Newsletter 108 January 2009
Contents
Malpractice
Filings Against Health Care Providers, Jan 2001 – Nov 2008
2008-09 Alliance Co-Presidents
Message - January
Southern
Nevada Health Officer Report
President’s Message – January
By
Jerry Jones, MD
CCMS
President 2008-09
Merry Christmas, Happy
Hanukkah, Happy Kwanzaa.
Congratulations
to Warren Evins, MD, PhD. The Clark
County Medical Society Board appointed Dr. Evins to the position of Executive
Director at CCMS. Dr. Evin’s wealth of
experience is especially valuable for the upcoming legislative year.
Playground Project
The American
PEER Support
We have been asked
by a CCMS member to consider creating a Peer Support Group. If you have a skill or an interest in
participating in a peer support group please call Nancy Sommer at 739-9989 or
e-mail nancysommer@lvcoxmail.com.
CCMS and the Las
Vegas OB/GYN Community lost a member physician on Thanksgiving weekend. The physicians, nurses and patients he worked
with and cared for remember Dr. Clifford Kahle.
He is survived by his wife and 4 children.
Enjoy the Holidays
With every day
bringing worrisome financial news, many of us may not be spending a lot of
money on holiday gifts. Remember, FAMILY
is the most important thing to enJOY over the holiday season.
Toys for Tots
CCMS has offered
to serve as a collection center for Toys for Tots. Stay tuned for details.
On-Campus Clinics
CCMS Community
Service and
Thank You
Thank you to Dr.
Neil Swissman for your contribution to the Past President’s column.
Thank you to
Antoinette Sparkuhl for your patient safety column titled HIPAA Part 1 General
Obligations in the Physician Office.
The CCMS Board
and Staff wish you a Happy
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Chronic Kidney Disease - A Growing Healthcare Concern
Did You Know?
• Statistics now show that 26 million Americans
have Chronic Kidney Disease (CKD) and another 20 million are at increased risk.
• Early kidney disease has no symptoms.
If left undetected, it can progress to kidney failure, with little or no
warning, which may require dialysis or transplant.
• The leading cause of kidney failure
is diabetes with a primary diagnosis of diabetes representing 41.5 percent of
patients receiving dialysis in 2005.
What can be done?
• Two types of blood pressure
medications – ACEIs and ARBs can slow and delay kidney failure even in people
who do not have high blood pressure.
• In people with diabetes, chronic
kidney disease is often under-diagnosed due to the absence of an annual urinary
microalbumin measurement to identify kidney damage.
Every day in
HealthInsight,
the Medicare Quality Improvement Organization (QIO) for Nevada, is one of ten
QIOs in the country awarded the Centers for Medicare & Medicaid Services
(CMS) contract to explore interventions to improve care related to CKD. Although CMS will monitor HealthInsight via
three targeted areas within the Medicare Fee-for-Service population, the
project focus is aimed at all persons at risk for chronic kidney disease
residing in
From page 3
1. Timely testing to detect kidney failure
due to diabetes;
2. Slowing the progression of this disease
in individuals with diabetes through the use of ACE inhibitor and/or an angiotensin
receptor blocking (ARB) agent; and
3. Arteriovenous fistula (AV fistula)
placement and maturation (as a first choice for arteriovenous access where
appropriate) for individuals who elect hemodialysis for kidney failure.
Clinical
consultants specializing in nephrology, endocrinology, cardiology, vascular
surgery, primary care, along with hospitalists, nurses, nurse practitioners,
certified diabetes educators, and a CKD Task Force of community partners has
been convened to evaluate the current state of CKD care in Nevada, identify and
implement quality improvement interventions and statewide system changes.
Intervention efforts will be aimed at patients and their
caregivers, providers, and community partners, along with a select group of
primary care physician offices. Success will be a direct result of partnerships
and community involvement to create and sustain improvements.
HealthInsight is
excited about this opportunity to collaborate with physicians and community
partners as part of a unified effort to demonstrate quality improvement
interventions that will benefit the entire country as we tackle this growing
health care concern.
For more
information, contact Donna Thorson at 702-933-7327 or
dthorson@healthinsight.org.
