Clark County Medical Society

County Line

Newsletter 96 January 2008

Malpractice Filings Against Health Care Providers, Jan 2001 – Nov 2007

Member News

Alliance Message

BOT Minutes for October 16, 2007

Quarterly Referrals

Attention All Members:

CME Calendar

Southern Nevada Health Officer Report

Classified Ads

County Line Advertisers

President’s Message - January

GOING ABROAD FOR MEDICAL CARE

“More Affordable” Access?

Weldon (Don) Havins, MD, JD

President, Clark County Medical Society

Clark County physicians are accustomed to seeing patients from other countries for medical care. Within the last two years there has been a trend to entice American patients to seek medical care in foreign countries. While this trend initially involved uninsured patients seeking elective surgery in other countries, the trend is evolving to include self-insured health plan employees covered under ERISA (Employee Retirement Income Security Act) rules. Health plans governed by ERISA are generally not subject to the insurance rules of individual States. ERISA became effective in 1974 as a response to fraud and mismanagement of employee pension funds. Specifically, ERISA law preempts or overrules conflicting state insurance law. Falling outside of state insurance commissioner authority, ERISA preemption creates an opportunity for self-insured plans to reduce their costs by encouraging employees to utilize medical care in foreign countries.

In an era of increasing economic globalization, including medical economic globalization, Americans have traveled to countries like Brazil for elective cosmetic surgery procedures not typically covered by their medical insurance. Americans living near borders have sought cheaper prescription medications and dental care in Mexico and Canada. Some Americans have sought medical procedures in foreign counties when those procedures have not been available in the United States. Added to these medical travelers are uninsured Americans who are seeking alternatives to their local facilities for their non-cosmetic medical care. Medical travel agencies are now advertising on the internet, selling “medical vacations” to foreign destinations. Hospitals in foreign locales are advertising on the internet, including costs of procedures and their high quality standards.

More than 500,000 Americans are expected to seek medical care in foreign countries such as India, Thailand, Singapore, Mexico, and South Africa in 2007. The director of medical services for the Singapore Tourism Board states that 555,000 tourists received medical treatment in that country last year. Singapore intends to increase that number to 1 million by 2012. Bumrungrad International Hospital in Bangkok stated they treated 55,000 American patients in 2005, with over 80% of them having received non-cosmetic care. The Confederation of Indian Industry states that “medical tourism” is a $300 million business and is anticipated to grow to $2 billion by 2012. At least one Indian hospital, Wockhardt Hospital, has posted a series of videos on YouTube’s website describing their hospital and specific procedures in which they excel. Wockhardt’s website indicates they are an associate hospital of Harvard Medical International and share the benefits of association with Harvard Medical School. Anadolu Medical Center in Istanbul advertises they have a formal association with Johns Hopkins Hospitals.

Medical tourism companies are aggressively marketing to large employers and self-insured health plans by promoting excellent foreign hospitals which are the equal to the best U.S. hospitals in objective quality measures and certification. Many hospitals are certified by the International Division of America’s Joint Commission on Allied Healthcare Organizations (JCAHO). As of 2007, the website of the Joint Commission International indicated that JCI has accredited more than 100 hospitals outside the U.S., including Bumrungrad International Hospital in Thailand. Over 100 physicians and surgeons practicing in Bumrungrad are ABMS certified in their specialty. Many of the physicians there are products of America’s J-1 visa program which requires foreign medical doctors trained in U.S. hospitals to return to their home country. The JCAHO International Division (JCI) also has certified six hospitals in India, eleven in Singapore, two in Taiwan, seven in Brazil and four in China.[i] Hospitals with Joint Commission International accreditation charge about a third more than nonaccredited hospitals. Some of the medical tourism companies send staff to nonaccrediated hospitals in various counties to select those hospitals with American-type standards which provide a “better value” than JCI accredited entities.

GlobalChoice Healthcare, based in Albuquerque, N.M., has evolved within the last two years from a company focused on marketing to uninsured patients to providing “global healthcare to self-insured employers.” GlobalChoice contracts with employers to direct them to foreign hospitals with the best rates and best quality. This company also handles all the arrangements for the patients choosing to travel for their medical care. This can include providing a person to meet the patient at the arrival airport and providing a translator for the duration of the patient’s stay in addition to providing all the travel arrangements.

