lifetime of a current 2007 graduate. This included nurse practitioners (NP) and physician assistants (PA) finishing their training and their specialty training and graduate degree as well as graduates of residency programs in family practice (FP), internal medicine (IM), and pediatrics (PD). The detailed information regarding the process of calculation was provided for nurse practitioners, but was used for all forms.
About 7,000 nurse practitioners complete training each year, a level that is stable to slightly decreasing. According to recent surveys about 71.4% have trained in primary care as defined by family practice, adult, and pediatric programs. Others have trained in specialties such as women's health (11%) and geriatrics (4%) that are not considered primary care in physician calculations (Geriatrics, Obstetrics-Gynecology). Nurse practitioners and physician assistants have followed the physician example with 1 - 3 new subspecialty programs, moving practitioners away from primary care workforce capacity.
In addition the impact is felt in nursing capacity as 20 - 30% of PAs and all nurse practitioners were previously involved in nursing. While some argue for more primary care through nurse practitioners, the other side of the equation is losses of 7,000 nurses a year, losses of nursing faculty that contribute to future nursing shortages, and losses of some of the best nurses needed in critical areas (hospital, management and leadership).
Nurse practitioner studies often list tables (Hooker and Berlin 2002) that are adapted from other studies. To interpret the missing data in the table for nurse practitioners, the 2004 AANP survey can be consulted. Hooker lists 19.3% of NPs trained in adult NP (internal medicine). This entire group is often counted as primary care. The actual primary care is limited. A similar inflated reporting of future primary care is used in considerations of the National Resident Matching Program match in physicians with actual primary care levels less than half of those categorized as primary care in the match. Only the family physicians listed in the match are reliable primary care measures with about 10% lost or less active in primary care and about 10% gained after the match.
In the 2004
nurse practitioner survey the actual primary care level for the internal
medicine specialties appears to be about 5% of NPs compared to the 19.3% of
adult trained NPs or about 25% of the total. Family nurse practitioners are
also involved in subspecialization so the actual
percentages are not apparent from the data presented. The internal medicine
subspecialties claimed 14.6% of NPs in 2004 and the newer graduates will have
levels above 23% throughout their careers. Cardiology has increased from a tiny
fraction to 6% of NPs in 2004. This is a level double the national physician
percentage of cardiologists of 2.8% or 2.6% for
These ratios of 25% in internal medicine primary care and 60% in pediatric primary care follow the similar primary care proportions found in internal medicine and pediatric residency graduates. The career choices follow the specialties favored by health policy, pursued by physicians, and allowing specialty physicians to hire more assistants of all types. Another factor is likely to be the experience of the nurse in the average 11 years prior to becoming a nurse practitioner (declining to 8 years now). It should be noted that over 50% of nurses are found in hospitals. Only about 20% of nurses are found in typical ambulatory primary care. (Spratley et al 2001) If studies indicated more relative losses in primary care, concerns should grow regarding the nursing changes and the actual delivery of primary care. Failure to address the needs of nurses continues to have devastating impact on health care.
Nurse practitioner studies can be confusing with different categories and with reporting of NP graduates by their training program type rather than their actual career. It should be remembered that nurse practitioners can and do switch specialty areas and can do so without the complicated, costly, yet somehow necessary years of training as in physicians.
One of the more detailed NP studies in 2002 found 0.54 FTE (22,000 FTE assembled from multiple duties for 39,000 responding NPs) in a nurse practitioner defined primary care specialty in 2002. This was not adjusted down for women's health or geriatrics (15% of NP), fewer work hours per week, lower volume, or inactivity of graduates. If the primary care value uses the 32 hour work week as full time and this is adjusted to 44 hours for full time, this results in only 0.41 FTE of primary care for the 39,000 NP Graduates who responded. A 36 hour work week figure results in 0.46 FTE of primary care. The average work week figures of 40 - 44 hours do not tend to be represented, possibly because there is wide variation. This is about 10 hours a week less than physicians and the most comparable female physicians have 52 hour work weeks. (AAMC Young vs Old)
Those making the calculations can vary the choice of hours that can be favor a current policy effort compared against physicians or physician assistants, but these are most commonly just confusing. Medical Group Management data is quoted, but these are studies in limited locations, usually the largest hospital and clinic practices. Physicians are involved in multiple other duties in such locations. These are the locations with 75% of the physicians, but the least and most atypical primary care physicians. These are also the least representative locations of family physicians, who are twice as likely to be found outside of zip code collections of 75 or more physicians, the so-called major medical center locations. Collecting data for family physicians, nurse practitioners, and physician assistants away from major medical centers is a more difficult process. The early physician assistant and nurse practitioner studies look very good for distribution, but these are long outdated studies. Also the physician and physician assistant data is widely available while the nurse practitioner data is dated and delayed. This also makes primary care, rural, and underserved contributions appear greater than reality in periods of decline. Only those who receive the nurse practitioner journals can receive the latest information which is embargoed from online access by the publishers for a year.
