Newsletter XXXV December 2002
Ethics And Truth In Medicine And Law
Clark County
Health District Disease Statistics – October 2002
By Weldon (Don)
Havins, M.D., Esq., C.E.O. and Special Counsel
While the cynic may disagree, doctors and lawyers do have much in common. As licensed professionals, each are bound by a social contract, known as the doctor-patient relationship or the attorney-client relationship. Basic to this contract is an obligation of trustworthiness, i.e., to serve their patients' or clients' best interests selflessly. Each are bound by traditions of "professionalism," which include obligations of placing patients' or clients' interests above self-interest, along with obligations to respect patients' and clients' privacy and confidentiality. Each are obligated to respect federal and state laws, and to be mindful of the rights of innocent third parties. Physicians and lawyers accept the duty to uphold their respective professional codes. Post-graduate educational requirements of both professions encompass at least three years, in the case of lawyers, to as many as twelve years, in the case of physicians. Each must pass arduous qualifying exams before they can practice their profession. Each must maintain and update their knowledge through on-going required education.
While physicians and lawyers both aver to the precept that they are bound by a fiduciary responsibility to their patient/client, lawyers approach their advocacy in a manner to "divorce their own sense of right and wrong from their pursuit of client objectives" and to "use all reasonable means to achieve the client's lawful objectives." 1 Physicians also pursue their patients' health interests without regard for the moral virtuousness of their patients.
Lawyers "shall not knowingly...offer evidence that the lawyer knows to be false" and a "lawyer shall not counsel a client to engage, or assist client, in conduct that the lawyer knows is criminal or fraudulent." 2 Similarly, the AMA Code of Ethics states that physicians "shall deal honestly with patients and colleagues ... [and not] engage in fraud or deception."
However, the lawyer-client relationship obliges moral, amoral and even possible immoral behavior of the lawyer. 3 As an example, in non-legal dealings, failure to disclose a material fact usually means fraud. In the context of a lawsuit, a plaintiff's lawyer has no obligation to disclose a material fact to the defendant if the defendant has not requested production of information containing the material fact. Some recognized legal tactics can hide or manipulate truth. Examples are discrediting a truthful witness, concealing evidence using the attorney-client privilege, and manipulating the context of unfavorable evidence. Contrarily, an ethical physician would not think of withholding or excluding information which could benefit his or her patient's health. Medical rules would never require such tactics. For example, the medical profession has vigorously protested the "gag" rule imposed on doctors by some HMO's that have tried to conceal beneficial but expensive treatments from patients.
Two Different Systems for Finding
"Truth"
Physicians and lawyers conduct the search for truth in quite different ways. Physicians seek to improve their knowledge (what is "true") utilizing the scientific or inquisitorial method by making and refining empirical observations. Physicians reason that the more accurate the facts, the more accurate the assessment leading to a correct diagnosis will be, thereby permitting the selection of the most effective treatment. No pertinent information is inadmissible or excludable, not even to protect the public welfare. Physicians tend to view the truth of facts concerning their patients as objective and value-free, such as the serum potassium level or the blood sugar level.
Lawyers conduct the search for truth through an adversarial system. The adversarial system assumes that truth is best served by subjective rather than objective inquiry. Lawyers contend that truth cannot be expressed as objective, indisputable facts. Disputes about facts (the truth) are resolved by allowing each side of a dispute to allege facts and argue in favor of their case, leaving judgment to an impartial judge or jury. The impartial judge or jury, after weighing the evidence presented, "finds" or determines the facts (the truth). Lawyers, as advocates, utilize their professional skills to persuade the "fact-finder" that their alleged facts are the "true" facts without regard for their personal moral beliefs.
A famous English barrister, Lord Brougham, defined the lawyer's role and methodology as follows: "an advocate, in the discharge of his duty, knows but one person in all the world, and that person is his client. To save that client by all means and expedients, and at all hazards and costs to other persons, and, amongst them, to himself, is his first and only duty; and in performing this duty he must not regard the alarm, the torments, the destruction which he may bring upon others." 4
Justifications for use of the adversarial method include: (1) the ultimate goal of law is justice rather than truth, i.e., the process can be as important as the end result; (2) since knowledge is never complete, there is always room for argument; and (3) values and rights are perceptions and cannot be uncovered by empirical methods, and are at least as important as objective truth; these intangibles are best investigated by assistance of counsel, due process, trial by jury, right to call and confront witnesses, and prevention of compelled self-incrimination. 5 Despite criticism that juries cannot scientifically evaluate matters requiring technical expertise or scientific wisdom, lawyers contend that the only legitimate way to resolve disputes is the tried and true method of adjudication in court by a jury.
Deceit, Misrepresentation, and Lying
Physicians, in the scientific tradition, aim for impartial, impersonal truth in diagnosing and treating their patients. The only desirable outcome, unless the patient knowingly chooses otherwise, is the one which will best promote the patient's health. The patient's informed choice is paramount. Scientists do not knowingly conjecture falsehoods nor use procedural rules to obfuscate and distort.