Some traditional American insurers are developing subsidiaries to become involved in this industry. Blue Cross/Blue Shield of South Carolina created a subsidiary company known as Companion Global Healthcare that assists with travel arrangements for patients going to Thailand’s Bunrungrad International hospital. Companion Global Healthcare negotiates prices with international hospitals for procedures not covered by Blue Cross/Blue Shield, where the patient pays in cash. In addition, Companion Global has begun to solicit business with self-insured employers with plans administered by Blue Cross/Blue Shield. This business includes developing incentives to induce patients to consider medical travel. Of course, Companion Global Healthcare offers its services to the uninsured.

Cost Savings

In 2004, the Christian Science Monitor reported that the average American hospital bill was $6,280, twice the bill of hospitals in other Western Countries.[ii] The cost of surgery can be up to 80% lower than the same procedure in U.S. hospitals. Reporters researching medical procedure costs have found that while a heart value replacement in a U.S. hospital may cost $200,000, one foreign hospital changes $6,700; a herniated disk repair costing $90,000 in a U.S. hospital cost $10,000 in a foreign hospital; a heart bypass costing $56,000 in the U.S., costs $8,000 in one foreign hospital; and, a liver transplant costing $300,000 in a U.S. hospital costs $30,000 in a foreign hospital (and the liver was available within two weeks of the patient’s arrival).[iii]

Inducements to Employees to Utilize Foreign Healthcare Programs

In addition to the excitement of travel to a foreign land with a companion, all expenses paid, the patients will often receive a cash bonus which may be a fixed amount or an amount based on the savings realized by the self-insured employer’s plan. Depending on the procedure, the costs savings can be so large that the self-insured employer can afford to “split the profit” with the employee and still reap substantial savings over paying for the procedure in the U.S. Privacy of medical information is generally assured by having the foreign hospitals and physicians sign a HIPAA business associate contract.

Concerns about Travel to Foreign Countries for Medical Care

A patient’s condition may worsen during the travel. Although payment for a companion is usually included in the self-insured programs, being away from other family and loved-ones during a period of illness may induce unusual stress. The potential for miscommunication due to language barriers is a risk. Finding a physician who will provide post-procedure medical care may be difficult, although this is increasingly being arranged before the patient leaves for the medical procedure. If complications arise during the post-procedure period, an anticipated longer stay will often be required. Lawsuits for medical malpractice may be practicably impossible to sustain against a doctor in a foreign jurisdiction.

How Good A Deal Is It? Federal Income Tax Considerations

The extent to which these programs will likely be used will depend upon practical economics, including the deductibility of the costs involved. Uninsured individuals will likely find the tax deductions more daunting and difficult to utilize than self-insured employer plans.

The Internal Revenue Service permits an individual who itemizes deductions to deduct medical costs over 7.5% of a person’s adjusted gross income (AGI). This percentage may seem daunting, but medical costs are liberally defined. Travel expenses to and from medical treatments are deductible at the rate of 20 cents per mile (in 2007). “Medical treatments” such as an extra pair of eyeglasses, an extra pair of contact lenses, dentures, hearing appliances, and artificial limbs may be counted as valid medical costs. The expenses associated with alcohol or drug abuse treatments are valid medical costs. Laser refractive surgery is a valid medical cost. Medical costs prescribed by a physician are valid costs. Examples of these are: a humidifier added to your home’s heating and air conditioning system to treat a person’s chronic pulmonary disease, which includes installation costs and costs to operate the devise; or a spa, both installation and operation costs, when prescribed by a physician as a necessary medical treatment for a person with a chronic medical condition. Costs of admission, lodging, and transportation to a seminar or education conference pertaining to the patient’s disease are recognized medical costs. When prescribed by a physician, weight loss programs and smoking cessation programs are valid medical costs. Additionally, medical expenses also include premiums paid for health, dental and vision insurance provided they are not paid by an employer-sponsored health insurance plan.

