Clark County Medical Society

County Line

Newsletter XVIII July 2001

Clark County Medical Society Installs Raj Chanderraj, MD as Society’s 2001-2002 president

The Clark County Medical Society held its 2001-2002 Inauguration Ceremony at Caesars Palace on June 12, 2001 inducting Raj Chanderraj, MD as the new society president. The event was a complete success.

We were fortunate to have Mayor Oscar Goodman and Commissioner Myrna Williams attend the event as special guests of Dr. Chanderraj. At the event, Joseph Rojas, Sr., MD was awarded the “Harold Lee Feikes Physician of the Year Award” for serving the community with excellent care.

The Clark County Medical Society would like to thank all those who attended this special function. We look forward to having Dr. Raj Chanderraj as our president.

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President’s Message

Following is an edited version of Dr. Chanderraj’s Inauguration Speech, June 12, 2001.

I am excited and honored to be installed as the 45th President of the Clark County Medical Society. At the outset, let me offer thanks to my beloved wife and 3 wonderful boys – Rishi, Ravi and Rajeev. Their exemplary behavior and scholastic achievements enable me to partake in numerous community affairs.

I am thankful to Kirsten, Deborah and Dot, the staff of the medical society, and especially to Marisol who made this event a memorable occasion. I am looking forward to working closely with Dr. Havins whose advice and guidance I shall closely seek.

I would like to thank all the sponsors for their generosity. I owe a special thanks to Carla Perez and Sam Kaufman from Desert Springs Hospital, who time and again, in spite of their marketing department, have stepped out to help me. My special thanks to Mr. Allan Stipe, CEO of Sunrise Hospital and Mr. Pramod Garg, who unlike the common perception in the media, are taking a lead in solving the urgent needs of the community.

It is my duty to present to you a statement of the facts, which underlie the common concerns, and objectives, which bring us together. We physicians are a diverse group. We each live in our own spheres, and while each sphere is different there are areas of overlap. It is important and smart to recognize the differences but it is also incumbent upon us to see the wisdom in coming together on common issues. We need to resolve these common issues through dialogue and partnership. We can make harmonious music if we heed each other’s voices or we can produce a cacophony and a dissonance that can end up making us not part of a solution but rather part of the problem.

For the past 10-12 years, physicians have been bombarded with multiple attacks from various sources - DRGs, CLIA, E&M, HIPPA, OSHA, ANBs, etc., - All these issues made us retreat into a cocoon for our survival and as a consequence shifted the focus away from patient care and public concern. In addition, we did not participate in the democratic processes of our society. At the recent legislative session some of the legislators made an observation that physicians come to testify only on bills that effect their turf or pocket books. We are not there for issues relating to public health.

With all these issues hitting us in all directions, we found ourselves at the end of the rope. As the old saying goes “when you are at the end of the rope, you tie a knot and hang on” - and hang on we did. Some of us paid our annual dues and hung in there and through persistent efforts, made the governmental agencies listen to us. Organized medicine, i.e. the AMA and its constituent medical associations and specialist societies have through their efforts cut the regulatory burden in caring for our patients.

Organized medicine was instrumental in convincing HCFA that their calculation of SGR (Sustainable growth rate) was erroneous.

We made them fix it, which resulted in an increase of 4.5% to our reimbursement. Because of our efforts, HCFA retracted the $1.50 charge that was to be levied for every claim submitted to Medicare. Organized medicine is also focusing on the disconnect between HCFA/DEA. Locally, the NV State medical association, through its constituent medical societies and through the efforts of concerned physicians of NV, has made significant gains by pushing SB 99 – a bill which abolishes the paneling fees and enforces prompt payment by insurers for submitted claims. In the 1997 legislature, partnering with the NV Healthcare Reform Project, we helped legislate AB 156, which created the office of Insurance Health Assistance. Working closely with this office and the Managed Care Industry we helped formulate a uniform prior authorization form. We are very close to creating a universal credentialing form and a single credentialing entity that would tremendously decrease the paperwork in performing our jobs. All these efforts put together save a physician nearly $4,000 annually. Bear this in mind when your annual dues statement comes to your desk in January. I encourage all of you to view these $1,000 dues in the larger context of the total benefit that is accruing to you - a return of 300% on your investment.