The decision was made to err in favor of greater nurse practitioner primary care contributions. A 0.5 FTE figure for primary care contributions per NP graduate was used. Nurse practitioners have a more limited workforce span since they average 11 years as a registered nurse prior to NP training. In addition the years of NP training also reduce the contribution.
The estimate of 20 years as a Nurse Practitioner is generous. Primary care physicians are likely to have at least 10 years greater primary care career length and physician assistants, who are younger, are also likely to have much the same although inactivity levels rise rapidly for PAs. With the use of a generous 20 years, this results in 70,000 raw workforce years for the 7,000 nurse practitioner graduates.
Further adjustments are needed. About 60% of nurse practitioner graduates are active (Spratley et al 2001) as nurse practitioners which adjust contributions down to 42,000 workforce years. The volume of primary care patients seen by NPs is 67% of the volume of a physician assistant. The volume of a PA is 75% that of a family physician (Larson, Hart, Ballweg) This means that the volume of a nurse practitioner is cut in half compared to family physicians. Again without the actual data it is difficult to separate these figures (activity, hours, lower volume) unless an actual primary care patient output is calculated in the same way for all types of primary care and tracked back to primary care graduates. In Medical Group Management Association studies, the NP and PA contributions using productivity to cost ratios were slightly below FP but similar. I suspect that these studies were heavily weighted toward major medical center locations where FPs are restricted in RVU productivity (fewer inpatient, ER, procedures, deliveries). FPs are much more productive "outside" and 50% have practice location outside of major medical centers. NPs and PAs have previously shared this level of outside location but are moving inside. They are also moving laterally to higher status urgent care locations that are outside, but lose their primary care, rural, and underserved contributions in the process.
This adjusts the workforce output to an estimated 21,000 years for the 7,000 NP graduates of 2007. This translates to an average of 3 years of primary care workforce for each NP graduate. It takes 5.6 nurse practitioner graduates to equal the primary care contributions of a family practice residency graduate. The workforce FTE for a nurse practitioner graduate is 0.15, the lowest of all forms. This level could be raised with more accurate data involving the actual contributions of those who have completed nurse practitioner training, including those remaining active in nursing or inactive. Again not all of the factors that could impact primary care contributions now or in the next two decades are considered. Those missing include losses to teaching, administration, research, hospital duties, urgent care, emergency care, inpatient, and multiple sites - all increasing in NPs and all decreasing primary care workforce contributions and capacity.
Estimated Primary Care Contributions of 2007 Graduates
PC FTE Per FP
Yrs Total Index
NP 3 0.15 5.6
PA 7.2 0.24 3.3
FP 25 0.84 1.0
IM 7.2 0.24 3.5
PD 16 0.53 1.6
A family medicine residency graduate provides 25.1 years of primary care, 0.84 FTE in primary care, and sets the standard for top levels of activity, primary care volume, distribution to rural areas (23%), and distribution to underserved areas. With fewer NPs and PAs training in family practice, training with family practitioners, and working with family practitioners, further declines will be seen in primary care, rural, and underserved contributions.
One of the key factors to understand in the declining primary care, rural, and underserved levels of the NP and PA graduates is the continued decline in contact with family physicians during training and during practice. The FP distributions do not tend to vary in primary care, rural, or underserved dimensions over years since graduation and over decades of class years of graduates. Family physicians increase in concentration in locations with fewer people, physicians, and health resources. What is important to remember is that all other forms of primary care are temporary and can leave at any time during training, at graduation, or after graduation. Those moving away from family medicine are moving away from greatest need.
