Newsletter XXXII September 2002
18th Special Session changes Nevada medical liability laws
Applicants To Go Before Credentialing Committee
Doctors converge on Carson City for 18th Special Session
Clark County Health District Disease Statistics – July 2002
By
Warren Evins, M.D.
2001-2002 CCMS President
At 5:30 a.m., on Thursday, August 1, 2002, I was sitting in the press section of the Nevada Assembly chambers in Carson City, along with CCMS CEO Don Havins, MD, JD, and Scott Cragie, NSMA lobbyist. We were alone in the chambers. A few minutes earlier, the Assembly had voted unanimously on a non-recorded voice vote to pass AB-1, the 18th Special Session's Malpractice Liability reform bill, then rapidly adjourned and cleared out of the Assembly chambers. We were reading for the first time the bill that they had voted for. At the time of the vote, only the legislators themselves had copies of the bill. None of the doctors had yet seen the final provisions or wording of the legislation. In a few minutes, we were to find out that many things that we thought were going to be included in the bill were not actually there.
I had been in the Legislative building since early Wednesday morning, having been awake all day and night. Officially, I was a registered lobbyist. The morning was spent trying to change the proposed "consensus" bill, that had many exceptions to the non economic cap limits with few other provisions that I thought were helpful to physicians. The Task Force met in late morning and assigned the job to CCMS and NSMA of writing and prioritizing those few requests that would make the reform bill "meaningful" to practicing physicians. We spent several hours doing this, but none of these requests were included in the bill as it came out of the Conference committee (Assembly: Speaker Richard D. Perkins (D), Majority Leader Barbara E. Buckley (D), and David Brown (R); Senate: Majority Leader William J. Raggio (R), Assistant Majority Leader Raymond D. Rawson (R), and Assistant Minority Leader Michael Schneider (D). This was the high level committee appointed by the leadership to reconcile the different bill versions passed in the Assembly and Senate. I was told that new revisions could be added at this time.).
I spent my time talking to Democratic and Republican legislators, insurance company and hospital representatives, the very few physicians who were there, and even a few attorneys. About 2:30 a.m., Governor Kenny Guinn returned for some last minute lobbying. He explained to me how physicians had achieved a great and notable victory. Malpractice Liability reform had been proposed and defeated for over thirty years, and could not even get a hearing in Chairman Bernie Anderson's Assembly Judiciary committee for the last two or three sessions. We had now established a major landmark in Malpractice tort reform (although he understood that we did not get everything that we wanted). Gov. Guinn urged all physician leaders to explain the bill to Southern Nevada doctors.
As we were reading the now enrolled AB-1 bill, several of the Assembly Republicans individually returned to the Chambers and came over to speak with us. Some admitted that they were pleased, although they did not expect physicians to get as much as we achieved. However, we all understood that, when the Legislature returns in February 2003, changes could be proposed. The Nevada Trial Lawyers Association (NTLA) is sure to seek changes in the upcoming session.
However you feel about this law (is it "meaningful" Medical Liability reform?) and additional reforms (such as abrogation/abolishment of joint and several liability), the primary election on September 3, and the general election on November 5, are of great importance to us. We can only advance by being politically active: voting, financially supporting (directly and through MedPAC and NemPAC), and working for legislators, judges, commissioners, and other elected officials who are sympathetic to physician and patient rights.
Cover Photo - CCMS President Dr. Warren Evins thanks Assemblywoman Barbara Cegavske for her prominent role in eliminating the most onerous provisions in the original special session tort reform bill. These provisions were amended out of the final bill, which was unanimously passed by both the Assembly and the Senate. For additional details, please see the CEO editorial on page 7.
In the article "Trial Verdicts Reveal…" in the August 2002 County Line, we included charts created by the Nevada Trial Lawyers Association that provided details of the malpractice verdicts in Clark County from 1996 through 2001 and the records of both trial and defense attorneys during that time. Unfortunately, these charts erroneously indicated that defense attorneys Sherman B. Mayor and Cheryl D. Horner of Mayor, Horner, Stryker & Burk, Ltd. had a medical malpractice trial record of 2 verdicts for the defense and 2 verdicts for the plaintiff. Moreover, the chart erroneously indicated that the 2 verdicts for the plaintiff attributed to that firm included a $5,421,000 excess verdict in the case of Burney v. Dr. Steven Kramer.