This material was
prepared by HealthInsight, the Medicare Quality Improvement Organization for
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Clark County District Court Medical Malpractice Filings
Member News
Applicants to go
before the Credentialing Committee
|
Peter Bernstein, MD - Diagnostic Radiology Galen Eversole, MD - Anatomic & Clinical
Pathology Stephanie Hansen, DO - Internal Medicine Frank Hsu, MD - Diagnostic Radiology Monsuru Ibraheem, DO - Internal Medicine Joel Lin, DO - Radiology Staci McHale, MD - Ob-Gyn John Middaugh, MD - Preventive Medicine Kevin Petersen, MD - General Surgery Matthew Pham, MD - Internal Medicine Adam Rovit, MD - Ophthalmology Terence Scipione, MD - Diagnostic Radiology Charles Tadlock, MD - Anesthesiology Anu Thummala, MD - Oncology Matthew Treinen, DO - Radiology Muhammad Tufail, MD - Internal Medicine Thomas Umbach, MD - General Surgery Rafael Valencia, MD - Cardiology Robert Wesley Jr, MD - Internal Medicine Richard Wasserman, MD - Ob-Gyn David Zipf, MD - Internal Medicine |
If you have any pertinent information about the membership
candidates listed above, please send written information to:
For
information on becoming a member, call Janiceanne Poblete, CCMS’ Membership
Coordinator at 739-9989 or download an application from the CCMS website: www.clarkcountymedical.org
Congratulations and Welcome to the
Kevin
Chang, MD
Diagnostic
Radiology
Andrea
Dempsey, DO
Internal
Medicine
Howard
Francois, MD
Diagnostic
Radiology
Rita
Maity, MD
Oncology
Joel
Schwartz, MD
Ob-Gyn
9280 W
Sunset Rd #236
Brian
Vicuna, MD
Internal
Medicine
Ob-Gyn
9280 W
Sunset Rd #236
Congratulations
and Welcome to the
Carmelo
Herrero, MD - Gastroenterology
Terrence
Higgins, MD - Plastic
Syrgery
Albert
T Mason, MD - Internal
Medicine
We regret to announce
the passing of CCMS member Clifford, Kahle, III, MD
For information on becoming a member of the
BOT Minutes Synopsis, October 21, 2008
CALL TO ORDER - The meeting was called to
order by Dr. Jones at 6:06 pm.
SPECIAL GUESTS Dr. Fred Redfern, President,
Minutes – The Minutes from the September 16, 2008 meetings were
unanimously approved.
Financial Report – by Dr. Alexander: Actual
income for 3 months of Fiscal Year 2008-09 is $110,215.27 compared to
$115,390.67 in Fiscal Year 2007-08, representing $5,175.40 less in revenues
over last year at this time. Operating
Expenses – Actual expenses for 3 months of Fiscal Year 2008-09 is $101,050.68
compared to $83,363.62, representing $17,687.06 more in expenses over last year
at this time. Overall, for 3 months of
our fiscal year, expenses exceeded our revenues by $9,164.59. The bank balance for the end of September was
$549,627.81 compared to $512,987.56 last year at this time.
COMMITTEE REPORTS Membership Count – As of September 30, 2008, total dues-paid
membership is 529, compared to 523 last year at this time. Total CCMS membership is 808, including 192
dues exempt members. There are 46 new
members, 87 student members and 22 reinstatements in the Fiscal Year
2008-09. There are 41 member applicants
pending.
Credentials
Committee Report – Candidates for membership listed
below were unanimously approved - Kevin Chang, MD - Diagnostic Radiology,
Andrea Dempsey, MD - Internal Medicine, Howard Francois, MD - Diagnostic
Radiology, Rita Maity, MD – Oncology, Joel Schwartz, MD - Ob-Gyn, Brian Vicuna,
MD - Internal Medicine, Quynh Vo, MD - Ob-Gyn, Lavanya Vuddagiri, MD -
Diagnostic Radiology.
Community
Health/Community Relations Committee – Dr. Forman stated
Dr. Zaven Khachaturian of the Brain Institute was the first guest, who gave
additional information about the institute.
He will provide a summary of his vision/goals for the institute,
including providing opportunities for research, CME programs, etc. The time commitment is extensive for anyone
who considers participating in collecting data.