Do nurse practitioners and physician assistants provide critical primary care workforce? Absolutely! The remaining programs and graduates that focus on primary care are major sources of primary care. They are also some of the most devoted, especially those that remain in continuity practices. A PA can gain 4% more by leaving a current job and 10% salary increase by leaving primary care. Hours, benefits, and support all increase. Over the years, these are difficult influences to avoid.
The massive increase in NP and PA annual graduations has managed to keep primary care solvent with new graduates replacing those leaving primary care, but the entire process is moving toward a shaky future with a rapidly growing population and greater diversity of population. The future primary care contributions of NPs and PAs as well as IM and PD are entirely dependent upon health policy support for primary care, upon emphasis of primary care in training and program design, and upon the decisions of major medical centers regarding salaries, benefits, hours, and support. These all favor further losses of primary care and nursing capacity.
References
Goolsby M. 2004 National NP Sample Survey Comparisons Over 15-Year Period. http://www.aanp.org/NR/rdonlyres/ewz24bs6jt72aeldxgvk3woyo4dhasuc5hvwpt65bs2iyej2edd3723ri3ggbwiptvoym2x7o37rwridsnb2tf3gfxh/2004NatlNPSampleSurveyWeb.pdf. Accessed February 22, 2007.
Goolsby MJ. AANP Survey Report 2002. http://www.aanp.org/NR/rdonlyres/ejazrhpkecffex5r25nono4434d3mr6p3s4ferrdkch5hreqjyxoid22tacrzfyzv7uav2bgvjt6oo/AANP%2bWebsite%2bPreliminary%2bReport.ppt#280,21,Roles Practiced, by Specialty.
Hooker RS, McCaig LF. Use of physician assistants and nurse practitioners in primary care, 1995-1999. Health Aff (Millwood). Jul-Aug 2001;20(4):231-238.
Hooker RS, McCaig LF. Use of physician assistants and nurse practitioners in primary care, 1995-1999. Hosp Q. Fall 2001;5(1):32-36.
Hooker RS,
Hooker RS. Physician assistants and
nurse practitioners: the
Larson E, Hart LG. Historical Trends in Physician Assistant Education and their Contribution to Primary Health Care for Rural and Underserved Populations in the U.S. 2000 http://www.ruralhealthresearch.org/projects/100002096/.
Larson EH, Hart LG, Ballweg R. National estimates of physician assistant productivity. J Allied Health. Fall 2001;30(3):146-152.
Primary Care Volume Statistics from the
American Medical Association. Physician Socioeconomic
Statistics. 2003 Edition from The Impending
Collapse of Primary Care Medicine and Its Implications for the State of the
Nation's Health Care: A Report from the
Spratley E. et al., The Registered Nurse Population, Findings from the National Sample Survey of Registered Nurses, March 2000 (Washington: Division of Nursing, Bureau of Health Professions, Health Resources and Services Administration, 2001).
1-6
NP PA FM IM Peds
Primary Care does not include practitioners with geriatrics, mental health, or women's health focus Training Program Grads Primary Care Residency Grads That Remain in FM, IM, or PD
Graduates Per Year Entering Workforce 7,000 8,000 2,784 7,840 2,658.2
Trained in Primary Care 71.4% 85.0% 100.0% 100.0% 100.0%
Office Primary Care FTE for those with Office Based Primary Practice Activities 0.5
FTE 0.4
FTE 0.9
FTE 0.3
FTE 0.6
FTE
Raw Primary Care Graduates Per Year 3500 3200 2505.6 2352 1594.9
Estimated Workforce Years (NP minus 9 years RN) 20 30 30 30 30
Raw Workforce Years in Primary Care 70,000 96,000 75,168 70,560 47,847.6
Active as Practitioners 0.67
0.87
0.93 0.93 0.93
Adjusted for Less Activity 42,000 76,800 69,906.2 65,620.8 44,498.3
Primary Care Volume 0.54
0.754
14, 8
0.868
0.958
Adjusted for Lower Volume 21,000.0 57,600.0 69,906.2 56,433.9 42,273.4
Primary Care Years Per Graduate Adjusted for Primary Care %, Inactivity, Lower Volume 3.00 7.20 25.11 7.20 15.90
Adjusted FTE of Primary Care Per Grad 0.15 0.24 0.84 0.24 0.53
Graduates Needed To Supply the Same Primary Care as 1 Family Physician 5.58 3.27 1.00 3.49 1.58
Rural Location 2000 - 2002 20% 20% 24% 9% 8%
Probable Rural Percentage Now 16% 16% 23% 8% 7%
Underserved Locations of 1987 - 2000 Grads Depends Depends 15% 9% 9%
- Adjustments for physician forms of office based primary practice activity usually reduce primary care numbers by 10% (teaching, administration, research, hospital based) but this adjustment was not used for NPs and PAs. Nurse practitioners count 11% in women's health and 6% in geriatrics (and others) as primary care, areas not considered primary care in physicians.
