Newsletter 101 June
2008
Contents
NSMA's
104th Annual Meeting Held in Las Vegas
Malpractice
Filings Against Health Care Providers, Jan 2001 – April
Southern
Nevada Health Officer Report
NSMA's 104th Annual Meeting
Held in Las Vegas
The NSMA Annual
meeting was held at the Embassy Suites,
The first order of
Business, Resolution #2008-01, “MEMORIAL RESOLUTION”, was discussed and
recommended for a
RESOLVED: THAT THE NEVADA STATE MEDICAL ASSOCIATION
HOUSE OF DELEGATES EXPRESS ITS SORROW AT THE PASSING OF THE FOLLOWING: David F. Charles, MD - CCMS 05/28/07, Eugene
M Eisenman, MD- CCMS 01/29/07, T.C. Harper, MD - WCMS 07/10/07, George F.
Magee, MD - WCMS 06/28/07, Peter
F. Mattimoe, MD - CCMS 09/11/07, David E. Owensby, MD - CCMS 06/12/07, George
(Tom) Shires, MD - CCMS 10/18/07, Edward R. Stevens, MD - CCMS 09/23/07 - DO PASS
The next item of
business, Resolution #2008-02, “NSMA TO PROVIDE FINANCIAL ASSISTANCE TO HELP
DEFRAY NSMAA LEADERSHIP TRAVEL EXPENSES”, was discussed and recommended for a
DO PASS AS AMENDED. RESOLVED: THAT THE NSMA TRANSFER $20,000.00 FROM THE
RESERVE ACCOUNT TO A NEW INTEREST
BEARING ACCOUNT FROM WHICH THE INTEREST INCOME WILL BE USED TO HELP DEFRAY THE
LEGITIMATE COSTS INCURRED BY THE NE
THE PRINCIPAL SUM WOULD ALWAYS REMAIN UNDER CONTROL OF THE NSMA EXECUTIVE
COMMITTEE; and, be it further RESOLVED: THAT THIS BEING A NEW AND UNTRIED USE
OF NSMA FUNDING, THE RESOLUTION SHOULD BE REVIEWED IN TWO YEARS. DO PASS AS AMENDED
Resolution
#2008-03, “ NSMA TO RENEW EFFORTS TO
MAINTAIN THE HIGHEST ETHICAL AND SAFETY STANDARDS AMONGST ITS MEMBERSHIP”, was
discussed and recommended for a DO PASS AS AMENDED. RESOLVED:
THAT NSMA RENEW EFFORTS TO MAINTAIN THE HIGHEST ETHICAL AND SAFETY
STANDARDS AMONGST OUR MEMBERS AND COLLEAGUES AS OUTLINED IN THE AMERICAN
MEDICAL ASSOCIATION/AMERICAN OSTEOPATHIC ASSOCIATION CODES OF ETHICS, and be it
further RESOLVED: THAT SUCH EFFORTS BE
COMMUNICATED TO THE PUBLIC. DO PASS AS
AMENDED
Resolution 2008-04
“QUALITY OF CARE”, was discussed and recommended for a DO PASS AS AMENDED. RESOLVED: THAT NSMA WORK WITH STATE AGENCIES
TO DEVELOP BETTER QUALITY OF CARE INFORMATION IN THIS STATE; and, be it further
RESOLVED: THAT NSMA TAKE A LEADERSHIP ROLE IN THE TRANSFORMATION OF HEALTH CARE
IN NEVADA BY ADOPTING A PROACTIVE STANCE ON QUALITY IMPROVEMENT. DO
PASS AS AMENDED
Resolution #2008-05,
“ADVERTISING/PROMOTION REQUIREMENTS FOR MEDICAL SPECIALISTS”, was discussed and
recommended for REFERRAL TO THE INTERNAL AFFAIRS COMMISSION. RESOLVED: THAT PHYSICIANS IN NEVADA THAT ADVERTISE OR
OTHERWISE PROMOTE THEMSELVES AS A SPECIALIST IN A PARTICULAR FIELD RECOGNIZED
BY THE AMERICAN BOARD OF MEDICAL SPECIALTIES MUST BE BOARD CERTIFIED OR HAVE
SUCCESSFULLY COMPLETED AN AMERICAN BOARD OF MEDICAL SPECIALTIES OR AMERICAN
OSTEOPATHIC ASSOCIATION APPROVED RESIDENCY OR TRAINING PROGRAM; and, be it
further RESOLVED: THAT PHYSICIANS NOT IN COMPLIANCE WITH THIS RESOLUTION
FORFEIT THEIR MEMBERSHIP IN THE NSMA. REFERRED
TO INTERNAL AFFAIRS COMMISSION
Resolution #2008-06,
“SECRET/RENTED PPO’S”, was discussed and recommended for REFERRAL TO THE
GOVERNMENTAL AFFAIRS COMMISSION.