I have, up until now, focused on organized medicine. There is yet another factor that is bringing about a change - our patients, the public. It was the public concern for rising costs that created managed care. Again it is public perception of compromised healthcare that is bringing about the patients’ bill of rights.

We have to make a concerted effort in dealing with public concern for health issues. George Washington once stated, “In proportion as the structure of a government gives force to public opinion, it is essential that public opinion should be enlightened.” In the next year, I propose to have a series of public interest forums that will educate the public and enable them to form informed opinions regarding healthcare issues- opinions that candidates seeking elected positions will be forced to heed. As President Franklin D. Roosevelt said, “There is no group in America that can withstand the force of an aroused public opinion.”

We also need to give back to the community in caring for the underserved and uninsured. In a hierarchical society such as ours –where there is a wide gap between poor/rich - health care indicators are always at the lower rung of the ladder. In the health Olympics we were 15th in 1970, 20th in 1990 and 25th in the year 2000, behind all major industrialized nations and some 3rd world countries. In contrast, in egalitarian societies such as Sweden where healthcare is equal and available to all, these indicators are at the top. We can help the uninsured if we put in the effort. Sunrise Hospital, under the leadership of Mr. Allen Stipe, conducted a study showing that providing free prenatal care caused a significant drop in the birth of premature babies. Prof. Tom O’Reilly, with the help of Great Basin Primary Care Group of Reno, has organized the Health Care Access consortium in Clark County. They put together a large network of caregivers who will provide needed healthcare to 200,000 residents of southern NV who are uninsured. We owe a special debt of gratitude to Commissioner Myrna Williams who helped get $1 million to fund this project. It is my privilege to be serving as the chairman of this Consortium. I look forward to seeing a lot of you participating in it.

For many years historic Cooper Union in New York conducted free lectures on several issues, followed by Q/A sessions. Every night, no matter what the subject was, a little man would show up, sit in the corner and at the end of the talk he would stand up and ask the same question – “From what you spoke tonight - will it help the working man”? There was no doubt in his mind as to what the goal should be. Similarly, folks, whatever we do we should focus on that single-minded attention of helping our patients and “perform every day like it is our last day and treat every patient like he or she is our first patient.”

God bless and thank you.

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Clark County Medical Society Board of Trustees Minutes

May 15, 2001

Present Were: Raul Meoz, MD, Presiding Raj Chanderraj, MD; Jeffery Cichon, MD; Andrew Cohen, MD; Warren Evins, MD; Weldon Havins, MD; John Ellerton, MD; Stacey Garry, MD; Kevin Hyer, MD; Edwin Kingsley, MD; Donald Kwalick, MD; Marietta Nelson, MD; Annette Teijeiro, MD; and Arnold Wax, MD.

Staff Present: Weldon Havins, MD, JD, Executive Director; Dot Freel, Office Manager; Deborah Spencer, Public Relations Coordinator; Marisol K. Aliaga, Public Relations Assistant; and Kirsten Allison, Membership Administrative Assistant.

At 6:00 PM Dr. Meoz called the Meeting to Order. Dr. Meoz set to review to April’s minutes and have them approved. Dr. Wax moved to approve the Minutes. Dr. Kingsley seconded it, which passed unanimously.

Closed Session

Building Committee

Dr. Teijeiro reported: She met with planners to go over building modifications. Also, Dot was able to come up with bids for landscaping. It was recommended that a more formal RFP be prepared. Dr. Teijeiro was empowered to make a decision regarding the winning bid. Dr. Kwalick moved to have RFP’s sent to the landscapers. Dr. Cohen seconded it, which passed unanimously.