The study results are projected to be helpful to
Marlene Richter of Shade Tree
Shelter was the second guest, who gave a summary of what services Shade Tree
provides. Shade Tree houses approximately
350 women & children per day, 4,000 per year, including 100 pregnant
women.
Remodeling Committee
- Dr. Fathie stated that the committee will meet November 5 to go
over the design plan and hopefully move forward with the project.
Unfortunately, the portable audio
equipment currently owned by the
The membership count in the
The holiday card project is
underway. All proceeds go to nursing
scholarships, which has been the tradition for the last 38 years.
SNHD CHIEF HEALTH
OFFICER REPORT – by Dr. Sands - In 2006, the state
of
Staff investigations have identified
issues that factor into the increase in cases since 2005. It is important physicians test patients for
syphilis and Nevada Revised Statute 442.010 outlines the requirements for the
examination of pregnant women.
Flu Vaccine – Although no reports of
flu have been reported yet, it is recommended that everyone, especially health
care providers receive a vaccination.
GME – UNSOM has had a plethora of
ACGME site visits. Family medicine and
surgery critical care had their initial re-accreditation visits last week. Sports medicine in
UNSOM is hosting the national
meeting for the Association of Standardized Patient Educators, scheduled for
the last week of June 2009 at the Marriott.
SCHOLARSHIP FUND
REPORT – The scholarship disbursements have been
received by the schools, as evidenced by the thank-you letters being
received.
NSMA REPORT – Dr. Seher reported that
Larry has been buried under a pile of tough issues. The Medicaid payment issue is critical with
pediatric level reimbursements lowered to the 2002 level. Larry is working hard to craft a message on
how to position ourselves on the issue. Larry added that the first round of
cuts eliminated $32 Million in increased physician payments. The second round of Medicaid cuts (passed by
the legislature) was implemented in September which cuts the pediatric
adjustment by 170% of the 2002 Medicare fee schedule, and the 128% of the
Medicare fee schedule to pay for
Dr. Seher talked with the Chamber of
Commerce in
The NSMA annual meeting is going
paperless in 2009. Everyone will be
supplied with a flash drive of all the information (participants must bring
their own laptop). The County societies
will be billed for any unreturned flash drives.
Larry Matheis stated the decision to
eliminate vaccines for children was not approved by the Governor’s office or
any other office; rather it was strictly a decision made by the Department of
Health & Human Services. Larry is
working with legislators to draft a bill to mandate coverage and detail
coverage fees for childhood vaccinations.
The Palmetto payer issue is becoming
critical. NSMA has received numerous
complaints by physicians. The first
Carrier Advisory Committee meeting will be held November 6, which will be open
all day so people can come in with their claims issues. The senior staff will be here with computers
to try and work through some of the critical issues.
The Injection Safety Project is
proceeding and working with ASIP, CDC and the FDA on choosing the materials for
the national campaign scheduled for the spring of 2009.
The integration of the ICD10 is
scheduled to replace the ICD9 codes in 2010.
The proposed regulations for the ICD10 codes have been issued and many
problems have been identified. NSMA has
joined other state societies on a national letter that has been sent to all of
the congressional offices requesting the postponement of ICD10.
MEDPAC REPORT – Dr. Evins stated that the most important issue with this
legislative session will be Tort Reform and its possible repeal.
AMA REPORT – by Dr. Kline and Dr. Nelson - Dr. Nelson and Dr. Kline were not
present; therefore, no report was provided.
Larry Matheis believes the discussion will revolve around Medicare,
prescribing requirements, SCHIP and Medicaid prescriptions.
NBME REPORT – by Dr. Rodriguez - Dr. Rodriguez was not present; therefore, no
report was provided.
PRESIDENT’S REPORT – by Dr. Jones - He read an article regarding the State Board of
Medical Examiners. They are referring
all comments for public opinion from the press to their Executive Director and
individual board members will no longer be making statements. Dr. Jones announced the recent passing of two
retired/former members, Dr. Thomas Brumfield, and Dr. Norman Brown. Dr. Jones stated that he had a very distasteful
experience in talking with Paul Harrison of the Review Journal, and advised
that he will never accept another call from him. He also cautioned the BOT that taking a call
from any reporter is done at their own peril.