- The calculations included all family physicians and general practice physicians rather than the office based forms which have greater rural and underserved distribution. The office based forms of pediatrics and internal medicine have 69% major medical center location compared to 82% for those not classified in a primary practice activity, those classified as residents and those in hospital based activities. Not classified international graduates include those unemployed (8%), those in residency (new, delayed, or specializing), non-responders, or those who have left the United States (20% average most nations) to return to their home nations except Canada which is much higher.
- The underserved and rural locations of NPs and PAs (and all forms of primary care) depend upon the underserved or rural origins of those selected, training emphasis (decentralized or not), and their supervising physicians during or after training. Because NPs and PAs are less and less likely to work with family physicians, their rural and underserved distributions are more limited by other employment.
1. Goolsby M. 2004 National NP Sample Survey Comparisons Over 15-Year Period. http://www.aanp.org/NR/rdonlyres/ewz24bs6jt72aeldxgvk3woyo4dhasuc5hvwpt65bs2iyej2edd3723ri3ggbwiptvoym2x7o37rwridsnb2tf3gfxh/2004NatlNPSampleSurveyWeb.pdf. Accessed February 22, 2007.
2. Goolsby MJ. AANP Survey Report 2002. http://www.aanp.org/NR/rdonlyres/ejazrhpkecffex5r25nono4434d3mr6p3s4ferrdkch5hreqjyxoid22tacrzfyzv7uav2bgvjt6oo/AANP%2bWebsite%2bPreliminary%2bReport.ppt#280,21,Roles Practiced, by Specialty.
3. Hooker RS.
Physician assistants and nurse practitioners: the
4. Hooker RS,
5. Hooker RS, McCaig LF. Use of physician assistants and nurse practitioners in primary care, 1995-1999. Health Aff (Millwood). Jul-Aug 2001;20(4):231-238.
6. Larson E,
Hart LG. Historical Trends in Physician Assistant Education and their Contribution
to Primary Health Care for Rural and Underserved Populations in the
7. Hooker RS, McCaig LF. Use of physician assistants and nurse practitioners in primary care, 1995-1999. Hosp Q. Fall 2001;5(1):32-36.
8.
Alliance
By Wendy Agrawal & Estela Hansen, 2007-08 CCMS
Southern Nevada Health District Report
Effective Infection Control Practices
By
Southern Nevada Health
District
National Infection Control Week was
recognized the week of October 18-24. This week is intended to focus attention
on the importance of protecting patients and health care workers from
infections acquired in health care settings.
It is estimated that each year
approximately 2 million patients develop an infection during their hospital
stay and of those nearly 88,000 will die as a direct or indirect result of
acquiring the infection. In addition, health care workers are also at risk for
acquiring serious infections such as hepatitis B and C and human
immunodeficiency virus.
With these known risks, and the
increase of methicillin-resistant Staphylococcus Aureus infections, health care facilities are committed to
implementing measures to prevent infections. These measures include a number of
best practices and we are encouraging all health care providers to follow these
guidelines in order to protect themselves and their patients.