RESOLVED: THAT THE NSMA SEEK
LEGISLATION REQUIRING FULL DISCLOSURE FOR INSURANCE COMPANIES WHO USE
SECRET/RENTED PPO’S IN THE STATE OF NEVADA; and, be it further RESOLVED: THAT
SECRET/RENTED PPO’S BE BANNED IN THE STATE UNLESS THERE IS FULL DISCLOSURE
GIVEN AT THE TIME SERVICE IS RENDERED; and, be it further RESOLVED: THAT IF A
PHYSICIAN IS TO BE REIMBURSED THROUGH A SECRET/RENTED PPO, HE/SHE WILL BE PAID
AT THE HIGHEST RATE OF REIMBURSEMENT FOR ALL THE PPO’S THAT HE/SHE IS ALREADY A
MEMBER; and, be it further RESOLVED: THAT IF THE PHYSICIAN IS NOT A MEMBER OF
ANY OF THE PPO’S THAT INSURANCE COMPANY IS CONTRACTED WITH, THE TREATING
PHYSICIAN WILL NOT BE FORCED TO TAKE A PAYMENT FROM THAT PPO, BUT WILL BE PAID
HIS/HER USUAL FEE IN FULL. REFERRED TO
THE GOVERNMENTAL AFFAIRS COMMISSION
Resolution #2008-07,
“REGULATION OF OIL COMPANIES AS UTILITY COMPANIES”, was discussed and
recommended for a DO NOT PASS.
RESOLVED: THAT THE NSMA SUPPORT
LEGISLATIVE INITIATIVES THAT WOULD REGULATE OIL COMPANIES AS UTILITY COMPANIES
(e.g. SIERRA PACIFIC POWER COMPANY, COMMONWEALTH EDISION, ETC.) DO
Resolution #2008-08
and 2008-20 were combined into 2008-08A, “NSMA ANNUAL MEETING LOCATION”, and
recommended for a DO PASS AS AMENDED.
RESOLVED: THAT THE NSMA ABOLISH ANY PRIOR MANDATES OR RESOLUTIONS THAT
RESTRICT OR LIMIT THE SITE SELECTION FOR ANNUAL MEETING; and, be it further
RESOLVED: THAT THE SITE OF THE NSMA
ANNUAL MEETING BE SELECTD BY THE EXECUTIVE COMMITTEE. DO PASS AS AMENDED
Resolution #2008-09
and 2008-10 were combined into 2008-09A, “SUGARY DRINKS AND UNHEALTHY SNACKS IN
SCHOOLS AND CHILD/ADOLESCENT OBESITY”, was discussed and recommended for a DO
PASS AS AMENDED. RESOLVED: THAT THE NSMA
PURSUE LEGISLATION RE-
QUIRING SCHOOLS TO SELL ONLY DRINKS THAT ARE COMPOSED OF NO LESS THAN 50%
FRUIT JUICE OR VEGETABLE JUICE, HAVE NO ADDED SWEETENER, CONTAIN MILK WITH
REDUCED FAT CONTENT, OR DRINKING WATER WITH NO ADDED SWEETENER AS RECOMMENDED
BY THE AMERICAN HEART ASSOCIATION, THE AMERICAN CANCER SOCIETY, AND THE
AMERICAN ACADEMY OF FAMILY PHYSICIANS; and, be it further RESOLVED: THAT THE NSMA PURSUE LEGISLATION REGULATING
SNACKS SOLD IN SCHOOLS. THESE SNACKS, AS RECOMMENDED BY THE AMERICAN HEART
ASSOCIATION, THE AMERICAN CANCER SOCIETY, AND THE AMERICAN ACADEMY OF FAMILY
PHYSICIANS SHALL NOT CONTAIN MORE THAN 35% OF CALORIES DERIVED FROM FAT
(EXCLUDING NUTS, NUT BUTTER, SEEDS, AND CHEESE), NO MORE THAN 10% OF CALORIES
FROM SATURATED FAT, NO MORE THAN 35% OF TOTAL WEIGHT BE COMPOSED OF SUGAR
(EXCLUDING FRUITS AND VEGETABLES), AND NOT EXCEED 250 CALORIES PER INDIVIDUAL
FOOD ITEM; and, be it further RESOLVED: THAT
THESE RESTRICTIONS DO NOT APPLY TO THE USDA MEAL PROGRAM. DO PASS AS AMENDED
Resolution #2008-21,
“CELL PHONE USE IN MOTOR VEHICLES”, was discussed and recommended for a DO PASS
AS AMENDED. RESOLVED: THAT THE NSMA ACTIVELY SUPPORT THE INTRODUCTION OF
LEGISLATION TO BAN THE USE OF HAND HELD CELL PHONES AND PERSONAL DIGITAL
ASSISTANTS (PDA) BY OPERATORS OF MOTOR VEHICLES IN THE STATE OF NEVADA; and, be
it further RESOLVED: THAT SUCH A BAN WILL INCLUDE THE PROHIBITION OF “TEXT
MESSAGING” ACTIVITIES INVOLVING A CELL PHONE OR PERSONAL DIGITAL ASSISTANT
(PDA) OR ANY OTHER HAND HELD DEVICE THAT REQUIRES A DRIVER TO DIVERT HIS
ATTENTION FROM THE OPERATION OF HIS MOTOR VEHICLE WHILE DRIVING; and, be it
further RESOLVED: THAT SUCH LEGISLATION WILL ENABLE LAW ENFORCEMENT AGENCIES TO
STOP VIOLATORS PRIMARILY FOR THE OFFENSE (PRIMARY CAUSE) AND NOT JUST IN
CONJUNCTION WITH ANOTHER VIOLATION.