Upon online research of these cases at http://courtgate.coca.co.clark.nv.us:8490/, we found that the Mayor, Horner, Stryker & Burk, Ltd. law firm did not represent Dr. Steven Kramer and was not the defense firm that received the $5,421,000 excess verdict, nor were they the defense firm for the second plaintiff's verdict also attributed to them (Abilock v. Sunrise Hospital). Rather, the information found under a District Court Case Inquiry showed that while Sherman Mayor represented the party that was initially the primary defendant, the jury verdicts came against secondary defendants in each case. (At this web site, cases can be found by searching the party name or attorney name. Once a case is found and selected, a Case Summary is available, as are links to the Case Activity, Calendar, Parties, and Judgments.)
Due to the errors brought to our attention by the Mayor, Horner, Stryker & Burk, Ltd. law firm, we requested they provide us with the accurate data regarding the firm's medical malpractice trial record in Clark County. The firm indicates they have been practicing in Clark County since 1981. They report that during that time, in cases where liability was contested, the medical malpractice trial record of attorneys of Mayor, Horner, Stryker & Burk, Ltd. is 10 verdicts in favor of the defense (either physician or hospital), and 1 verdict for plaintiff ($250,000). The firm's non-medical malpractice defense jury verdicts are not included in these totals.
We sincerely thank the law firm for assisting us by providing this corrected information and apologize for any misunderstanding which may have arisen as a result of the inaccurate information.
Paul Casey, MD, Ophthalmology, 2080 E. Flamingo Rd., Las Vegas, NV 89119
Carlos W. De Araujo, MD, Oncology/Hematology, 1950 E. Desert Inn Rd. #A, Las Vegas, NV 89109
If you have any pertinent information about the following membership candidates, please contact:
Clark County Medical Society, 2590 E. Russell Rd. , Las Vegas, NV 89120
Daniel L. Burkhead, MD Pain Management
James D. Curry, MD General Surgery
Aman Dhindsa, MD Diagnostic Radiology
Wilson H. Huang, MD Maternal/Fetal Med.
Ronald M. Kline, MD Pediatrics
Wayne Wei-Teh Liou, MD Diagnostic Radiology
David M. Moon, MD Diagnostic Radiology
Kimberly A. Moseley, MD General Surgery
Monica J. Wall, MD Internal Medicine
Stephen M. Wold, MD Maternal/Fetal Med.
By
Weldon (Don) Havins, M.D., J.D.
CCMS CEO and Special
Counsel
Assembly Bill 1 (AB1) of the legislative special session has passed and been signed into law by the Governor. The full text of the bill can be read online and downloaded from the legislative counsel bureau web site at: www.leg.state.nv.us and from the NSMA website at: www.nsmadocs.org Described below are physician relevant statutory changes. Unless otherwise indicated, these changes become effective October 1, 2002. The "Section" mentioned refers to the sections in AB1.