Community Relations Committee

Deferred to the next meeting

Credentialing Committee

PROVISIONAL MEMBERS

Angus, Arsenio, MD, Family Practice; Kaplan, David DO, Orthopaedic Surgery; Letelier, Carlos H.. MD, Oral and Maxilliofacial Surgery;

Knight, Patrick MD, Pathology; Weinstein, Jonathan MD, Ob-Gyn

FULL MEMBERS

Bassewitz, Hugh MD, Orthopaedics; Batiste, Stan MD, Diagnostic Radiology; Goli, Vijay MD, Urology; Mirkil, Jerome V. MD, Family Practice; Reddy, Tushina MD, Ophthalmology; Turner, Carla MD, Ob-Gyn

LIFE MEMBER

Patrick Flangan, MD, Gynecology

Dr. Hyer moved to approve the Provisional, Full and Life Members. Dr. Ellerton seconded the motion, which passed unanimously.

New Business

Dr Havins reported that our subscription(s) to the Ralston Report needs to be renewed, if the board would like to renew it. A discussion was held regarding the necessity of the subscription. Dr. Chanderraj requested that one subscription be renewed and held at the Society’s office for members to review at their leisure. Dr. Hyer seconded it, which passed unanimously.

Dr. Meoz requested that the minutes in the newsletter be put in an abbreviated format. A set of the full minutes would be available at the society’s office for members to view. Dr. Ellerton moved to approve highlights for the newsletter and to have a full copy for our members. Dr. Garry seconded it, which passed unanimously.

Dr. Havins suggested we change the name of our newsletter so it sounds more geared to physicians. Dr. Chanderraj suggested that we have a contest. A discussion of a prize for the contest came up. Dr. Ellerton and Dr. Wax will donate a book for the winner of the contest. Dr. Chanderraj suggested that we have a contest to come up with a new name. Dr. Kwalick seconded it, which passed unanimously.

There being no further business, the meeting was adjourned by Dr. Meoz at 7:45 PM

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Referral Tallies

The following referrals were provided to CCMS members in the second quarter of 2001 (through June 15)

Specialty	Referrals
Allergy	3
Anesthesiology	0
Cardiology	2
Card. Vascular Surgery	3
Colon & Rectal Surgery	0
Dermatology	11
Diagnostic Radiology	0
Ear, Nose & Throat	4
Endocrinology	4
Family Practice	25
Gastroenternology	2
General Surgery	3
Genetics	0
Geriatrics	2
Gynecology	3
Hematology	1
Infectious Medicine	2
Internal Medicine	17
Nephrology	2
Neurology	9
Neurosurgery	5
Ob-Gyn	5
Oncology	4
Ophthamology	3
Orthopaedic Surgery	9
Pain Mgt.	6
Pathology	0
Pediatrics	2
Ped. Endo.	1
Ped. Psychiatry	1
Plastic Surgery	9
Psychiatry	13
Pulmonology	2
Radiology	0
Rheumatology	2
Urology	2
Vascular Surgery	1
Other	0
Totals	158

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Executive Director Editorial – NBME’s SB 91: Changes in Nevada’s Medical Practice Act

Weldon (Don) Havins, M.D., J.D., CCMS Executive Director and Special Counsel

The Nevada Board of Medical Examiners’ (NBME) bill, Senate Bill 91, has passed the two houses of the legislature and has been signed by the Governor. The sections amending the NRS 630 affecting the practice of medicine became effective on July 1, 2001. The unusually long, 46-page bill amends NRS 630 in ways that will have a profound impact on the practice of medicine in Nevada. Nevada now has the greatest training requirements for initial licensure. Five new provisions under which physicians can be disciplined have been added. The regulations of the board, now by statute, replace the accepted standard of medical care for the treatment of intractable pain. These pain regulations of the Board have been, and continue to be, very controversial.

Section 17 of SB 91 amends NRS 630.160 to require medical licensure applicants to have completed 36 months of progressive postgraduate education as a resident in the United States or Canada in a program approved by the Board, the AMA’s ACGME, or the Canadian equivalent. NRS 630.160 formerly required three years of approved postgraduate training. Now applicants for a medical license in Nevada must demonstrate completion of three progressive years of training, PGY1, PGY2, and PGY3 in an approved program. While it appears Nevada is the only state to have adopted this requirement, the Federation of State Medical Boards’ Model Medical Practice Act contains this provision.¹

Section 21 amends NRS 630.261 permitting the board to issue a special purpose license to a physician licensed in another state to permit the transmission of a patient’s medical condition via electronic, telephonic, or fiber optic means. Physicians practicing “telemedicine” will be required to obtain this special purpose license to conduct medical business in Nevada. The Board may now charge up to $400 for this license.