Once medical costs reach the 7.5% threshold in a year, they become deductible. An uninsured’s medical expenses for a procedure conducted in a foreign country may well exceed the threshold. For example, if an individual’s U.S. medical costs total 5% of AGI in the year, none will qualify as an itemized deduction on schedule A of the IRS Form 1040 . However, if that individual obtains medical care in a foreign jurisdiction during the year, valid medical costs associated with obtaining that procedure may total 20% of that individual’s AGI. In this case, medical expenses equal to 12.5% of the person’s AGI would be deductible . Data published by Families USA in mid-December 2007 concludes that 1 in 12 Nevadans will spend more than 25% of their pre-tax earnings on out-of-pocket medical expenses in 2008.[iv] For the uninsured, paying substantially less for a necessary medical procedure overseas, combined with the tax deductibility constitutes a double measure of motivation to seek foreign jurisdiction medical care.

Of those with medical insurance, the Families USA study found that about 657,000 Nevadans under age 61 are in families that in 2008 will spend more than 10 percent of pretax earnings on health care not covered by insurance. The study also showed nearly three-quarters of those Nevadans are covered by health insurance - which means insurance "simply no longer offers the protection that America's families need," Ron Pollack, the nonpartisan group's executive director concluded. Thus, even Nevadans with medical insurance have a motive to seek less expensive medical care outside the U.S.

Employers with self-insured health care programs are greatly advantaged by employees choosing to obtain their much less expensive medical care in foreign jurisdictions.[v] Employers may deduct, as corporate medical care benefits, the costs of transportation expenses for the patient, transportation expenses for a traveling companion (assuming a physician certifies that a traveling companion is medically necessary due to the patient’s serious medical condition), necessary incidental expenses for the patient and for the traveling companion (although hotel lodging expense deductibility may be limited to $50 per person per day), translation expenses, expenses for consultation with American doctors while in a foreign hospital; and passport and visa expenses (necessary to travel to the foreign venue for required medical care).[vi] Even with paying all these expenses, self-insured programs find they save so much money over domestic medical care, they can offer financial cash incentive payments to induce employees to opt for the foreign medical treatment rather than to obtain the medical care locally.

The above information is not to be construed as tax advice. Individuals should consult with their own tax advisor regarding their own tax circumstances.

Opportunity and Threat for Local Physicians

While these programs currently constitute a small percentage of the medical care rendered on southern Nevada residents, the likelihood of these programs growing is substantial. A strong plurality of employed individuals is enrolled in self-insured medical insurance plans. These plans are continually seeking alternatives to increasingly expensive medical care costs. The foreign medical care programs are an obvious means to ameliorate the high cost of providing health care to employees.

Physicians performing relatively high cost medical procedures are most subject to feeling the effect of implementation of foreign medical care options in self-insured health care programs. In this age of increasing economic globalization, there does not appear to be an obvious method to subvert this trend. The AMA has appointed a committee to investigate the issues surrounding foreign medical care, but the AMA has yet to take a position on this issue or offer suggestions to American physicians regarding a preferred method of confronting the trend. Some States are considering requiring physicians to discuss with patients the risks associated with foreign medical care. However, to CCMS’ knowledge, this has not proceeded beyond the talking phase.

As many physicians await some mechanism to ameliorate this foreseeable threat to medical market share, other physicians have opted to join these foreign programs and provide post-procedure care to patients returning to the U.S. The liability issues associated with providing this care has not been elucidated. It would appear that the participating U.S. physicians would be likely targets of medical malpractice claims for negligent care in the foreign jurisdiction because American physician are accessible, foreign venue providers are not. Medical liability laws in most foreign jurisdictions are not plaintiff oriented and don’t follow the English common law theories of U.S. law. The U.S. physician is a much easier target.

Others opine that participating U.S. physicians are simply recognizing the reality that an increasing share of medical care will be rendered outside the U.S. The participating physicians are grabbing a share of this market now before others “wake-up” to the reality of increasing medical economic globalization.