NEW BUSINESS - United/Sierra Merger – Dr. Redfern advised that he has been
appointed to the Sierra/United Merger Physician Advisory Council. The members of the council are Dr. Keith
Brill, Dr. Warren Volker, Dr. Rod McBeth, Dr. Jim Christenson, and Dr.
Redfern.
FUTURE MEETINGS Next meeting is scheduled for Tuesday, November 18, 2008 at
6:00pm. This will be a regular meeting
for full attendance by the Board of Trustees.
ADJOURNMENT Meeting adjourned at 8:16 pm.
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HIPAA Part 1: General Obligations in the Physician Office
By Antoinette
Pretto-Sparkuhl, RN, BSN, MHA
The Health Insurance Portability and Accountability Act of 1996
became effective on April 14, 2003. Its
purpose is to provide federal protection of the privacy of personal health
information or PHI while allowing the flow of health information needed to
provide and promote high quality health care, and to protect the public’s
health and well being. PHI includes all
individually identifiable health information and may be in any form, such as
written, oral, fax or electronic. The duty of confidentiality extends to all
employees in a physician’s practice including but not limited to: physicians,
nurses, medical assistants, receptionists, billing clerks, etc. In addition, the physician-employer will
share liability in the event of an unauthorized disclosure by an employee.
Therefore, there are general obligations for your practice in order to be
compliant with HIPAA regulations.
Some of these
obligations include:
• Designation of a privacy officer
responsible for the development and implementation of office privacy policies,
training of staff and handling alleged complaints of possible violation.
• Include education regarding patient privacy
as part of new staff orientation, and reinforce its importance in staff
meetings.
• Provide patients with a written notice of
your privacy practices.
• Allow patients to request an amendment to
their medical record. (Physicians can deny this request, if the record is
accurate).
• Provide the patient with an accounting of
PHI disclosures, if requested.
• Require business associate agreements
between providers and individuals/organizations whose services involve use
and/or disclosure of PHI.
• Monitor employees to ensure compliance with
office policies regarding PHI disclosures.
• Develop a plan to ensure that electronic
and paper records remain secure.
• Do not leave medical records unattended in
public areas in the office.
• Reports should not be left on printers, fax
machines or copiers. Also ensure that these reports cannot be viewed by
passer-by’s.
• Develop a policy to keep PHI out of view on
computers by implementation of automatic log off after inactivity, and locating
computers in areas where patients cannot easily view monitors.
• Implement password protection for
computers.
• Do not discuss patients by their first and
last names within earshot of other patients/visitors, especially in public
areas such as waiting rooms or hallways.
• Ensure security when computer equipment,
back-up tapes, and storage devices are removed from the office. E.g. For repairs or when taken to an off-site
repository.
• Develop procedures for secure disposal of
PHI for both paper and electronic formats.
Thus, the physician,
along with his/her employees, is responsible for the management of PHI in the
office, regardless of its form. It is
essential for your office to develop and implement comprehensive privacy
policies that outline procedures for protecting patient information, as well as
ramifications for staff non-compliance. Next month there will be another
discussion on HIPAA in relation to disclosures of PHI which will include
situations in which PHI disclosure is permitted with or without the patient’s
authorization. For additional
information on HIPAA please visit:
www.hhs.gov/ocr/hipaa
Antoinette Pretto-Sparkuhl
can be contacted at 700 Shadow Lane #430, Las Vegas, NV 89106.
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Past President’s Message
By Neil Swissman, M.D.
1976-77 President,
In 1976, this great nation rejoiced
in its bicentennial and
• As
now, the Society was committed to the promotion of community health. The 70s support and training of EMT personnel
were the infancy of today’s advanced trauma care. CCMS also supported the Clark County Health
Systems Agency with physician volunteers and funding.
• A
major professional/ethical issue of the day focused on the establishment of
guidelines for a previously unheard of practice – the advertisement of
physician services.
• The
fledgling Nevada Physicians Union posed a major, though short lived challenge
with an aggressive attempt to represent all physicians statewide at the expense
of existing organization – a move that was rejected by most.
• CLAMPAC
and NEMPAC, then as now, struggled with a less-than-adequate percentage of
participation.
• Mr.
James Joyce was hired as a public relations consultant and non-member
recruitment initiatives were undertaken, focusing on the importance of
membership to the Society as well as to the physician.