DO PASS AS AMENDED
The Committee
nominated the following physicians for officers of the Association:
President Elect – JACK L. DAVIS, DO
Treasurer – T. BRIAN CALLISTER, MD
Secretary -- RONALD M. KLINE, MD
AMA Delegate (South) –
AMA Alternate (South) – RONALD M. KLINE, MD
DO PASS
Resolution #2008-11,
“REGISTRATION OF BOARD
CERTIFIED SURGICAL TECHNICIANS AND CERTIFIED FIRST ASSISTANTS”, was
discussed and recommended for a
Resolution #2008-12,
“REIMBURSEMENT FOR DEATH CERTIFICATE COMPLETION”, was discussed and recommended
for REFERRAL TO THE GOVERNMENTAL AFFAIRS COMMISSION. RESOLVED: THAT THE STATE
LEGISLATURE BE PETITIONED REGARDING THE STATUTE THAT PROHIBITS CHARGING FOR
SUCH SERVICE, AND THAT THIS STATUTE BE REPEALED AND THAT A STANDARD FEE (FOR
EXAMPLE $25.00) BE PERMITTED TO BE CHARGED FOR THE PAPER WORK AND RESEARCH
INVOLVED FOR A PHYSICIAN TO SIGN A DEATH CERTIFICATE. REFERRED TO THE GOVERNMENTAL AFFAIRS
COMMISSION
Resolution #2008-13,
“NEED FOR ALL AMBULATORY SURGERY CENTERS IN NEVADA TO BE ACCREDITED BY NATIONAL
ACCREDITATION AGENCIES”, was discussed
and recommended for a
Resolution #2008-14,
“OPPOSITION TO ADMINISTRATION’S 15% CUT IN HOSPICE RATES ”, was discussed and
recommended for a DO PASS AS AMENDED. RESOLVED: THAT NSMA OPPOSES THE 15% CUT
IN HOSPICE REIMBURSEMENT RATES IN THE ADMINISTRATION’S BUDGET PACKAGE AND THAT
NSMA CONTACT THE
Resolution #2008-15,
“MANAGED CARE/HEALTH INSURANCE REFORM”, was discussed and recommended for
REFERRAL TO THE GOVERNMENTAL AFFAIRS COMMISSION WITH EMPHASIS ON DATA GATHERING
AND PHYSICIAN EDUCATION. RESOLVED: THAT
THE
1. FAIL TO COMPLETELY DISCLOSE THE ENTIRE FEE
SCHEDULE APPLICABLE TO INDIVIDUAL PROVIDERS.
2. FOLLOW NON-STANDARD CLAIM PROCESSING
PRACTICES, SUCH AS: A. BUNDLING SEPARATE CPT CODES, WHICH SHOULD BE PAID AS
SEPARATE CHARGES, INTO ONE INAPPROPRIATE CODE. B. UNJUSTIFYABLY DOWNCODING
LEGITIMATE CPT CODES TO A LOWER PAYING CPT CODE.
3. DELIBERATELY LOSE CLAIMS TO DELAY PAYMENT,
AND REQUIRE RESUBMISSION BY THE PROVIDER; and, be it further RESOLVED: THAT
SIGNIFICANTLY HARSH MONETARY PENALTIES BE INCORPORATED AS PUNISHMENT FOR
VIOLATION OF THESE STATUTES, AND THAT THE STATUTES PROVIDE THAT VIOLATIONS BE
ACTIVELY INVESTIGATED AND ENFORCED BY THE INSURANCE COMMISSIONER OF THE STATE
OF NEVADA; and, be it further RESOLVED: THAT THE NEVADA STATE MEDICAL
ASSOCIATION CREATE A COMMITTEE WHICH WILL DEVELOP A REPORTING FORM THAT WILL BE
HIPAA COMPLIANT, WHICH WILL ALLOW FOR DOCUMENTATION ON INDIVIDUAL CLAIMS OF
INSURANCE COMPANIES’ UNFAIR BUSINESS PRACTICES. IT WILL BE THE CHARGE OF THIS
COMMITTEE TO SEND REPORTING FORMS TO ALL MEMBERS OF THE NSMA TO DOCUMENT AS
MANY INCIDENTS OF THESE PRACTICES AS POSSIBLE, WHICH CAN THEN BE USED TO
CONVINCE LEGISLATORS OF THE NEED FOR INSURANCE REFORM. IT WILL ALSO BE THE
CHARGE OF THIS COMMITTEE TO FIND PAST AND CURRENT EMPLOYEES OF INSURANCE
COMPANIES WHO WOULD BE WILLING TO TESTIFY ABOUT THESE UNFAIR PRACTICES BEFORE A
LEGISLATIVE COMMITTEE.