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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 78

Nov 38 184 59 78 73 50 53

Dec 9 170 67 47 30 28

Sum 372 823 1246 867 581 720 771

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Member News

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

· Constantine George, MD - Internal Medicine, 2725 S Jones Blvd #100, Las Vegas, NV 89146

· Elissa J Palmer, MD - Family Medicine, 2410 Fire Mesa St #180, Las Vegas, NV 89117

Welcome Reinstated Members:

· Tanvier Ahmad, MD

· Tanvir Ahmad, MD

· Dodd D Hyer, MD

· Jaswinder Grover, MD

· Jammejay Patel, MD

Applicants to Go Before Credentialing Committee

· Kellie Anne DeLozier, MD - OB-Gyn

If you have any pertinent information about this membership candidate, 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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Alliance Message

By Wendy Agrawal & Estela Hansen, 2007-08 CCMS Alliance Co-Presidents

Happy New Year 2008! We are very excited about 2008 at the CCMSA! We are looking forward to some wonderful events this year! Our monthly luncheon for January will be at the Dragon Ridge Country Club in MacDonald Highlands. This event will be Tuesday, January 15th at 11:30. (see menu below) For February, Heather Gerson and Christina Duke are busy planning a Membership Recognition luncheon. We will be recognizing our long-term members at this festive luncheon. Also in February, please Save-the-Date for a fabulous social event with spouses on February 9th in the evening. The location is to be determined. In March, we will be having our annual meeting and distributing the Nursing Awards. The Nursing Awards are the result of earnings from our Annual Holiday Greeting Card Project. We would like to thank Lisa Gollard, Bonnie Ng and Andrea Yu for a fantastic job this year working on this very important project. Our Annual Fashion Show is fast approaching on Wednesday, April 9th, 2008. The event will be held at the gorgeous Four Seasons Ball Room. Emilio Pucci is our Fashion House and all proceeds will benefit The Shade Tree. Please plan to attend and bring your friends. We are encouraging all members to help in some way with the event. Please contact our Chairperson, Jacqueline Nguyen-Lee for further details at 302-6157 or jlnguyuen@gmail.com. The 2007-2008 CCMSA year will wrap up with our Annual Hat luncheon in May.

We wish everyone a very happy, healthy, safe and prosperous New Year! We are looking forward to seeing you all at these upcoming events!

Sincerely,

Wendy Agrawal and Estela Hansen

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Board of Trustees Meeting Minutes Synopsis

November 20, 2007

I. Call to Order

The meeting was called to order by Dr. Havins at 6:00 pm.

II. Action Items

A. Minutes from the October 16, 2007 meeting were unanimously approved.

B. Financial report was presented by Dr. Havins:

l General Revenue - Actual for 4 months of Fiscal Year 2007-08 is $272,995.50 compared to $261,011.48 in Fiscal Year 2006-07 for an increase of $11,984.02 over last year at this time.

l Operating Expenses - Actual for 4 months of Fiscal Year 2007-08 is $132,233.87 compared to $122,838.90 for an increase of approximately $9,394.97 over last year at this time.

l Overall, for the first four months of our fiscal year, revenues exceeded our expenses by $140,761.63. The bank balance for the end of October was $623,575.57 compared to $528,913.27 last year at this time.

III. Committee Reports

A. Membership Count

Dr. Havins presented the Membership Report:

l As of October 31, 2007, total dues-paid membership is 588, compared to 586 last year at this time. This is a net increase of 2 members.

l Total CCMS members is 872, including 196 dues exempt members.

l There are 16 new members, 21 new student members and 1 reinstatement in the Fiscal Year 07-08.

l There are 88 Student members in the Fiscal Year 07-08.

B. Credentials Committee Report

Dr. Baron presented the Credentials Committee Report. Members were unanimously approved.

Constantine George, MD - Internal Medicine

Elissa J Palmer, MD - Family Medicine

Reinstated Members

Tanvir Ahmad, MD

Robert J. Comeau, MD

Dodd Hyer, MD

Jaswinder Grover, MD

Janmejay Patel, MD

C. Community Health/Community Relations

Dr. Teijeiro was not present, therefore, no report was presented.

D. Remodeling Committee Dr. Fathie presented the Remodeling Committee report:

l Dr. stated that there are no formal proposals at this time. A contractor met with Dr. Fathie and Nancy Sommer two weeks ago and went over the entire building. It was decided that the best way to approach the remodeling of the facility is by creating a timeline and stage several smaller projects, thus reducing the interruption time of staff and facility.