Section 28 of the bill adds five (5) additional grounds for initiating disciplinary action or denying licensure:

1. “Disruptive behavior with physicians, hospital personnel, patients, members of the families of patients or any other persons if the behavior interferes with patient care or has an adverse impact on the quality of care rendered to a patient.”² What specifically constitutes “disruptive behavior” has not been defined. In the absence of a definition, the common law would indicate that disruptive behavior is what an ordinary, reasonable, prudent person would consider disruptive. However, Nevada’s Medical Practice Act (NRS 630) gives the NBME the authority to determine, by a preponderance of the evidence, whether this section of the act has been violated. Violation of a provision in NRS 630 or NAC 630 subjecting the doctor to sanctions, including license revocation.³ So, without a statutory definition, the NBME determines what behavior is sufficiently disruptive to interfere with patient care or is sufficiently disruptive to have an adverse impact on the quality of care rendered to a patient.

2. “The engaging in conduct that violates the trust of a patient and exploits the relationship between the physician and the patient for financial or other personal gain.”⁴ While this may sound reasonable a first glance, the ambiguities in this law fosters a physician’s license being revoked on the word of a patient alone. If the NBME believes a patient’s allegation over the physician’s explanation, no other evidence being available, the Board may find, by a preponderance of the evidence, that the physician has violated this statute and subjecting to licensure discipline, including revocation of the physician’s license.

3. “The failure to offer appropriate procedures or studies, to protest inappropriate denials by organizations for managed care, to provide necessary services or to refer a patient to an appropriate provider, when such failure occurs with the intent of positively influencing the financial well-being of the practitioner or an insurer.”⁵ Like the other four disciplinary offenses that Section 28 adds to NRS 630, this provision appears to be taken, almost in whole, from the FSMB’s Model Medical Practice Act.

4. “The engaging in conduct that brings the medical profession into disrepute, including, without limitation, conduct that violates any provision of a national code of ethics adopted by the board by regulation.”⁶ Since the Board has not adopted a “national code of ethics,” the provision authorizes licensure discipline of any medical doctor who “brings the medical profession into disrepute” - whatever that means. The definition will be determined by a majority of the Board, at a “preponderance of the evidence” standard of proof.

5. “The engaging in sexual contact with the surrogate of a patient or other key persons related to a patient, including, without limitation, a spouse, parent or legal guardian, which exploits the relationship between the physician and the patient in a sexual manner.”⁷ NRS 630.301 already provides for licensure discipline for “engaging by a practitioner in any sexual activity with a patient who is currently being treated by the practitioner.” This new law prohibits “sexual contact” with patient surrogates, including spouses, parents or legal guardians, which “exploits” the physician – patient relationship “in a sexual manner.” The new law expands prohibited activity. How this will be interpreted awaits disciplinary actions of the Board.

Section 29 of the bill provides that a physician must not only maintain medical records relating to the diagnosis, treatment and care of a patient, the licensee must now maintain timely, legible, accurate and complete medical records.

Section 30 relates to the treatment of pain. Currently, NAC 630.230(m) directs that physicians shall not “engage in the practice of writing prescriptions for controlled substances to treat acute pain or chronic pain in a manner that deviates from the guidelines set forth in the FSMB’s Model Guidelines for the Use of Controlled Substances for the Treatment of Pain...” The first guideline, found in Section II of the Model Guidelines mandates that, when evaluating a patient for the use of controlled substances to treat pain, “a complete medical history and physical examination MUST be conducted and documented in the medical record.”⁸ Section 30 of SB91 changed the requirement that the treatment of intractable pain must be in accordance with accepted standards for the practice of medicine. Now the treatment of intractable pain must be in accordance with “regulations adopted by the board.”