REFERRED TO THE
GOVERNMENTAL AFFAIRS COMMISSION
Resolution #2008-16,
“BILLING AND REIMBURSEMENT”, was discussed and recommended for REFERRAL TO THE
GOVERNMENTAL AFFAIRS COMMISSION. RESOLVED: THAT THE NSMA LOBBY THE NEVADA STATE
LEGISLATURE TO REQUIRE THE DEPARTMENT OF INSURANCE TO INVESTIGATE DOWN-CODED,
PENDED AND/OR UNETHICALLY DENIED CLAIMS FOR PHYSICIANS AND REQUIRE THE
INSURANCE COMPANIES TO PAY INAPPROPRIATELY DENIED CLAIMS; and, be it further
RESOLVED: THAT THE NSMA WORK WITH THE AMA TO ENHANCE AND EXPAND ITS MEDICAL
BILLING EDUCATIONAL PROGRAMS TO FOCUS ON THE PROCEDURES FOR DEALING WITH CLAIMS
DENIAL AND UNETHICAL PRACTICES OF INSURANCE COMPANIES IN DEALING WITH PHYSICIAN
CLAIMS; and, be it further RESOLVED: THAT OUR AMA DELEGATES ASK THE AMA TO
PUBLISH A LIST OF DENIED CLAIMS VS. PAID CLAIMS IN MONETARY AMOUNTS, PER
INSURANCE COMPANY, ON A WEBSITE. REFERRED
TO THE GOVERNMENTAL AFFAIRS COMMISSION
Resolution #2008-17,
“NATIONAL PATIENT DATABASE ELECTRONIC MEDICAL RECORDS”, was discussed and
recommended for a DO PASS AS AMENDED.RESOLVED:
THAT NSMA SUPPORTS ALTERNATIVE FUNDING TO ALLOW PHYSICIANS TO EMBRACE
ELECTRONIC MEDICAL RECORD KEEPING, and, be it further RESOLVED: THAT NSMA OPPOSES UNFUNDED MANDATORY ELECTRONIC MEDICAL RECORDS
REQUIREMENTS. DO PASS AS AMENDED
Resolution #2008-18,
“CREATION OF AN ELECTRONIC DATABASE FOR HOSPITALS ACCEPTING TRANSFERRED
PATIENTS”, was discussed and recommended for a DO PASS AS AMENDED. RESOLVED:
THAT NSMA WORK WITH THE
Resolution #2008-19,
“ROUTINE SCREENING FOR BLOOD LEAD LEVELS IN WOMEN DURING PREGNANCY”, was
discussed and recommended for a REFERRAL TO THE PUBLIC HEALTH ISSUES
COMMISSION. RESOLVED: THAT THE NSMA
SUPPORTS THE ROUTINE SCREENING FOR BLOOD LEAD LEVELS OF WOMEN DURING PREGNANCY. REFERRED
TO THE PUBLIC HEALTH ISSUES COMMISSION
Resolution
#2008-22 “MENTAL HEALTH PARITY”, was
discussed and recommended for a DO PASS AS AMENDED. RESOLVED:
THAT NSMA SUPPORTS THE
Resolution #2008-23,
“SAFE INJECTION TECHNIQUES”, was discussed and recommended for a DO PASS AS
AMENDED. RESOLVED: THAT THE NSMA APPOINT
AN AD-HOC COMMITTEE TO WORK WITH HONOREFORM TO DEVELOP AN ACCEPTABLE
PUBLIC RELATIONS CAMPAIGN FOR THE EDUCATION OF MEDICAL PROFESSIONALS AND THE
PUBLIC REGARDING SAFE INJECTION TECHNIQUES, and be it further RESOLVED: THAT AN ACCEPTABLE CAMPAIGN REFLECT THE
SCIENTIFICALLY BASED PRACTICE OF SAFE INJECTION TECHNIQUES CONSISTENT WITH THE
DRUG, VACCINES, AND MEDICAL EQUIPMENT MANUFACTURER’S GUIDELINES AND
RECOMMENDATIONS. DO PASS AS AMENDED
Resolution #2008-24,
“PROVIDER REIMBURSEMENT FOR VACCINES”, was discussed and recommended for a DO
PASS AS AMENDED. RESOLVED: THAT NSMA
SUPPORTS LEGISLATION TO GUARANTEE PROVIDER REIMBURSEMENT FOR VACCINES IN
ACCORDANCE WITH THEIR COSTS. DO PASS AS
AMENDED
President’s Message June
By Weldon E Havins, M.D. J.D, 2007-2008, CCMS President
In 2006, an article in the Annuals of Internal Medicine
predicted an impending collapse of primary care medicine. The situation has not improved since that
time. With the exception of
anesthesiology,
Several months
ago, Chris Bosse, governmental affairs director for
Across the
country, primary care practitioners are increasingly unhappy with their
workload and their relatively poor reimbursement. A recent New England Journal of Medicine
article stated that “not only has the number of primary care tasks grown
exponentially, but physician performance is being measured and physicians paid
according to their ability to perform these tasks reliably and
consistently. In an average primary care
practice of 2500 patients, it has been estimated that it would take 10.6 hours
per working day to deliver all recommended care for patients with chronic conditions,
plus 7.4 hours per day to provide evidence-based preventive care.” i It appears there are not enough hours in the
day to perform the job expected of primary care physicians. Added to the misery is the low reimbursement
rate for primary care services.
A survey
conducted by the Medical Group Management Association found that median income
for all primary care physicians increased 9.9% from 2000 to 2004, compared to a
15.8% increase for all non-primary care specialties.ii In particular, family practice physicians’
income increased 7.5% during this period, invasive cardiologists increased
16.9%, hematologists/oncologists increased 35.6%, and diagnostic radiologists
increased 36.2%. Fifteen percent of full
time family physicians earned less than $100,000 in 2004 while 20% of invasive
cardiologists, 25%f of neurosurgeons, and 14% of orthopedists earned incomes of
greater than $600,000.iii
The RBRVS system of reimbursement relatively penalizes primary care
physicians. A 99214 complex medical
office visit pays about 25% of the reimbursement for a colonoscopy, the time
involved being approximately the same.