The Centers for Disease Control and
Prevention released its Guideline for Isolation Precautions: Preventing
Transmission of Infectious Agents in Health Care Settings in June 2007. This
documents updates and expands the 1996 Guideline for Isolation Precautions in
Hospitals and includes a review of scientific data regarding transmission in
health care settings, strategies to prevent transmission, Healthcare Infection
Control Practices Advisory Committee (HICPAC) precautions to prevent
transmission, and recommendations designed to prevent transmission among
patients and health care personnel in all settings where health care is
delivered. The full document may be accessed at:
http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf
As a result of the increased focus
on this important topic several health care facilities in
There is also an emphasis on the
role health care organization administrators should play to ensure the
implementation of infection control recommendations. Other areas of emphasis in
the updated guideline include education and training, surveillance, standard
precautions, transmission-based precautions and protective environments for
patients and staff that provide for their treatment.
At the local level health district
staff has been working in conjunction with the Nevadans for Antibiotic
Awareness (NAA) provider education subcommittee to develop an environmental
infection control poster. The poster is intended for display within the exam
rooms and lab rooms of health care provider offices. The poster includes information
on cleaning and storage of instruments, using protective apparel, cleaning
environmental surfaces and waste management. More than 2,000 copies of the
posters were distributed during the month of October to health care providers.
Infection control is an important
public health concern and the Southern Nevada Health District is committed to
working with health care providers to address concerns regarding the
transmission of infections and to provide information on updated
recommendations that address new and emerging issues related to infectious
agents.
Additional information about
infection control is available from CDC's Hospital Infections Program,
Board of Trustees Meeting Minutes Synopsis
September
18, 2007
I.
Call to Order The meeting was called to order by Dr. Havins at
II. Action Items
A. Audit Compilation Presentation by PBTK
Martha Ford, CPA from PBTK presented the compilation
analysis to the Board of Trustees. Trial
financial statements indicate growth, with an increase in net assets of over
$100,000.
Control test - a statistical sampling found that 5
checks payable to delegates had been issued but not released. To avoid repeating the accounting error,
checks will only be issued upon receipt of all expense documentation. A motion was made/passed to accept the
compilation report.
B. Minutes from the
C. Financial report was presented by Dr. Havins:
§
General Revenue – Actual for 2 months of Fiscal
Year 2007-08 is $50,623.19 compared to $45,881.57 in Fiscal Year 2006-07 for an
increase of $4,741.62 over last year at this time.
§
Operating Expenses – Actual for 2 months of Fiscal Year
2007-08 is $60,783.94 compared to $55,905.10 for an increase of approximately $4,878.84
over last year at this time.
§
Overall,
for the first two months of our fiscal year, expenses exceeded our revenues by
$10,160.75. The bank balance for the end
of August was $473,156.44 compared to $380,687.24 last year at this time.
III. Committee Reports
A. Membership
Count
Janice
Poblete presented the Membership Report:
§
As
of
§
There
were 82 new members and 10 reinstatements in the Fiscal Year 07-08.
§
Dues
exempt status granted by NSMA - Dr. Mulkey
§
Half
Dues status granted by NSMA - Dr. Charles Ebert and Dr. John Hazen.
B.
Credentials
Committee Report
Dr.
Havins presented the Credentials Committee Report. Members were
unanimously approved.
|
Applicant Names |
Speciality |
|
John S. Anderson, MD |
Radiology |
|
Bennett K. Abe, MD |
Radiology |
|
John R. Gosche,
MD |
Pediatric Surgery |
|
Matthew W. Schwartz, MD |
Radiation Oncology |
|
Scott G. Shipley, MD |
Otolaryngology |
|
Michael J. Todd, MD |
Radiology |
Student Members
Jonathan
A. Santana
Lindy
Lay
Linda
Lay
C.
Community Health/Community Relations
Committee
Dr.
Teijeiro presented the report.
§
At
the last meeting, the website information was reviewed and updated.
§
The
service opportunity with Westcare has been put on hold. The type of opportunity turned out to be
different than the committee’s initial understanding. A meeting is scheduled for October 3 to
discuss options. A report will be provided
at the next BOT meeting.
§
Dear
Doctor - The newspaper has requested new/updated articles. Dr. Alexander is working with the newspaper
to accommodate their request.