Thus, the regulations of the Board mandate that, when evaluating a patient for treatment of the patient’s pain with controlled substances, the physician must perform and record a complete history and physical. Failure to do so is a violation of a Board regulation. Such violation subjects the physician to disciplinary action including license revocation. Not evaluating a patient for the use of controlled substances to treat intractable pain additionally becomes a violation of a legislative statute (NRS 630.3066) If the complete history and physical is not documented in the patient’s medical record in a timely, legible, accurate and complete manner, the physician has violated yet another new statute, NRS 630.3062. Further, if you are a licensed medical doctor and you know, or have reason to know, of another licensed medical doctor who is not complying with the regulation, you must report that non-complying physician to the NBME or you are subject to licensure discipline, including revocation of your Nevada medical license. See NRS 630.3062(6). Ironically, a licensee physician can avoid a licensure sanction action by NOT treating the patient’s pain with controlled substances. This appears to be precisely the opposite of the intention of the Board members which was to encourage the treatment of pain with adequate prescription of controlled substances. You can confirm all the above by reading the relevant statutes and regulation, as well as the changes in NRS 630 found in SB 91. The statutes of Nevada’s Medical Practice Act, NRS 630, and the regulations of the NBME, NAC 630, can be found through the NBME’s website: www.state.nv.us/medical. SB 91 can be found on the Legislative Counsel Bureau’s website: www.leg.state.nv.us I would advise doubters to download NRS 630, NAC 630 and SB 91, and obtain an independent legal opinion, in writing,⁹ regarding the current status of pain evaluation and treatment laws in Nevada.

With this new legislation, the NBME also becomes the regulator of the “practice of respiratory care.” At the June meeting of the NBME, the NBME staff indicated they plan to have proposed respiratory therapy regulations ready to present at the next regularly scheduled board meeting, Sept. 7-8. If you wish to be appraised of these regulations are they are developed and adopted, you will need to write the NBME as ask to be placed on the “mailing list”. This obligates the NBME, under Nevada’s Open Meeting Act, to mail you all proposed regulation, notice or workshops on regulations, and agenda of Board meetings.¹⁰

The civil professional liability (medical malpractice) significance of violating a statute versus violating a regulation will be the subject of a future editorial.

¹ The Federation of State Medical Boards’ Model Practice Act states: The applicant should have satisfactorily completed at least thirty-six (36) months of progressive postgraduate medical training approved by the Board or by a private nonprofit accrediting body approved by the Board in an institution in the United States, its territories or possessions or Canada approved by the Board or by a private nonprofit accrediting body approved by the Board.

² The FSMB’s Model Medical Practice Act wording: “disruptive behavior and/or interaction with physicians, hospital personnel, patients, family members or others that interferes with patient care or could reasonably be expected to adversely impact the quality of care rendered to a patient.”

³ NRS 630.352 Notification of disposition of charges; board may provide physician with copy of complaint; disciplinary actions available to board.

1. Any member of the board, except for an advisory member serving on a panel of the board hearing charges, may participate in the final order of the board. If the board, after a formal hearing, determines from a PREPONDERANCE OF THE EVIDENCE that a violation of the provisions of this chapter or of the regulations of the board has occurred, it shall issue and serve on the physician charged an order, in writing, containing its findings and any sanctions.

3. Except as otherwise provided in subsection 4, if the board finds that a violation has occurred, it may by order:

(a) Place the person on probation for a specified period on any of the conditions specified in the order;

(b) Administer to him a public reprimand;

(d) Suspend his license for a specified period or until further order of the board;

(e) Revoke his license to practice medicine;

(f) Require him to participate in a program to correct alcohol or drug dependence or any other impairment;

(g) Require supervision of his practice;

(h) Impose a fine not to exceed $5,000;

(i) Require him to perform public service without compensation;

(j) Require him to take a physical or mental examination or an examination testing his competence;

(k) Require him to fulfill certain training or educational requirements; and

(l) Require him to pay all costs incurred by the board relating to his disciplinary proceedings.

⁴ The FSMB’s Model Medical Practice act wording: “conduct which violates patient trust and exploits the physician-patient relationship for personal gain.”