While a Medicare colonoscopy paid 15% less in 2004 than in 2001, the
number of Medicare colonoscopies increased in those years by 30%. During the same period, the number of more
highly reimbursed medical procedures increased at double the rate in the
increase of E&M codes billed.
Because of technologic improvements and increasing efficiency over time,
specialists can perform many procedures more quickly, whereas office visits
cannot be shortened without reducing the quality of care or patient
satisfaction.
This is not
likely to change anytime soon. E&M
codes constitute 50% of Medicare physician payments. Any small increase in E&M reimbursement
will cause a corresponding dramatic increase in Medicare spending. Medicare spending is like a pie, an increase
in one section of the pie must be compensated by a decrease in someone else’s
portion of the pie. The Relative Value
Committee consists predominately of specialists, 23 of the 29 members of the
committee are named by specialty societies.
While primary care physicians provide about half of Medicare patient
visits, primary care doctors make up only 15% of the voting power of the reimbursement
decision-makers. Senator Max Baucus,
chairman of the U.S. Senate Finance Committee, has indicated that he would like
to “do something” for primary care in the next 12 months of Medicare budgeting. Knowledgeable pundits believe that Congress
will hold reimbursements relatively level or provide for a 1% increase for the
next year. If Senator Baucus' sentiments
prevail and primary care physicians are given a greater increase, non-primary
physicians will likely witness a net decrease in reimbursements, just to keep
Medicare spending level.
Not surprisingly,
the percentage of
Another well
known franchise is MD2 (MD squared) which started in
Larger healthcare
systems are beginning to offer concierge services. The Lewis and
Without
fundamental changes in reimbursement of primary care, who will be the primary
care providers of the future?
Increasingly, it will be physician extenders – physician assistants and
nurse practitioners. Physician
assistants are now, and foreseeably will continue to be, supervised by licensed
physicians. Simply to attempt to keep
pace with the increasing volume of patients, primary care physicians might
consider adding physician assistants to their practice to help provide the more
routine care and preventive care.
Nurse
practitioners in
Nurse
practitioners have been a favorite of the burgeoning retail medical
clinics. In
Wal-Mart”, Target is said to be negotiating with RediClinics to
expand into retail medical clinics, and the Kroger food chain is considering
opening retail medical clinics in their food stores.
In the April 2,
2008 edition of the Wall Street Journal an article discusses the increasing
number of Doctors of Nurse Practice or DNPs.
DNPs, or DrNP, also use the designation of Dr. in their title. There are now about 1,874 DNP students
enrolled in programs nationwide, up from 862 in 2006. Just as pharmacists now graduate with a
Pharm.D. as the standard degree, Physical Therapists will soon be graduating
with a Doctor of Physical Therapy degree, and all nurse practitioners will be
graduating with a DNP, or DrNP, by 2013 as the standard degree. The Wall Street Journal indicated there could
be a shortfall of 85,000 to 200,000 primary care physicians by 2020, and that
nurse practitioners will serve to fill the void in primary care services. The National Board of Medical Examiners is
developing a certification examination for DNPs.
Primary care
providers in
be a practical option.
Involvement as a supervising physician or collaborating physician with a
retail clinic’s PAs or NPs, although not without liability risk, may be worth
examining. The ultimate key to a revival
of primary care rendered by physicians is a change in health policy valuing
primary care services equal to those of specialty care.
Referrences
i Bodenheimer, Thomas, Primary
Care-Will It Survive?, NEJM, Aug. 31, 2006.
ii Bodenheimer, Thomas; Berenson, Robert;
Rudolf, Paul, The Primary Care Specialty Income Gap: Why It Matters, Annals of
Internal Medicine, 146, 301-306, 2007.
iii Lowes, R, The earnings freeze.
Now it’s everybody’s problem, Medical Economics, 82:58-62, 2005.
iv See i. above.
v See
Concierge Medicine, Journal of Health and Life Sciences Law, Vol. 1, No. 3.,
2008.
vi Sayewitz, Ronni, Retainers for doctors
under attack, S. Fla. Bus. J., April 12. 2002 and MD2-the Definitive Provider
of Concierge Medicine, www.md2.com.
vii GAO Report to Congressional Committees,
Physician Services” Concierge Care Characteristics and Considerations for Medicare,
GAO-05-929 (Aug. 2005).