D.
Building Committee
Dr.
Jones presented the Building Committee report:
§
The
Tonapah property proposal was presented, and after discussion, it was decided
to decline the offer.
§
A
proposal for real estate brokerage services was submitted, offering a 6%
commission fee. Dr. Jones requested the
Board review the proposal and make any comments/recommendations no later than
October 1. Dr. Jones also requested that
any members wishing to bring forth a potential broker for consideration please
do so before October 1.
§
The
next Building Committee meeting will be held October 9. Upon her request and with Dr. Jones’
approval, Dr. Fathie was added to the Building Committee.
IV.
Estela Hansen and Wendy Agrawal were
not present. Therefore no report was
given.
V.
County Health Officer Report (in packets)
Dr.
Sands presented the SNHD Report
- The Southern Nevada Health
District is advising the community of an increase in the number of cases
of cryptosporidiosis. Currently, seven confirmed cases have been reported
in
VI.
Dr.
Lenhart was not present, therefore, no report was
given.
§
Dr.
Havins announced that Dr. Lenhart is now the Vice-Chancellor of Academics and
External Affairs for the Nevada System of Higher Education for the Health
Sciences Division.
VII.
Dr.
Foreman presented the Touro Report:
§
A
letter generated by the Dean of UNSOM regarding student mentoring was
discussed, and strong opinions were expressed as to the lack of collaboration
between the medical schools being fostered with such
actions.
§
A
motion was made by Dr. Jameson to have CCMS adopt a resolution that encourages
collaboration among the medical schools in Nevada in the education of medical
students and residents, and that a copy of the resolution be sent to the Dean’s
and CEO’s of the schools and universities in Nevada. The motion was unanimously passed.
§
A
motion was made to have the resolution published in the
VIII.
Scholarship Fund Report
§
Dr.
Ellerton was not present.
§
Dr.
Havins advised that Selma Bartlett made a $2,000 contribution to the
scholarship fund.
§
The
next Scholarship Funding Committee meeting is October 16 at 5:30 pm.
IX. NSMA Report
Dr.
Evins presented a brief update of NSMA activities:
§
The
Public Health Commission met last week
§
The
CME commission met September 17
§
The
Government Affairs commission’s upcoming meeting is Thursday, September 19
§
The
Internal Affairs commission meeting will be held next week
§
NSMA
is still very active with David Balto, Esq. regarding
the United merger.
IX.
AMA Report
Dr.
Horne presented the report
§
The
deadline for resolution submissions for the interim meeting (held in November) is
September 28.
XI. NBME Report
Dr. Rodriguez was not present:
§
The
NBME audit, as reported by Nancy Sommer, CCMS office manager who attended the
NBME Board meeting September 17, revealed a $1,000,000 loss in operating
expenses for the past year and $900,000 of operating losses the year
prior. Two physician’s licenses were
revoked on ground of conduct involving moral turpitude. $94,000 in fines is due the NBME. The net assets of the NBME stands at
$350,000, with $71,000 unrestricted.
XII.
President’s Report:
§
Dr.
Havins announced the passing of two members:
Dr. Gerald Jones and Dr. Peter Mattimoe
§
§
Dr.
Lonnie Hammargren requested a formal endorsement by CCMS of his application for
the position of State Health Officer.
After much discussion, a motion was passed for CCMS to decline to endorse
any candidate for the position at this time.
XIII.
Administrative Report
Dr.
Havins stated there was no Administrative Report.
XIV.
New Business
§
Solutions
for Solo Practitioners - Dr. Fathie requested and received permission to
announce the next meeting of this group and invited Board members to attend.
XV.
Old Business
None
to report.
XVI.
Future Meetings
Next
meeting is scheduled for Tuesday,
XVII.
Adjournment
Meeting
adjourned at
Resolution
Regarding Medical Schools in Nevada
The resolution below was passed unanimously by the
Clark County Medical Society Board of trustees, September, 2007:
Resolution of the
WHEREAS, the education of medical students and
residents in
WHEREAS, the collaboration of medical schools is
necessary to provide training for all medical students and residents; therefore
be it
RESOLVED: THE
Weldon (Don)
President,
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x 258
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