IV. Alliance Report (reported out of normal agenda sequence) Wendy Agrawal presented the report.

l Holiday Greeting Card Project - A copy of the fundraiser flyer was distributed to the BOT, and a request for support by the BOT was made. Forms will be accepted through the end of this week, and accepting checks through the end of next week.

l Greeting cards will be mailed December 7th.

V. County Health Officer Report (in packets)

Dr. Sands presented the report

l The Influenza season has started. Immunizations can still be obtained for $30/injection.

l Working with Nevadans for Antibiotic Awareness on their environmental infection control healthcare poster.

VI. University of NV School of Medicine Report

l Dr. Havins stated that Dr. McDonald's office called to advise that Dr. McDonald would be in attendance at this meeting. As he was unable to attend, no UNSOM report was given.

VII. Touro University College of Osteopathic Medicine Report Dr. Foreman presented the report:

l Touro is in the process of recruiting new students for the next class of 135.

l Everyone is invited to the first graduation May 18, 2008.

l Touro built out 35,000 additional square feet for a clinical research center that will be up and running within the next two months

l Touro hired Craig Seiden to formulate a practice plan program and he is making great contributions at Touro.

l The Autism Center for diagnosis and management will be operational within the next two months.

VIII. Scholarship Fund Report

Dr. Ellerton was not present, therefore no report was presented.

IX. NSMA Report

Larry Matheis presented the report:

l We are into the political season for the PAC activities and developing the strategies for the next two years.

l Larry participates in the regulatory hearings.

l The next council meeting is the second Saturday in January (January 12).

l A letter from Governor Gibbons was issued urging the Department of Justice to look closely at the United Health issues.

l The Attorney General continues to look at the options available to the State regarding possible anti-trust violations.

l Last week, United Health acquired Fiserv (the largest 3rd party administrator). The acquisition raised additional concerns with the Attorney General and the Department of Justice.

IX. MedPAC Report Dr. Evins presented the report.

l $1,500 was recently contributed to Senator Joe Heck's campaign, and $1,000 to Senator Bob Beer's campaign.

l Dr. Evins stated that NemPAC contributed to a number of Clark County races, including three district court races.

l We have raised some monies as a result of the MedPac mailer solicitation. Dr. Evins urged everyone to contribute $500 to MedPAC 2008/09.

l Dr. Jones stated that Garn Mabey and Valerie Weber are not running for re-election.

l A MedPAC meeting will be scheduled for January, 2008.

X. AMA Report Dr. Nelson presented the report:

l The AMA met in HI two weeks ago.

l 830 total resolutions were submitted, however, many of the resolutions have already been addressed in AMA policies.

l There was a huge discussion on physician anti-trust relief. The resolution passed with a majority vote, seeking legislative and regulatory law to negotiate better with health insurers.

l A resolution was heavily favored to implement Medicare Balance Billing. The AMA is requested to work on state laws that currently prohibit balance billing.

l A number of resolutions were presented to help with economic hardship for residents.

l The AMA opposed, after much debate, calling for reauthorization of the SCHIP.

l The AMA did vote to support alternative initiatives to expand coverage to the uninsured.

l Dr. Nelson commented that it seems as if every year there is less and less support for the system we have now, and more people who are willing to support single payer government sponsored socialized medicine.

XI. NBME Report Dr. Rodriguez presented the report

l The Board will meet in November.

l Dr. Havins advised that a newsletter was issued by the NBME stating that physicians must treat patient's pain in accordance with the Model Guidelines/Policy of the Federation of State Medical Boards. The document just has one "must"; the balance of document was stated as "should", which is ambiguous when put into law. The Legislative Council Bureau reviewed all the Nevada statues about 12 years ago and removed all the "shoulds". In 2000, the Board adopted the federation guidelines. If you read the guidelines, they appear to be aspirational suggestions for the treatment of chronic pain, but really do not differentiate between chronic pain and acute short term pain. The standards suggest in that document are inappropriate for the treatment of acute, short term pain. However, with the Board coming out with this threat of licensure discipline because "pain must be treated according to these guidelines", it creates some ambiguity.

l Dr. Havins talked with Ed Cousineau, and wrote an article in the December County Line regarding this issue.

l Dr. Havins stated that the NBME should revisit this issue and come up with some rational guidelines for treatment of chronic pain, which will be quite different than the treatment for short term acute pain.

l Dr. Havins asked Dr. Rodriguez to take this issue back to the NBME for discussion/review.