viii They are:
Clark County District Court Medical Malpractice Filings
2001 2002 2003 2004 2005 2006 2007
2008
Jan 39 33 108 61 41 50 109 64
Feb 20 14 98 72 63 61 41 77
Mar 35 30 169 123 64 38 70 3126
Apr 37 34 111 81 70 58 60 505
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 53
Sum 372 823 1246 867 581 720 824 3772
Member News
The ballots have been counted. Congratulations to the 2008-09 BOT Officers
and Trustees
·
Annette
Teijeiro, MD - President-elect
·
Kevin Hyer, MD
- Delegate Chair
·
Mitchell
Forman, DO - Secretary
·
George
Alexander, MD - Treasurer
·
·
·
John
Kurlinski, MD - Trustee
·
James Lenhart,
MD - Trustee
·
Rhonda
Robbins, MD - Trustee
Nominating Committee
·
Warren Evins,
MD, PhD
·
Ronald Kline,
MD
·
·
Carol Van der
Harten, MD
Congratulations and Welcome to the
·
Naomi L
Chaney, MD - Internal Medicine, 5380 S
Rainbow Blvd #218, Las Vegas, NV 89118
·
George
Westerman, MD - Psychiatry, 8689 W Sahara
Ave #280, Las Vegas, NV 89117
Applicants to Go Before Credentialing Committee
·
Joseph Khoury,
MD - Anatomic & Clinical
Pathology
·
·
Michael Tay,
MD - Radiation Oncology
·
Steven Thomas,
MD - Maternal/Fetal Med
·
Anu Thummala,
MD - Oncology
If you have any pertinent information about the
membership candidates listed above, please contact:
For information
on becoming a member of the
SNHD Health Officer Report
Health District identifies 77 potential clinic-associated infections
By
On
May 8, 2008, the Southern Nevada Health District announced it had identified 77
potential clinic-associated hepatitis C infections during its continuing
investigation into the outbreak associated with the Endoscopy Center of
Southern Nevada,
In order to evaluate
patients’ risk factors and to determine if their infection is related to the
clinic, a set of criteria was developed to classify patients based on the
likelihood of exposure at the clinic or based on risk factors that occurred
prior to undergoing a procedure at the clinic. Following are the case
classification for the ongoing hepatitis C investigation:
Clinic-associated infections
Clinic–associated
acute hepatitis C: A person diagnosed with laboratory-confirmed acute
hepatitis C who had a procedure at the Endoscopy Center of Southern Nevada or
the Desert Shadow Endoscopy Center within 6 months prior to onset, AND
• Denies having other significant risk
factors for HCV infection during the six months prior to onset OR
• Has an HCV isolate that is related to that
of another patient who had a procedure at the same clinic on the same day
Clinic-associated
hepatitis C virus (HCV) infection: A person who has
laboratory-confirmed HCV infection with laboratory and epidemiologic links to
another HCV-infected person who had a procedure at the Endoscopy Center of
Southern Nevada or the
Possible clinic-associated
HCV infection: A person with laboratory-confirmed
HCV infection who:
• Was not tested for HCV or had a negative
HCV test prior to undergoing the procedure, AND
• Denies having other significant risk
factors for HCV infection prior to diagnosis, AND
• Had a procedure at the Endoscopy Center of
Southern Nevada or the
Unrelated HCV
infection: A person diagnosed with HCV infection before
having undergone a procedure at the Endoscopy Center of Southern Nevada or the
Indeterminate HCV
infection: A person infected with HCV who is not classified as having a
clinic-associated HCV infection, possible clinic-associated HCV infection, or
unrelated HCV infection.
These classifications
were designed to assist staff in better understanding patients’ risk factors
prior to having procedures at the clinics and the extent of transmission of HCV
among clinic patients.
Since the initial
patient notification February 27, approximately 50,000 test panels have been
ordered through local labs; however, this number represents the number of tests
ordered and not the number of patients who have been tested. The health
district cannot say for certain that the number of test panels represents
everyone who received a notification.
Because the patient
list received was not complete it cannot be determined whether all of the
affected patients have been tested. The health district continues to receive a
higher number of positive test results than before the notification in
February. Additionally, testing for patients who underwent procedures at the
end of 2007 or early 2008 will not be complete until July.
At this point in the
investigation health district staff continues to sort through positive test
results to determine which patients received procedures at the clinic, what
prior risk factors they have to determine potential exposure, and which results
are duplicates or retests. Staff is also looking into the records of the
It is important for physicians to follow the recommended testing
algorithm and to order the custom panel of tests provided by Labcorp, Quest or
Clinical Pathology Laboratories. While other tests may be ordered it is
important to consider that offering acute or comprehensive hepatitis panels on
asymptomatic person slows down the testing process and does not include the HIV
test. Also, ordering individual tests on asymptomatic persons without custom
coding or tests not in the algorithm may lead to false positive results or
omission of reflex testing. For more information please access the technical
bulletins on our website at:
http://www.southernnevadahealthdistrict.org/outbreaks/hepc-hcp.htm.
The health district
continues to update its website as resources and information become available,
www.SouthernNevadaHealthDistrict.org. For additional information, patients can
contact the helpline, (702) 759-4636 (INFO).
SNHD Disease Stats
Alliance
By Wendy Agrawal & Estela Hansen, 2007-08 CCMS
Wow! What a Year!
We cannot believe that the CCMSA 2007-08 year is
over! It has really been a very busy,
fun, productive year with the
We are especially proud of the 7th Annual
Fashion Show. We raised over 70,000
thousand dollars and the proceeds will benefit The Shade Tree. These funds were presented to The Shade Tree
in May, 2008.