Medical Liability Reform
The Cap on Noneconomic Damages
Section 5 provides for a $350,000 cap on noneconomic damages, with two (actually three) exceptions. This cap applies to every defendant from every plaintiff. If there are two plaintiffs and two physician defendants, each physician would be liable for up to $350,000 in noneconomic damages to each of the two plaintiffs (i.e., for a total of $700,000 in noneconomic damages from each physician). (Section 5 (1))
The first exception is for gross negligence defined as a conscious indifference to the consequences which may result and a disregard for and indifference to the safety and welfare of the patient. (Section 5(2)(a))
The second exception to the cap on noneconomic damages occurs when the judge finds, after a jury verdict, by clear and convincing evidence, exceptional circumstances justifying an award in excess of the $350,000 cap restriction. (Section 5(2)(b))
In these two circumstances the amount of noneconomic damages may not exceed the policy limits of the physician, assuming the physician or dentist has at least $1 million/ 3 million policy limits. (Section 5(3))
The "third" exception applies to a physician who does not have $1 million/$3 million professional liability insurance at both the date of the incident and the date of filing the malpractice claim in District Court. In this situation, there is no cap on noneconomic damages whatsoever. (Section 5(4))
There is no cap and no limit on the total economic damages for which any defendant is entirely liable. (Section 5(5))
Joint and Several
Liability change
AB1 adopted the California Joint and Several liability provision, which, incidentally, was not part of MICRA (California's Medical Injury Compensation Reform Act of 1975). Noneconomic damages are severally liable to the health care provider. Of the noneconomic damages awarded, each defendant must pay only that portion for which the jury finds the defendant at fault. For example, if the jury awarded $100,000 in noneconomic damages with Dr. A being found 10% at fault, Dr. A must pay $10,000 to the plaintiff. Dr. B being 40% at fault would liable to the plaintiff for $40,000 in noneconomic damages. Dr. C being 50% at fault would be liable to pay $50,000. (Section 6)
Economic damages are subject to Joint and Several Liability. If the jury awarded $100,000 in economic damages, Dr. A though only 10% at fault is liable to pay the entire $100,000 upon demand by the plaintiff. Dr. A must then file a motion for contribution from Dr. B and Dr. C to be reimbursed for their percentage. If Drs. B and C are insolvent, Dr. A will not be reimbursed for the portion Dr. A is not at fault.
In summary, for economic damages, there is no limit of liability (no cap) and a defendant 1% at fault is liable for the entire amount (the "deep pocket"). For noneconomic damages, each defendant is liable for only that portion of fault ascribed to him or her. Noneconomic damages are "capped" at the physician's policy limits if the physician's policy is at least $1 million/$3 million. If the physician does not carry at least $1 million/$3 million limits, there is no cap on either economic or noneconomic damages. (Section 5(4))
$50,000 Total Damages
(economic and noneconomic) Cap on Trauma Patients
A traumatic injury means any acute injury which, according to standardized criteria for triage in the field, involves a significant risk of death or the precipitation of complications or disabilities. (Sec. 1.4.(b)) If a physician or dentist renders care or assistance to a patient who enters the hospital through the hospital's emergency room or trauma center, and that care is necessitated by a traumatic injury demanding immediate medical attention, that physician or dentist is not liable for more than $50,000 in civil damages, exclusive of post-judgment interest, if the care was rendered in good faith and in a manner not amounting to gross negligence or reckless, willful or wanton conduct. This $50,000 total damages liability limit applies whether the medical care was rendered gratuitously or for a fee. (Section 1(e)(2))
The $50,000 cap does not apply for any act or omission in rendering care after the patient is stabilized, and capable of receiving medical treatment as a nonemergency patient, unless surgery is required as a result of the emergency within a reasonable time after the patient is stabilized. The cap does not apply to any act or omission unrelated to the original traumatic injury. (Section 1(2))
If the physician or dentist provides follow-up care to his or her traumatically injured patient for a medical condition directly related to the original traumatic injury, there is a rebuttable presumption that the medical condition was the result of the original traumatic injury and is subject to the $50,000 cap. (Section 1(3))
Statute of
Limitations Change
An action for an injury from medical malpractice, or for a wrongful death related to medical malpractice, may not be commenced more than three years after the date of injury or two years after the plaintiff discovers or, through the use of reasonable diligence should have discovered the injury, whichever occurs first, on or after October 1, 2002. This time limit is tolled for any period during which the provider of health care has concealed any act, error or omission upon which the action is based and which is known, or through the use of reasonable diligence, should have been known to the health care provider. The parent, guardian, or legal custodian of any minor child is responsible for exercising reasonable judgment in determining whether to sue for medical malpractice. If the parent, guardian, or legal custodian fails to bring a suit for medical malpractice within these time limitations, the child cannot later sue for medical malpractice except in the case of: (a) brain damage or birth defect, in which the statute of limitations is extended until the child attains 10 years of age, or (b) sterility, wherein the period of limitation is extended until 2 years after the child discovers the injury.