⁵ The FSMB’s Model Medical Practice act wording: “failure to refer, failure to offer appropriate procedures/studies, failure to protest inappropriate managed care denials, failure to provide necessary service or failure to refer to an appropriate provider when such actions are taken for the sole purpose of positively influencing the physician’s or the plan’s financial well being.”

⁶ The FSMB’s Model Medical Practice act wording: “engaging in conduct calculated to or having the effect of bringing the medical profession into disrepute, including but not limited to, violation of any provision of a national code of ethics acknowledged by the Board.”

⁷ The FSMB’s Model Medical Practice Act wording: “commission of any act of sexual misconduct, including sexual contact with patient surrogates or key third parties, which exploits the physician-patient relationship in a sexual way.”

⁸ The FSMB’s Model Guidelines for the Use of Controlled Substances in the Treatment of Pain can be found online at the Federation’s website: www.fsmb.org

⁹ Get the opinion in writing. If the opinion states that the statute or regulation doesn’t mean what it clearly states, you will have legal redress to recover at least some of the money paid to the plaintiff when you lose your malpractice suit. Unfortunately, if you suffer licensure discipline by the NBME for violating a medical practice act statute or regulation of the board, redress is much more difficult.

¹⁰ Nevada Board of Medical Examiners, 1105 Terminal Way, Suite 301, Reno, Nevada 89502.

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Alliance Message

Debbie Chino, Alliance President

It is my honor and pleasure to serve as President of the Clark County Medical Society Alliance for the 2001-2002 term. I have served as historian, treasurer and second vice president during the last seventeen years as a member of this fine organization.

The Alliance is a special organization to me because of the many friendships that have developed over the years, having met some of my closest friends at an Alliance luncheon. The spouse of a physician needs a support system unlike any other. Due to the many hours that physicians spend devoted to their profession, we find ourselves spending many evenings and weekends alone. Those are the times when we especially need friends that understand our unique situation. With children it becomes even more important to have someone to talk to since we are very much like single parents. The Alliance serves as a great networking tool to discover resources available to our families and us.

Our membership has grown this past year and it is one of my goals to see this trend continue. We need to introduce our organization to new people while keeping our veteran members. With a strong membership we will be better able to impact the community and fulfill the mission of our organization:

To assist in the programs of the Clark County Medical Society that improve health and quality of life for all people;

To promote health education;

To uphold the programs of the Nevada State Medical Association Alliance and American Medical Association Alliance;

To encourage participation of volunteers in activities that meet health needs and,

To initiate and support health-related, charitable endeavors.

As a member of the Alliance you have the opportunity to meet the spouses of other physicians in support of these common goals that comprise the bylaws of our organization. We need spouses to join and then take an active role in the Alliance. The number of physicians moving to Las Vegas is astounding and each of us need to reach out to those prospective members with a personal invitation. Invite your friends who are not yet members to join us for a luncheon and see what the CCMSA is all about, I would like to introduce this year’s hard working and enthusiastic board members:

President Elect	Karen Schroeder
1st Vice Presidents	Rebecca Canale and Annette Mohs
2nd Vice Presidents	Susan Bowers and Ercy Rosen
Treasurer	Lisa Cohler
Assistant Treasurer	Ana Brooker
Corresponding Secretary	Christina Duke
Recording Secretary	Marian Haas

Ercy and Susan are busy planning future luncheon sites along with some interesting and informative programs. Our luncheons are usually the third Tuesday of the month, so plan to join us September 18th for our first meeting of the year. Let’s keep the membership growing! You will be receiving a renewal form in August or you can complete and mail the Alliance membership application in this newsletter. Send in your membership dues early so that you will be listed in our annual directory of members that Annette and Rebecca will be putting together. We need your support to make this a productive and memorable year!! Visit our web site at www.ccmsa-lv.org for more information or call me at 369-6660 if you have any questions or suggestions. See you in September!!

ATTENTION ADVERTISERS!!! Business card size ads {3.5”(w) X 2”(h)} for the September issue of the Alliance newsletter are now available for $25/month or $125/nine months. You can also help sponsor our members’ directory for the same rate. Call Rebecca Canale (498-7750) or Annette Mohs (248-9624) for details.