Besides the Fashion Show, the CCMSA has
completed many important, successful and time consuming projects and events
this year including:
• Two
Faux Paws Internet Safety Public Relations Events: one with Miss
• Implementation
of the Faux Paws Internet Safety Program in the
• Member
Recognition Luncheon
• Evening
Event with Spouses at Red Rock Casino
•
• Homeless
Healthcare Week at The Shade Tree
• Monthly
Luncheon Meetings
• Successful
Gourmet Alchemists cooking events
• Other
membership groups such as Book Club, Knitting, and Playgroup
All of these events and projects would not
have been possible if not for the team effort of our amazing CCMSA Board
members, committee chairs, committee members and general members. As well, the
work of the
We are looking forward to another
wonderful year for the CCMSA in 2008-09! Remember our annual year is June 1st to
May 31st. We congratulate and welcome
the members of our new Board:
Beverly Daly Dix & Sheila Bazemore –
Co Presidents
Lisa Cohler & Lisa Gollard - Co-President Elects
Cindy Choi & Karen Schroeder -
1st VP Membership
Ryan Tselikas - 2nd VP Luncheons
Bonnie Ng - Treasurer
Agatha Addo-Quaye - Assistant Treasurer
Janice Burt - Corresponding Secretary
April Stewart - Recording Secretary
Pauline Ng Lee - Parliamentarian
Sincerely,
Estela
Hansen and Wendy Agrawal
Co
Presidents
BOT Meeting Minutes Synopsis March 18, 2008
I. Call to Order -The meeting was
called to order by Dr. Havins at 6:04 pm.
II. A. Minutes from the February
19, 2008 meeting and the March 5, 2008 emergency meeting were unanimously
approved.
B.Financial report was
presented by Dr. Steinberg:
General
Revenue – Actual for 8 months of Fiscal Year 2007-08 is $380,372.89 compared to
$392,741.93 in Fiscal Year 2006-07 for a decrease of $12,369.04 over last year
at this time.
Operating Expenses – Actual for 8
months of Fiscal Year 2007-08 is $256,970.81 compared to $253,351.33 for an
increase of approximately $3,619.48 over last year at this time.
Overall, for the first eight months of
our fiscal year, revenues exceeded our expenses by $123,402.08. The bank balance for the end of February was
$604,023.18 compared to $531,040.17 last year at this time.
III. A. Membership Count - Dr. Adashek was not
present; therefore, Janice Poblete presented the Membership Report:
As of February 29, 2008, total
dues-paid membership is 689, compared to 749 last year at this time. This is a net decrease of 60 members.
Total CCMS members is 976, including
197 dues exempt members.
There are 27 new members & 12
reinstatements in the Fiscal Year 07-08.
There are 90 Student members in the
Fiscal Year 07-08.
B. Credentials
Committee Report - Dr. Baron presented the Credentials Committee
Report. Candidates for active
membership were unanimously approved: Andrew Eisen, MD – Pediatrics and Raji
Venkat, MD – Internal Medicine. Student Membership was approved for Allen
Ozeran,
C. Community Health/Community Relations
Committee - Dr. Teijeiro presented
the report.
Dr. Jones requested the BOT approve
joining the
Community Schools – Dr. Noah Kahn is
working with the community schools to engage volunteers in GYN, ENT and
pediatric surgeons for their K-18 age group.
A joint effort is being proposed for publication on our website that was
primarily written by Dr. Jones.
VIM Clinic -- The Committee voted to
approve the VIMI clinic (Dr. Jameson’s project) for the purposes of AB629’s
legislation for a pilot project. The
BOT unanimously passed the motion.
Feasibility Study -- A motion was made to approve allocation of
the $22,000 for the Feasibility Study for the VIM clinic. The BOT voted/approved the motion.
D.Remodeling
Committee - Dr. Fathie
presented the report.
Dr. Fathie received a quote for
painting the interior and exterior of the building, plus all fencing, sidewalks
and block walls for $8,500. Dr. Fathie
is awaiting more quotes before making a recommendation.
CCMS has already received a bid from
another company for $17,000 for a lesser scope of work. Dr. Jameson offered to provide Dr. Fathie
with another contact so that three competitive bids can be presented for
consideration by the BOT.
IV. Delegate Chair Report - Dr. Forman presented
the report.
Dr. Forman encouraged all BOT members
to sign up as a Delegate. Currently,
there are 27 proposed Delegates.
However, the NSMA has received registration/payment for only 3
Delegates.
Nancy Sommer advised that
registration/payment must be received by NSMA no later than April 7th to
receive a meeting packet and to be listed on the roll call roster. The drop dead date for registration is April 14th.
The reimbursement to Delegates for the
2008 meeting will be $300. In order to
qualify for reimbursement, a Delegate must be present for roll call as follows:
Friday afternoon opening session and
Sunday morning closing session, OR
Saturday morning opening session and
Sunday morning closing session
You are welcome to attend all three
sessions, if so desired.
V.
The fashion show is April 9 at the
Four Seasons. Males and females are
welcome to attend.
VI.
Anthem Blue Cross/Blue Shield awarded
Nevada Health Centers $50,000 grants to provide free testing for Hepatitis B,
C, and HIV for the
The Endoscopy Centers are being
re-opened in a limited capacity so that patient records can be accessed and
scripts can be provided. Actual
procedures will not resume at this time.
The seventh case of Hepatitis C has
been confirmed. This one occurred at the
Burnham facility.
Dr. Jameson was informed by Quest that
they have performed 22,000 tests to date.
VII.
All the students matched.
Effective July 1, 2008, Dr. Ole
Thienhaus will take on the role of Dean of UNSOM. Dr. McDonald will be exclusively the
Vice-President of Health Sciences, with the new Health Sciences division in
Reno which will include Nursing, Social Work, Public Health, and a division on
substance abuse.
VIII.