• The
Women’s Auxiliary to the Society coordinated and managed the spouse program for
the American Associations of Ophthalmologists and Otolaryngologist’s annual
meeting in
• On
September 21, 1976, the Executive Council “…voted to endorse a feasibility
study for a four-year medical school in
We were a social, collegial bunch
who took the work of this young Society very seriously. It was my honor and privilege to be judged
worthy of its presidency then, and gratifying, now, to have been part of its
growth. CCMS remains the best and most
effective voice for medicine and physicians in this community.
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2008-2009 CCMS Alliance
By
Beverly Daly Dix and Sheila Bazemore
We wish
everyone a healthy, happy 2009! We would
like to take this opportunity to thank the Clark County Medical Society for
your enthusiastic support in 2008. The
strong partnership of CCMS and our
Dr. Florence Jameson,
This holiday season our
Passport to Elegance, our holiday
luncheon and Fashion Show launch was a huge success. Monterey Brookman made the arrangements at
the famous
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SNHD Health Officer Report
Rabies Post-Exposure Prophylaxis
Protocol
By
In
Though only one of the
animals involved in these reported exposures was positive for rabies, potential
exposure to rabies is and will continue to be an ongoing issue in our
community. In response to this risk and
a shortage of rabies vaccine nationwide, the Southern Nevada Health District
has developed a protocol for assessing exposure situations and providing rabies
post-exposure prophylaxis.
The rabies virus is
present in the saliva, brain and spinal cord tissue of an infected animal. The
potential for exposure to rabies virus should be assessed in accordance with
the following guidance from the Centers for Disease Control and Prevention:
“When an exposure has
occurred, the likelihood of rabies infection varies with the nature and extent
of the exposure. Under most circumstances, two categories of exposure (bite and
nonbite) should be considered. The most dangerous and common route of rabies
exposure is from the bite of a rabid mammal. An exposure of rabies also might
occur when the virus, from saliva or other potentially infectious material
(e.g., neural tissue), is introduced into fresh, open cuts in skin or onto
mucous membranes (nonbite exposure). Indirect contact and activities (e.g.,
petting or handling an animal, contact with blood, urine, or feces, and contact
of saliva with intact skin) do not constitute exposures; therefore
post-exposure prophylaxis should not be administered in these situations.” (Human Rabies Prevention – US 2008, MMWR
2008; 57(RR03):1-28.)
When assessing patients
with bite wounds from rabies susceptible animals, health care providers are
required to contact the animal control agency in the jurisdiction where the
bite occurred to report the incident.
Additionally, immediate
and thorough washing of all bite wounds and scratches with soap and water or a
virucidal agent are important urgent measures for preventing rabies. If rabies
post-exposure prophylaxis is warranted, the health district should be contacted
to report the circumstances surrounding the bite incident and to request the
vaccine order code. A copy of the complete protocol, including a complete
rabies post-exposure prophylaxis schedule, is available on the health district
website at: www.southernnevadahealthdistrict.org/download/epi/rabies-protocol.pdf.
Currently Novartis, the
manufacturer of RabAvert®, which is used for rabies post-exposure is able to
deliver the vaccine without supply restrictions. The new product identification
number for this vaccine is 63851-501-01. Questions can be directed to Novartis
customer service at 1-800-244-7668. Sanofi Pasteur continues to have IMOVAX®
Rabies for post-exposure prophylaxis only. The health district Office of
Epidemiology must be contacted at 759-1389 to obtain the IMOVAX® rabies
vaccine. When contacted, health district staff will conduct a risk assessment
for the suspected exposure. Once it is determined that post-exposure
prophylaxis is indicated a passcode and additional instructions for ordering the
vaccine will be provided.
It is also important to
note that both rabies vaccine manufacturers have patient assistance programs to
provide medications to uninsured and underinsured patients. Sanofi Pasteur’s
Indigent Patient Program is administered through the National Organization for
Rare Disorders (NORD). Information can be obtained by calling 1-877-798-8716 or
by e-mailing nnadiq@rarediseases.org to obtain an application. The RabAvert®
Patient Assistance program is managed through Rx for Hope and can be reached at
1-800-244-7668 or www.rabavert.com on the “How to Order” page.