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Clark County Medical Society New Members June 2001

Robert Berkley, MD, Cardiology, 3150 N. Tenaya Way #550, Las Vegas, NV 89128

Steven Holper, MD, Physical Med & Rehabilitation, 3233 W. Charleston Blvd., Las Vegas, NV 89102

Arpine Tacvorian, MD, Pediatrics, 3150 N. Tenaya Way #250, Las Vegas, NV 89128

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June 2001 Provisional Members

If you have any pertinent information about the following candidates, please contact: CCMS, 2590 E. Russell Rd, Las Vegas, NV 89120

Oscar Batugal, MD – Internal Medicine

Gregory Bryan, MD – Internal Medicine

Kathleen Cansler, MD – Internal Medicine

Ralph Conti, MD – Pediatrics

Michael Fitting-Karagiozis, DO – Osteopathic Medicine

Mark Glyman, MD, DDS – Oral/Maxilliofacial Surgery

Vicki Hom, MD – Pediatrics

Rajendrakumar Ingle, MD – Pathology

Michael Jacobs, MD – Internal Medicine

Richard Jones, MD – Family Medicine

Thomas Kelly, MD – Ophthalmology

Eva Liang, MD – Ophthalmology

Asma Mian, MD – Internal Medicine

Elmer Palitang, MD – Infectious Disease

Thomas Vater, DO – Othropaedic Surgery

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Medical Tort Reform in Nevada: A View from the Insurance Brokerage Industry

In the late 1970’s Nevada faced a shortage of professional liability carriers in the Medical malpractice Market. Most carriers would not look to writing coverage here. Over the past 20 years, how has this situation changed and is it improving? Is there adequate coverage at a reasonable price?

Currently filed with the State of Nevada are medical malpractice rate increase requests from 35% to 108% in Clark County. Recent claims experience for insurance carriers has been poor to disastrous. One carrier in Nevada collected a premium of $ 500,000 and paid out more than $6,000,000 in 1999. Year 2000 was no better for these companies. The current trend prospects are very negative. In the last year, there have been several malpractice awards in Clark County that have exceeded the limit of policies with the physician being exposed over the policy limit.

How will this situation affect us as these trends continue?

1. Rates will go up as we experience medical care reimbursements going down.

2. We will have physicians with 1 single claim losing standard coverage. The physician will then fall under a special market with rates 3 to 5 times higher than the current premium.

3. Filing of screening panel claims has increased and does not appear to be slowing in the near future.

4. Tort reform never made it out of the legislature’s Government Affairs Committee.

As a result, there will be no change for the next two years until the legislature can take up this issue again.

Indemnity payments and claims expenses continue to rise each year. Professional liability insurance premiums will continue to rise until insurance carriers receive sufficient funds to pay claims and make a profit. Quite soon, the projected rate of increase for insurance premiums will make them unaffordable for many physicians.

The current legal system is quickly becoming unaffordable for the medical field. There are no caps on damages in Nevada. Jury awards are unpredictable. The entire legal system is structured in favor of the plaintiff. As an example, by design, there is no concrete definition of a legal standard of care for a physician. This allows the plaintiff’s attorney and his “hired gun” expert in each case to redefine what the standard of care is and that there was a breach of that standard. Thus, physicians have no guidance as to what the standard of care is and no chance of avoiding being sued. Under the current system it is a virtual guarantee that a physician will be sued if there is a bad outcome and substantial damages, regardless of how well the physician did his job. Medical malpractice awards are very popular with the plaintiff’s bar and society. They are seen as a road to quick riches. The plaintiff’s bar will continue to aggressively pursue and generate medical malpractice claims.

Your premiums will continue to rise toward unaffordable levels. There is not enough money in the medical system to pay for malpractice claims under the current legal system. Clark County, in particular, is known throughout the insurance industry as a very dangerous place to be in the medical malpractice business.

In the final analysis, premium rates will rise so that insurance carriers can continue to operate and generate a profit. When they cannot generate a profit, they will leave.

The only long term solution is tort reform with a cap on awards. Alternative solutions, which do not address the cost of our current legal system, will do little to solve our problems. Talking and lamenting this sorry state of affairs will do nothing to ameliorate the problem. Physicians must join the insurance industry and make tort reform physicians’ top priority in the next legislative session.