Clinical Skills and Simulation
Laboratory – a multi-disciplinary educational effort to include UNLV, NSC UNLV
School of Nursing and UNSOM on Shadow Lane Campus, Building B is being
developed to inform what the HSC does.
Dr. Trevisan is developing a joint Department
of Public Health in
Dr. Lenhart will be developing a similar
initiative in nursing to bring together the nursing departments in the state to
organize nursing education and research.
Dr. Lenhart spoke with Dr. Trevisan
regarding attendance at the BOT meetings.
Dr. Trevisan appointed Dr. Lenhart as the designee for the Health
Sciences System.
IX.
An open house was held March 18th at
Touro for the 35,000 square foot facility that houses an autism and development
disorders center.
Touro is preparing to open a clinical
research center and clinical practice program along with other new programs in
progress.
X. Scholarship Fund Report - Dr. Ellerton presented the report.
The annual meeting was held March 18th
at 5:30 pm wherein the investment strategies were reviewed with the investment
adviser who stated the fund is doing well and the investments are sound.
The distributions for the fall of 2008
were determined as follows:10 scholarships will be awarded to each of the
medical schools; 3 scholarships to each of the system nursing schools in
XI. NSMA Report - Dr. Kingsley presented the report:
The annual NSMA meeting will be held
in
One of the items to be discussed is
restructuring the annual meeting to be a dinner meeting only, and the business
aspect of the annual meeting to be separate meetings scheduled individually.
Dr. Kingsley appeared on Face-to-Face
last week in conjunction with the Hepatitis C outbreak.
The NSMA is working on 2009 strategies
to be presented at the annual meeting.
XII. MedPAC Report - Dr. Evins
presented the report.
At the last CCMS BOT meeting, four
MedPac Directors were selected. They,
along with the 4 appointed Directors from CCMS, and the 4 Directors elected
from the general membership are as follows:
Dr. Evins, Chair
(appointed by CCMS)
Dr. Kingsley
(highest ranking NSMA Officer from the south)
Annette Mohs,
(appointed by CCMSA)
Dr. Jones, Secretary
(elected by general membership)
Dr. Baron, Treasurer
(elected by general membership)
Dr. Jameson
(appointed by CCMS)
Dr. Nelson (elected
by general membership)
Dr. Havins
(appointed by CCMS)
Dr. Kline (appointed
by CCMS)
Dr. Wellish (elected
by general membership)
April 7, Justice Mark Gibbons will be
interviewed at the CCMS offices, along with 4 additional candidates for the
judicial races.
A second meeting in April will be held
wherein more candidates will be interviewed.
Interviews are open to all MedPAC members and all are encouraged to
participate in the interviewing process.
The judicial races filing closed
January 18; the other races close mid-May at which time an interviewing list
will be developed.
Dr. Evins stated that KODIN medical
tort reform will be challenged given the Hepatitis C outbreak, the recent
physician indiscretions, etc. and encouraged everyone to join MedPAC to help
prevent KODIN from being abolished and malpractice rates from escalating.
XIII. AMA Report - Dr. Horne
presented the report.
The next AMA meeting will be held in
June. Dr. Horne encouraged anyone who
has resolutions to be presented at the meeting to contact him.
XIV. NBME Report - Dr. Rodriguez
presented the report
Three members of the NBME recused
themselves from any dealings with the
Doug Cooper, Chief Investigator for
the NBME is in southern
An emergency phone conference is
scheduled for tomorrow to formulate an investigative committee, including two
members from northern
The next Board meeting will be held
March 28 and 29, 2008. There are no
plans to meet more frequently than four times per year.
XVI. Administrative Report - Dr. Havins
provided the Administrative Report.
Landscape Bids – Nancy Sommer
presented three bids to the BOT. The BOT
voted to accept Cruz Lawn Service.
St. Mary’s Health Insurance Plan –
Open enrollment is March 20 through May 20.
Computer for Dot – The BOT
voted/approved a motion to purchase a new computer for Dot. This computer will replace her 7 year old
computer which will not support the new publishing software.
Joint Statement (NSMA/CCMS) – after
much discussion, the BOT voted/approved a motion to publish the revised joint
statement as a ½ page in the Review Journal, Nevada Section, on Sunday, March
23, 2008, utilizing the dollar value contract, reducing the price $2,000+. NSMA agreed to reimburse CCMS for half of the
ad placement cost.
Dr. Nelson advised that another “Open
Letter to the Community” is in the process and if any physician wants to add
their name to the letter, to contact Dr. Ripley.
Dr.
Havins advised there will be a new insert in the Review Journal April 9 titled
“Health Crisis Consumer Guide”. If anyone
is interested in advertising, contact the Review Journal.
Dr.
Hammargren is applying for the State Health Officer’s position and requested
CCMS issue a letter of endorsement.
After discussion, the BOT voted to not endorse/recommend any member
applying for the State Health Officer position.
Dr. Havins advised that physicians are free to write a personal letter
on Dr. Hammargren’s behalf.
XVII. New Business - Dr. Havins announced the
birthdays for the month of March: Dr.
McDonald and Dr. Brill.
XVIII. Old Business -None to report.
XIX. Future Meetings - Next meeting is
scheduled for Tuesday, April 15, 2008 at 6:00pm.
XX. Adjournment- Meeting adjourned at 7:35
pm.
sss
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