The statute of limitation is changed from 2 years/ 4 years to 2 years/ 3 years, beginning October 1, 2002. (Section 11)
"Fast
tracking" Medical Malpractice cases
From October 1, 2002 to October 1, 2005, a medical malpractice lawsuit is subject to dismissal upon the motion of any party, unless good cause can be shown for the delay, if the case is not brought to trial within three years after filing the case. On or after October 1, 2005, the case must be brought to trial within two years of filing the case in District Court. (Section 7)
Expert Affidavit
required upon filing a medmal case in District Court
On and after October 1, 2002, an action for medical or dental malpractice is subject to dismissal, without prejudice (can be filed again), if the action is filed without an affidavit, supporting the allegation contained in the action, submitted by a medical expert who practices or has practiced in an area that is substantially similar to the type of practice engaged in at the time of the alleged malpractice. (Section 8)
Likewise, expert medical testimony may only be given at trial by a provider of medical care who practices or has practiced in an area that is substantially similar to the type of practice engaged in at the time of the alleged negligence. (Section 12)
Pretrial Settlement
Conference required on all medical malpractice cases
On or after October 1, 2002, all the parties, their attorneys and insurers shall attend and participate in a settlement conference before a district court judge, other than the judge assigned to the case, to ascertain whether the case can be settled before trial. Failure to attend and participate in good faith in the conference is grounds for sanctions by the judge. Only the judge may excuse a party, attorney, or insurer from attending. (Section 9)
Good Samaritan Law
expansion
Any licensed physician or dentist who renders care or assistance to a patient at a health care facility of a governmental entity or a nonprofit organization is not liable for any civil damages as a result of any act or commission by the physician or dentist in rendering that care or assistance if the care or assistance is rendered gratuitously, in good faith and in a manner not amounting to gross negligence or reckless, willful or wanton conduct. (Section 1.5(5))
Changes in
Medical Practice Act - NRS 630
Whistleblower
immunity for reporting to NBME
A physician, or his agent, or his employee shall not retaliate or discriminate against an employee of a physician or person acting on behalf of the employee who in good faith reports to the Nevada Board of Medical Examiners a physician's conduct which may constitute grounds for initiating disciplinary action. Nor shall a reporting employee be subject to retaliation or discrimination for reporting conduct raising reasonable questions regarding a physician's competence. (Section 48)
Any employee subject to retaliation or discrimination for such reporting may file an action in court for appropriate relief. (Section 49)
The sections of AB 1 pertaining to the NBME do not become effective until July 1, 2003.
New reporting
requirements of the NBME
Before February 15 of each odd-numbered year, the board shall submit to the Governor and to the Legislative Counsel Bureau a written report compiling disciplinary actions taken by the board during the previous two years against physicians for medical malpractice or negligence.
Reporting requirement
of Licensees
Each licensee must submit a list to the NBME of all actions filed or claims submitted to arbitration or mediation for malpractice or negligence against him during the previous two years, on or before July 1 of each alternate year at the time of the biennial license renewal.
Insurers Reporting
Obligations
The insurer of a physician must report to the NBME any action filed or claim submitted to arbitration or mediation for malpractice or negligence against the physician and the settlement, award, judgment or other disposition of the action or claim within 30 days after the action was filed or the claim submitted to arbitration or mediation, and within 30 days after the disposition of the action or claim. (Section 54(1))
Reporting Conduct to
the NBME
Any person that becomes aware that a person practicing medicine has, is, or is about to become engaged in conduct which constitutes grounds for initiating disciplinary action shall file a written complaint with the NBME within 30 days after becoming aware of the conduct. (Section 55(1))
Any hospital, clinic, or other medical facility shall report to the NBME any change in physician's privileges to practice medicine while the physician is under investigation and the outcome of any disciplinary action taken against the physician concerning patient care or competency of the physician within 30 days after the change in privileges is made or disciplinary action is taken. (Section 55(2))
The clerk of every court shall report to the NBME any finding, judgment or determination of the court that the physician is mentally ill, mentally incompetent, convicted of a felony or any law governing controlled substances, guilty of abuse or fraud under any state or federal program, or is found liable for malpractice or negligence within 45 days after such a finding, judgment, or determination. (Section 55(3))
Osteopathic physicians are subject, generally, to the same reporting requirements to the Board of Osteopathic Medicine.