XII. President's Report:

l Dr. Havins announced that our member, Edward Stevens, MD, passed away and will be recognized at the Annual Delegates Meeting.

l David Balto, Esq. has made a request to CCMS for an additional $10,000. NSMA and SEIU have committed to an additional $10,000.

l Dr. Colletti asked if Washoe County has pledged any support to Mr. Balto. Larry Matheis stated "no". The impact in Washoe County will not be direct.

l After much discussion, a motion was made and passed to approve an additional $10,000 to be paid to Mr. Balto, with the caveat that no more monies will be authorized by CCMS in the investigative phase of addressing the merger.

l If the case goes to litigation, CCMS and NSMA would rely on the AMA counsel as CCMS and NSMA do not have the resources to support such an effort.

l Dr. Evins suggested a change to the Bylaws (via CCMS ballot) to establish an Ex-Officio position on the Board of Trustees for the Executive Vice Chancellor of the University of Nevada Health Sciences System or his designee. A motion was so made and passed. The proposed Bylaw amendment will be put to the membership in March.

XIII. Administrative Report There was no report.

XIV. New Business

l Dr. Jones advised that a fax was sent to the Board Members of a proposal from a construction company to tear down the current building and build a series of buildings, staging construction as the buildings and/or spaces are pre-sold.

l Dr. Lenhart requested that the Board of Trustees allow him to invite Dr. Trevesian to the January meeting to introduce him and give him an opportunity to share his perspective on the health systems.

XV. Old Business None to report.

XVI. Future Meetings Next meeting is scheduled for Tuesday, December 18, 2007 at 6:00pm. The December meeting is an Executive Council Meeting, however, all Board of Trustee members are welcome to attend.

XVII. Adjournment

Meeting adjourned at 7:26 pm.

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Referrals

The following referrals were provided to CCMS members in the fourth quarter of 2007 (through December 15, 2007)

Specialty Referrals

Allergy 1

Anesthesiology 0

Cardiology 2

Cardiovascular Surgery 0

Colon & Rectal Surgery 0

Dermatology 2

Diagnostic Radiology 0

Ear, Nose & Throat 3

Emergency Medicine 1

Endocrinology 11

Family Practice 14

Gastroenterology 1

General Surgery 2

Genetics 0

Geriatrics 0

Gynecology Oncology 1

Hematology 0

Infectious Medicine 0

Internal Medicine 9

Nephrology 3

Neurology 4

Neurosurgery 1

Ob-Gyn 5

Oncology 4

Ophthalmology 4

Orthopaedic Surgery 6

Pain Management 15

Pathology 0

Pediatrics 1

Ped. Endocrinology 0

Ped. Neurology 0

Ped. Psychiatry 0

Ped. Surgery 0

Plastic Surgery 11

Psychiatry 5

Pulmonology 0

Radiology 0

Rheumatology 1

Urology 3

Vascular Surgery 2

Other 0

Web Referral 22

Totals 134

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Attention All Members:

Board of Trustees Elections are Upcoming

The Nominating Committee's slate for the 2008-09 Board of Trustees will be mailed to the entire membership in March.

If you are interested in becoming a nominee, please inform a member of the Nominating Committee or CCMS staff at 739-9989 as soon as possible.

2008 Nominating Committee

Florence Jameson, MD (Chair) 702-262-9676

George Alexander, MD 702-242-6776

Warren Evins, MD 702-383-3600

Edwin Kingsley, MD 702-952-3400

Ron Kline, MD 702-732-0971

Rhonda Robbins, MD 702-734-9664

Carol Vanderharten, MD 702-733-3771

Per the CCMS bylaws, the committee must choose their slate from physician members having two or more years membership. If you are not on the Nominating Committee’s Slate, you can still be nominated by any voting member. Your endorsement must bear the signature of 4 voting CCMS members in good standing. All nominations must be submitted in writing before April 15, 2008.