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Classified Advertising

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· OFFICE SPACE FOR RENT in Green Valley by Anthem/Seven Hills! Two furnished exam rooms & one procedure room for lease on Mon.-Sat. mornings, with two additional offices. Magnificent features include Roman columns, water fountains, crystal chandeliers, and spiral staircases. Call Judi at 938-0190.

· OB/GYN established practice for sale. Call 384-7756.

· OPHTHALMOLOGIST. Well established and expanding Las Vegas Ophthalmology practice has an immediate opening for general ophthalmologist with possible interest in Glaucoma to complement group. Two prime locations in growing community areas. Fax CV with cover letter to include salary and practice expectations to (702)732-7549.

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· OFFICE SPACE AVAILABLE. Desert Professional Plaza, 2225 E. Flamingo Rd., Ste. 103 (Across from Desert Springs Hospital). 1160 sq. ft., 3 exam rooms, move in ready, wired for computers, phone system, some medical equipment, coordinating furniture, pictures and desks for sale. Call 734-2292, Dr. John Pinto/Deena Pinto.

· FURNISHED AND EQUIPPED OB-GYN OFFICE, 1047 sq. ft. with two exam rooms available for lease occupancy in 30 days or by October 1st, in the Partel Medical Center on Maryland Parkway just north of Sunrise Hospital. Call 732-2599 for details.

· OFFICE SPACE FOR RENT. 1600+ sq. ft. business office space next to Desert Springs Hospital. $1.75 per sq. ft. Optional clinic space. Inquiries contact Dr. Robert Shreck at 733-8803.

· HOSPITAL PRACTICE FOR SALE. $100,000+/year hospital practice available to hospital-based Internist or Family Physician. Inquire at (888) 385-0203.

· MEDICAL OFFICE SPACE FOR LEASE: 3006 S. Maryland Pkwy., Suite 530, Las Vegas, NV. 2621 sq. ft. currently $1.49 sq. ft. Recently remodeled - Available immediately. Contact Tanya 367-7867.

· PERSONAL HOME ASSISTANT seeking to exclusively manage household estate. Administrative Assistant, will manage staff/vendors, travel arrangements, run errands, etc. Work from your home during day, on call 24 hours. Experienced, energetic professional, friendly, highly respected with impeccable/verifiable corporate references. Mary (702) 243-5697 or (708) 749-1249.

· OFFICE SPACE TO SHARE Surgical specialist wishes to share completely furnished office suite. Flamingo/Burnham location. Immediate occupancy available. Call 734-1940.

· X-RAY EQUIPMENT. Like new! 500 MA Continental 125 KV with high frequency generator. Wall Bucky stand. Four-way float table. Floor rail mounted tube stand. Konica table model automatic processor. Cassettes - other accessories. New $20,000.00. Yours for only $9,800.00. Please call Family Medical Group, Evelyn (02) 459-5500.

· PHYSICIAN WANTED. Immediate opening for established wellness center in Las Vegas, part time, 8-12 hours per week. For information call the office at 733-9797 Mon.-Thurs. 8:30-6:00 and Friday 8:30-2:00. After hours call 860-9616.

· OFFICE SPACE FOR RENT. 2500+ sq. ft. business office space available. Located on S. Rainbow between Sahara and Spring Mountain. For additional information, please contact Lucinda Stanley at 737-8000.

· MEDICAL OFFICE SPACE FOR RENT. Subleasing shared office & clinic space up to 5 exam rooms and private office. Located on Tenaya, 2 blocks from Mountain View Hospital. For additional information, please contact Lucinda Stanley at 737-8000.

· ARE YOU WAITING FOR YOUR OFFICE BUILDOUT TO BE COMPLETED? There is a terrific opportunity to start building your practice in Green Valley Ranch Area! Beautifully furnished medical office in prime location off I-215 and Eastern attached to new St. Rose Siena Hospital. Leased on a half-day per week basis, 1,200 sq. ft. office with 3 exam rooms and consultation office. Interested parties call Ellen at (702) 454-6226.

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