Elimination of the
Medical Dental Screening Panel Claims on File with the MDSP before October 1,
2002
Where the claim has been filed with the MDSP before October 1, 2002, the claimant may elect to either have a determination made by the screening panel (by filing written notice of such a request before December 1, 2002) or the claimant may file an action for malpractice or negligence in the district court. The tolling of the statute of limitations for cases before the MDSP, which are not requested to proceed to a panel finding, ceases on December 1, 2002. (Section 75)
Changes in
Judicial Duties
Mandatory training of
District Court Judges
The Nevada Supreme Court shall develop rules for appropriate training of District Court Judges regarding complex medical issues for those judges to whom medical malpractice cases are assigned. (Section 15)
Mandatory sanctions
against attorneys filing frivolous cases
If the court finds an attorney has filed or maintained a case not well grounded in fact or not warranted by existing law or by an argument for changing the existing law that is made in good faith; or finds that an attorney has unreasonably and vexatiously extended a civil case, the court shall require the attorney to pay the additional costs, expenses, and attorney's fees reasonably incurred because of such conduct. (Section 16)
Expediting Resolution
of Malpractice Claims
By March 1, 2003, each district court shall adopt court rules to expedite the resolution of an action involving medical malpractice or dental malpractice.
Medical Error
Reporting
Sections 18 through 39 of AB 1 involve medical facility reporting of "sentinel events". These sections become effective July 1, 2003. These sections require funding and may well be modified in the regular legislative session, beginning February 1, 2003, before their effective date of implementation.
EXAMPLES OF THE APPLICATION OF AB 1
Example A
The jury verdict awarded the plaintiff $350,000 in future medical damages, $1,000,000 in past pain and suffering, and $4,000,000 in future pain and suffering against Dr. OB, a local obstetrician. With no limits on noneconomic damages, Dr. OB was liable for the entire amount, $5,350,000. After October 1, 2002, this verdict would have resulted in the judge reducing the award to $350,000 in economic damages plus $350,000 in noneconomic damages, for a total of $700,000 liability of Dr. OB. Alternatively, after the jury verdict, upon motion of the plaintiff, the judge could find, by clear and convincing evidence, exceptional circumstances justifying the elimination of the noneconomic damages cap; thus, Dr. OB would be liable for up to $1,000,000, Dr. OB's policy limit.
Example B
A jury awards $2,000,000 in economic damages and $1,000,000 in noneconomic damages (pain and suffering) in a medmal lawsuit. Dr. A, a trauma surgeon who saw the Medicare insured patient in a public hospital emergency room for the patient's life-threatening traumatic injury was found 50% at fault. Dr. B, a consulting internist, saw the patient after the patient was stabilized post-op, for the purpose of controlling the patient's diabetes mellitus, was found 30% at fault. Nurse J, an employee of the hospital, was found 20% at fault for the patient's injuries.
Dr. A is covered by the $50,000 total damage cap and will be only liable for that $50,000 and nothing more.
Dr. B is liable for $300,000 in noneconomic damages (30% times $1,000,000 = 300,000; noneconomic damages are severally liable only) plus up to $1,950,000 in economic damages. There is no cap on economic damages, and economic damages are Jointly and Severally liable. However, if the plaintiff demands payment of the $1,950,000 which is over Dr. B's policy limit of $1,000,000, Dr. B must pay the $1,950,000 but will not be liable for any noneconomic damages. A defendant is not liable for noneconomic damages over the defendant's policy limit. If the plaintiff demands only $700,000 in economic damages from Dr. B, Dr. B will be liable for the full $300,000 in noneconomic damages, bringing Dr. B's total liability up to Dr. B's policy limit of $1,000,000. [Should Dr. B have policy limits of $2 million/ 6 million, Dr. B would be liable to pay up to his $2,000,000 policy limits (say, $1,950,000 plus $50,000 in noneconomic damages)].
The hospital employing Nurse J is liable for $200,000 in noneconomic damages and up to $1,950,000.