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CME Calendar

AHEC 318-8452 x 258

Online - "Domestic Violence and Medical Ethics"

Bechtel Nevada 295-0208

NV Cancer Institute 822-5290

Jan 4 - “Tobacco Control, Health Eating & Obesity Prevention”

NV Chapter AACE 434-8400

Pri-Med Institute (877) 4PRI-MED

Sierra Health Services 242-7735

Southern Nevada AHEC 318-8452

Southwest Medical Associates 242-7735

Sunrise Hospital 731-8210

Jan 4 - “Neurovascular Case Discussion” 1.5 CME Credits

Jan 12 - “Pediatric Neurodevelopmental Disorders”

4 CME Credits

Jan 26 - “Thoracic Surgery Conference”

4 CME Credits

Feb 1 - “Neurovascular Case Discussion”

1.5 CME Credits

Feb 15 - “Pulmonary Embolism” 1.5 CME Credits

UMC 383-2604

Jan 4 - “Avian Flu: The Next Pandemic”

Jan 11 - “HIV Update and Treatment 2008”

Valley Hospital 388-4847

University of Utah 801-587-3411

Education Opportunities for Practice Managers 697-5471 ext 134

Call the NV Medical Group Management Association

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

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Southern Nevada Health District Report

Childhood Lead Poisoning Prevention Program

By Lawrence Sands, DO, MPH, Chief Health Officer

Southern Nevada Health District

Recently, the Centers for Disease Control and Prevention released new blood lead level guidelines indicating there are no safe levels of lead exposure. While higher levels can result in mental retardation, seizures, coma and even death, lower levels of exposure have been associated with permanent loss of I.Q. points, learning disabilities and behavioral issues. These new recommendations are especially important because there is no treatment for lead exposure (other than chelation therapy for very high levels) and the effects of lead poisoning are often irreversible.

In order to address the issues of lead poisoning and exposure, the Southern Nevada Health District officially began a lead poisoning surveillance program in 2004, when the Office of Epidemiology received a small sub-grant from the Centers for Disease Control and Prevention (CDC) Environmental Public Health Tracking System program through the Nevada State Health Division. This grant was also used to help fund a pilot program conducted by HeatlhInsight for physician education on childhood lead poisoning.

In 2006, the health district was awarded a five-year Childhood Lead Poisoning Prevention Program (CLPPP) grant. The availability of this funding has allowed for an expansion of the program and the development of Childhood Lead Poisoning Elimination Plan to support CDC’s goal of eliminating childhood lead poisoning by the year 2010.

The program made considerable progress in its first year including: establishing a strategic advisory coalition and the adoption of a charter; developing a screening/case management plan for children 6 years of age and younger and focusing on Medicaid-eligible children; identifying potential high-risk areas of Clark County for lead exposure and hazards based on the number of pre-1978 housing units in each zip code; producing patient information, physician education and other outreach materials (in English and Spanish); developing regulations to mandate all positive blood lead level screening results be reported to the health district; certifying staff as risk assessors; and organizing Continuing Medical Education (CME) training for physicians and child care professionals.

In addition to these accomplishments the program was also able to raise awareness of the importance of childhood lead poisoning prevention through a proclamation from the Nevada State Legislature and resolutions passed by the Nevada State Medical Association (NSMA). In both cases the legislature and NSMA expressed their support for development of the program, and advocated for childhood screenings for elevated blood lead levels, reporting to health authorities and public and professional education.

Additionally, through the blood lead level screening initiative more than 10,000 children, age 6 or younger, were screened over a two-year period. The results of these screenings demonstrated that only a small number (less than 1 percent) of the children tested in Clark County had blood lead levels of 10 µg/dL or higher, and that a quarter of those screened had some exposure to lead. These results demonstrate the need for a program that addresses primary prevention activities focused on identifying and eliminating sources of lead in the community.