A copy of the full
protocol is available on the health district website at
www.SouthernNevadaHealthDistrict.org. For additional information on animal bite
risk assessment contact Anette Rink, DVM, or Keith Forbes, DVM, at the Nevada
Department of Agriculture at 775-688-1182.
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SNHD Disease Stats Nov 2008
CME CALENDAR
Bechtel
NV Chapter AACE 702-434-8400
NV
Cancer Institute 702-822-5290
Pri-Med
Institute 877-4PRI-MED
Sierra Health Services 702-242-7735
Southwest Medical Assoc 702-242-7735
www.sunrisecme.com
UMC 702-383-2604
www.umcsn.com/events/cme/asp
Jan 9 - "Addressing Health Care
Disparities,
Changing Demographics, and the
Unsustainable
System..."
Jan 10 - Save the Date -
Jan 16 - "VTE/PE Prophylaxis &
Treatment"
Jan 30 - "Update on Treatent of
Genital Herpes"
Education Opportunities for Practice
Managers,
Call
the NV Medical Group Management Association: 702-697-5471 ext 134.
Only CME Activities
held at the Clark County Medical Society office are specifically endorsed by
CCMS.
Classifieds
EXPERIENCED
OB/GYN: Nevada Health Centers is
recruiting for an experienced Ob/Gyn clinic.
We offer a competitive compensation package complete with incentives and
full benefits. Please email your CV to
sharders@nvrhc.org
SPACE
FOR RENT- 2108 sf, 5755 S Rainbow near
Spring Valley Hospital, end cap in free-standing building, Rainbow frontage
near Russell Road, built as therapy office, NNN lease, rate negotiable,
available immediately, good for medical,dental, rehab, or retail.
Add
another zip code to your letterhead by sharing office space near
Summerlin. Westside “timeshare space”
for lease. New medical office building
(full or half days available) convenient to 215 near Flamingo Hualapai. Call 458-4263 ext 209
FOR
STRIMLING
DERMATOLOGY, Mohs Skin Cancer &
Cosmetic Laser Surgery accepting NEW PATIENTS. Skin/Hair/Nail/Vein disorders
and Mohs Surgery for difficult/facial skin cancers. Same day appointments available. 3150 N. Tenaya, #350,
for
Pediatricians: interested in an educational
CME cruise on pediatrics? No specifics
available yet. First choice would be
Crystal Cruise Line, “Serenity”
Eastside
office: Need an eastside office location? Sublease space - low $ per sq ft 100-3000sq
ft available as needed. Physicians,
Chiropractors, Podiatrists, Physical Therapists welcome. If interested, please contact Kelly at
702-367-0808.
Available
Immediately: 2 exam rooms and an office available
to lease in Physical Medicine and Rehabilitation Practice located in the
medical office building at Summerlin Hospital.
Support staff welcome. Inquire by
email to dlangdon@lvcoxmail.com
FOR
LEASE: 1750 sqft (+-) suite available in free
standing building in SW area (215 &
FOR
RENT—VIP ROOM.
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County Line
Nevada Mutual Insurance Company ….. 798-6001 ….. www.nevadamutual.com
Medicus……..512-467-2800 ……. www.medicusinsurance.com
Consultants in Marketing for Hutchison & Steffen ……944-2464 www.wemarketo.com
SK+G for NV Cancer Institute … 478-4122 … www.skgadv.com
Ensemble Real Estate, LLC …. 562-7595
Premier Physicians Insurance Company…..860-6130 ... www.ppicmedmal.com
The Firm for Comprehensive Cancer Centers …..702-739-9933
21st Century Oncology ……274-2000 … www.21stcenturyoncology.com
R&R Parterns, Inc for Saint Mary’s Health Plans …..702-318-4331
Jacob Hafter, Esq … 702-405-6700 … www.hafterlaw.com
Joe Kaufman Physician Mgnt Co …..702-318-6517
BJC Investments, LLC ……228-7464 …. www.priorityonecommercial.com
Nevada Docs Support Association, Inc ….. 702-215-4894… www.nvdocs.com
Anne Aniello Insurance Agency ….702-259-0250 … www.anielloinsurance.com
Vertical Media for Dakem & Assoc …702-807-6045
Medical Group Management Association ….. 697-5471 ext. 134