Under AB1, hospitals become particularly attractive targets because hospitals usually carry higher policy limits than physicians, except if the hospital is UMC where a $50,000 sovereign immunity cap applies (not to be confused with the $50,000 total damages cap provided to physicians treating a life-threatening traumatic injury patient).
Likewise, a doctor with policy limits of $2 million/ 6 million may well be a more attractive target in a high jury award than a doctor with $1 million/ 3 million policy limits.
Example C
Dr. A, B, and C are sued for malpractice by the Estate of Doe, Doe's spouse Ellen, and children Flo and Greg. The Estate of Doe is suing for medical malpractice causing the death of Doe. Ellen, Flo, and Greg are suing under a derivative cause of action known as wrongful death.
The jury awarded the Estate of Doe $100,000 in economic damages and $1,050,000 in noneconomic damages. The jury found that Dr. A, B, and C were equally at fault.
Further, the jury awarded $1,050,000 in noneconomic damages in favor of Ellen, with each doctor being equally at fault. Similarly, the jury awarded Doe's children Flo and Greg $1,050,000 each for noneconomic damages.
The total noneconomic damages each doctor owes would be $1,400,000 since each doctor is severally liable for $350,000 to each plaintiff. However Section 5(4) of AB 1 limits noneconomic damages to the $1,000,000 policy limit of each doctor. Thus, Dr. A, B, and C would each be liable for $1,000,000. One of the doctors, or all the doctors, at the plaintiff's choice, would be liable for the $100,000 economic damages since economic damages are Jointly liable. In this situation, because the economic damages do not exceed $1,000,000, no physician will be liable for greater than his or her policy limits of $1,000,000.
If, however, one of the doctors was not carrying $1,000,000/$3,000,000 insurance, there would be no limits to that doctor's liability. The noneconomic cap limitations only apply when the physician's medical liability policy limits are at least 1 million/ 3 million.
For completeness, one should be aware that NRS 41.141, the comparative negligence statute, remains intact. That statute provides that when the plaintiff is comparatively negligent, and thus is asserted in the answer to the complaint, joint liability of health care providers is abrogated and health care providers are severally liable only, for both economic and noneconomic damages. There is no "deep pocket" when the provisions of NRS 41.141 are applicable.
The above examples are but three of perhaps hundreds of variants of the application of AB1. Accounting legerdemain may be the normal course of business for plaintiffs squeezing every dollar out of a jury verdict under our new medical liability reform laws.
Photos - Top Left: Nevada State Legislature in Carson City. Top Right: Contingency representing Clark County physicians chat with Governor Kenny Guinn outside the Legislature. Bottom Left: Assemblyman David Brown (R-22) with NSMA President Dr. Robert Shreck. Bottom Center: CCMS Office Manager Dot Freel with Governor Guinn. Bottom Right: Dr. Shreck, Assemblyman John Marvel (R-34), and CCMS CEO Dr. Don Havins. Assemblyman Marvel has introduced legislation regarding limitations on medical malpractice awards for the past three sessions but the Assembly leadership never addressed the bill.
September 3 - Primary Election Day
September 5 - International Literacy Day Dinner, New York-New York Hotel and Casino. Contact the Southern Nevada Literacy Coalition for details at 223-1200.
October 10 - Governor’s Points of Light awards dinner, Stardust Hotel and Casino. Call the Nevada Commission for National and Community Service at 888-338-9759.
November 5 - Election Day
November 16 - “Blow the Whistle On Asthma” Walk at the UNLV McDermott Center. Call 431-3590 on information about setting up teams and challenges.
Cardiovascular Consultants 691-9154
Clark County Medical Society 739-9989
Southwest Medical
Associates 242-7347
9/12 - “Clinical Pearls in Cardiology,” 7:30 a.m.
10/10 - “Headaches,” 7:30 a.m.
Sunrise Hospital 731-8210
UMC 383-2604
Valley Hospital 388-4847
9/10 - “HIV: Care and Treatment of the Hospitalized Patient,” noon
9/24 - “Heparin Induced Thrombocytopenia,” noon
Mayo Clinic 1-480-301-4580
9/12-9/14 - “Clinical Updates 2002,” Aladdin Hotel and Casino
*Special Note: CCMS members can receive free CME courses on the internet with World Medical Leaders.