Moving forward, the overarching goal of the lead prevention program continues to be the elimination of lead exposure as a potential health risk, especially for children. Additional program goals include expanding the elimination plan to the entire state of Nevada, developing legislation as needed to support lead elimination efforts, maintaining an advisory committee to support the goals and objectives and to foster ongoing partnerships, conducting environmental assessments and investigations, and transforming the lead program into a “Healthy Homes” program. The Healthy Homes Initiative is a U.S. Department of Housing and Urban Development (HUD) program that addresses multiple childhood diseases and injuries in the home.

Another key component in our efforts to identify children who have been exposed and eliminate the sources of exposure is increased awareness and educational opportunities for health care professionals. It is important for health care professionals to be educated on the importance of screening for blood lead levels, the risks of elevated blood lead levels and the methods for eliminating sources of lead exposure. To this end the Area Health Education Center of Southern Nevada (AHEC) is offering an online training program, “They Run Better Unleaded: Childhood Lead Poisoning in Southern Nevada.” More information about the program is available at http://www.snahec.org/moodle/.

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Classifieds

Medical Office Space For Lease: 1000-6,000sf ready for occupancy, location: Pecos and Bonanza, free covered parking, professional daily maintainence, adjacent Desert Pines Golf Course, surrounded by new retail developments, convenient to I-15/ Hwy 95 and downtown. Call for details: 702-938-6561 Stephen Balfour 702-938 6550 Ben Millis.

general & laparoscopic surgery: We strive to provide high quality & timely general & laparoscopic surgery services. Inpatient, outpatient, emergent & elective consulations. Kevin Rayls, MD, FACS & Stephen Horsley, MD. Mountain West Surgical 796-0022, 9280 W Sunset, Suite 300.

FOR LEASE - Completely builtout- medical office space - 3585 sf: Highly visible professional office park on Sunset Rd. between Pecos and Sandhill. Nine exam rooms, abundant 5.1/KSF parking. Competitive modified gross lease. Call Owner, Dr. M.J. Montgomery, 595-3557.

Physicians wanted: Physicians Medical Center is looking for motivated physicians to join our group. Locations are available at our Maryland Parkway and Tenaya offices. Physicians who have current patient populations are preferred. Please fax CV to 320-3856.

laproscopic surgery: Obesity (weight loss), lap band, gastric bypass, antireflux (Nissen), gall bladder, colon, splenectomy, stomach, rectum, wounds, PEGS, amputations, hernia, trachs, poracaths. Bernadine A. Hanna, MD 258-1293, 501 S Rancho, Suite F-38, 89106.

Physician wanted: Seeking BE/BC OB/GYN to join Henderson Est. Practice on St. Rose de Lima Campus

Competitive salary and benefits. For confidential inquiry or interest please call, Cheryl at (702)271-4451.

FOR SALE: 2 matching Earthlife medical exam beds. Beige. Electric height adjustment. Like new $1,500 each

Laserscope Gemini Laser (2005) 1064ndYag/532KTP combo. Like new. See www.Laserscope.com for specifications and treatment spectrum. Asking $80,000 (Retail $136,000) Call 254-7892

For Sale: Datum Rotary Action File Medical chart filling cabinet. Twice the files half the space. Spinning inner unit Holds Approx 2000 charts Brand new $1500. Call 242-6488

Physician Needed: The University of Nevada School of Medicine in Las Vegas is recruiting a full-time Allergy and Immunology physician for the department of Internal Medicine with an excellent benefit package. For complete position duties and to apply online visit: www.unrsearch.com/applicants/Central?quickFind=52584

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County Line Advertisers

21^st Century Oncology……990-4767. …… www.21stcenturyoncology.com

Comprehensive Cancer Centers of NV ……952-3400

Consultants in Marketing for Hutchison & Steffen ….. 944-2464 … www.wemarketo.com

E & S Medical Billing … 362-9494

Five Star Mortgage ….. 947-7827……. www.mortgage4doctor.com

IND………697-6400 www.ind-insurance.com

MassMedia for Territory … 433-4331 …. www.massmediacc.com

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

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

Nevada Docs Support Association, Inc ….. 702-215-4894… www.nvdocs.com

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

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

Southfork IREALTY … 376-3434

St Joseph’s Hospital ….602-406-3929 or 877-602-4111

The Firm……. 739-9933

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