To have your CME courses listed on our calendar, please contact Deborah Barton at 739-9989 prior to the deadline of the 12th of each month.
DISEASE CASES REPORTED YEAR TO DATE
7/ 2001 7/2002 2001 2002
VACCINE PREVENTABLE DISEASES
DIPTHERIA 0 0 0 0
HAEMOPHILUS INFLUENZA 0 0 2 4
(invasive)
HEPATITIS A 2 2 36 11
HEPATITIS B 3 4 19 25
INFLUENZA 0 0 28 59
MEASLES 0 1 0 1
MUMPS 1 0 2 2
PERTUSSIS 0 3 3 13
POLIOMYELITIS 0 0 0 0
RUBELLA 0 0 0 0
TETANUS 0 0 0 0
SEXUALLY TRANSMITTED DISEASES
AIDS 9 12 86 138
CHLAMYDIA 299 354 2247 2604
GONORRHEA 130 145 980 997
HIV 8 14 72 102
SYPHILIS 0 1 1 6
(Primary & Secondary)
SYPHILIS (Early Latent) 0 0 5 4
ENTERICS
AMEBIASIS 1 0 1 10
BOTULISM-INTESTINAL 0 0 0 0
CAMPYLOBACTERIOSIS 12 15 94 69
CHOLERA 0 0 0 0
CRYPTOSPORIDIOSIS 0 0 2 2
E. COLI O157:H7 0 3 2 9
GIARDIASIS 5 7 58 57
ROTAVIRUS 16 9 334 332
SALMONELLOSIS 13 14 74 106
SHIGELLOSIS 1 3 24 8
TYPHOID FEVER 0 0 0 0
YERSINIOSIS 0 0 0 0
ANTHRAX 0 0 0 0
BOTULISM INTOXIFICATION 0 0 0 0
BRUCELLOSIS 0 0 0 0
COCCIDIOIDOMYCOSIS 4 0 16 15
ENCEPHALITIS 0 1 0 2
HANTAVIRUS 0 0 0 0
HEMOLYTIC UREMIC
SYNDROME (HUS) 0 0 0 0
HEPATITIS C 0 1 0 3
HEPATITIS D 0 0 0 1
LEGIONELLOSIS 0 0 2 1
LEPROSY (HANSEN'S DISEASE) 0 0 1 0
LEPTOSPIROSIS 0 1 0 1
LISTERIOSIS 0 0 4 0
LYME DISEASE 0 0 1 0
MALARIA 0 0 1 3
MENINGITIS,
ASEPTIC/VIRAL 8 8 29 43
MENINGITIS, BACTERIAL 1 1 12 14
MENINGOCOCCAL DISEASE 0 2 4 13
PLAGUE 0 0 0 0
RABIES (HUMAN) 0 0 0 0
RELAPSING FEVER 0 0 0 0
RSV (RESPIRATORY 15 34 1259 1754
SYNCYTIAL VIRUS)
ROCKY MOUNTAIN SPOTTED 0 1 0 2
FEVER
TOXIC SHOCK SYNDROME 0 0 0 1
TUBERCULOSIS 6 3 36 31
TULAREMIA 0 0 0 0
*Numbers include confirmed and probable cases
American Association of Medical Review Officers (800) 489-1839 www.AAMRO.com
Campbell Court 364-0909
Claim Solutions of Nevada, LLC 655-1847
Clark County Credit Union 228-2228 www.ccculv.org
Comprehensive Cancer Centers of Nevada 952-3400
Datapulse (800) 627-3283 www.dpulse.com
Desert Radiologists 382-XRAY (382-9729) www.desertrad.com
Irwin Union Bank, FSB www.irwinunion.com
Jeffrey L. Burr & Associates 433-4455 www.jeffreylburr.com
Mad River Community Hospital (707) 445-4221 www.madriverhospital.com
Pfizer Labs 338-4526 www.pfizer.com
Raymond James Financial Services 383-5092 www.financialprudence.com
Shred-it 25-SHRED (257-4733) www.shredit.com
Topaz Ridge Luxury Homes – William Lyon Homes 233-6751 www.lyonhomes.com