A lawyer's avowed goal is justice, not absolute truth. In civil actions, "neutral partisanship" seeks not truth, but to win. Lawyers must fulfill their duty as advocates only, and leave determination of truth to the court, not the individual lawyer. Loyalty to the client is the ethical standard governing counsel, not any obligation to tell the truth.
Legal and medical professions both expressly prohibit fraud. Each profession, however, condones at least some kinds of lying in fulfillment of their respective fiduciary responsibilities. Thirty years ago physicians felt they had a right to withhold potentially harmful information from a vulnerable patient. In recent decades, however, medical consensus has tended to discourage such deception, even for benevolent purposes. Instead of lying to the patient, some physicians more recently have used another form of deception, i.e., lying on behalf of the patient; for example, to HMO's or insurance companies when treatment denial threatens their patients' health. Many doctors consider it ethical to lie to an insurance company or HMO if patients cannot get treatment any other way.
Legal rules of professional conduct do not permit lawyers to make false statements of law or fact to tribunals (courts) or knowingly represent a client perpetrating fraud. However, as advocates, lawyers may use techniques including blocking material evidence, confounding, evading, or concealing the facts, all with the intent to deceive. Deceit may be justified by such arguments as: (1) it ensures that the defendant will get the full benefit of the legal process; (2) it protects all members of society by upholding human dignity rather than merely seeking truth; (3) our courts are not just, especially in discriminating against minorities and the poor; (4) judges are arbitrary, selfish, negligent, unfair, and autocratic; (5) the police lie; (6) prosecutors suppress evidence; (7) the adversarial process will expose the truth; and (8) our prisons are cruel and unjust punishment. 6 One famous law professor, F. S. Cohen, stated that "in a certain sense, it is true that lawyers are liars," as are poets, historians, and map makers, who do not reproduce reality, but instead "illumine some aspect of reality." 7
The Professional Doctor-Patient and
Lawyer-Client Relationship
Law and medicine share a commitment to the furtherance of self-determination, privacy and confidentiality. Such professional assurance encourages clients and patients to reveal adverse truth necessary to optimal defense (for lawyers) or health management (for physicians). It upholds the basic rights and dignity of the client or patient in time of vulnerability. Another argument, propounded by lawyers, contends that violation of confidentiality would subvert the adversarial system.
However, all jurisdictions require physicians to breach confidentiality by reporting patients with contagious diseases. Lawyers need not respect a client's confidentiality if the particular information is necessary to prevent the commission of a criminal act, or to provide a defense on behalf of the attorney as regards to a controversy between client and attorney. Although a lawyer is permitted, but not required, to violate confidentiality to protect himself or a third person (e.g., to prevent or conceal a crime or to prevent imminent death or substantial bodily harm), a lawyer has no duty to reveal that to the client. Under the new HIPAA Privacy standards, physicians must maintain, and provide to patients upon request, a log of every instance in which the patient's medical information was disclosed to a third party, including those instances where the patient authorized the disclosure.
Professional Regulation
The State Bar Association licenses and disciplines lawyers. The American Bar Association promulgates non-binding "Model" Rules and Codes regulating professional and judicial conduct. The Supreme Courts of states are free to adopt all or most of these in their Rules of Professional Conduct. Legislatures do not, generally, directly regulate the licensure or discipline of lawyers. Lawyers must be members of the bar to be licensed. All regulators of lawyers are lawyers, on the theory that "issues of professional responsibility are too complex to be left to laypeople ... ." 8
In contrast, physicians' licensure and discipline are subject to the legislatures who pass and amend the State's Medical Practice Act, and delegate to a Board of Medical Examiners the duty to implement that Act. Physicians do not have to be members of the medical society (American Medical Association or individual state societies) to practice medicine. Thus, the law, not medical authorities, controls the issuance medical licenses and is the final judge of professional conduct. It is a curiosity that the issues of professional responsibility are too complex to be left to laypeople as applied to attorneys, but not to physicians. Further, disciplinary and malpractice actions against doctors have, more and more, become a matter of public record. In contrast, admonitions against attorneys remain private in most instances.
Sex in the Doctor-Patient and the Attorney-Client
Relationship
The ABA Committee on Ethics and Professional Responsibility found sexual relations between lawyers and clients unethical, because this conduct "could lead to abuse of fiduciary obligations, impairment of independent judgment, involvement in conflicts of interest and exposure of confidential information." 9 Nevertheless, the Model Rules do not prohibit such relationships unless they harm the attorney-client relationship or if the sexual affair predated the professional liaison. Nevada has adopted this portion of the Model Rules. Some have characterized a sexual relationship with a client as "poor form," but not threatening of licensure discipline.
Sexual relations between a physician and a patient, or even a guardian or care-taker of a patient, is a violation of legislatively promulgated statutes as found in the Medical Practice Act, NRS 630. Such a violation will likely result in revocation of a physician's license.
Malpractice
Physicians fear the threat of malpractice more than lawyers do. Physicians tend to view themselves as compassionate guardians of their patients' health and they tend to identify self-esteem and reputations with good results and flawless performance. Physicians in Nevada are subject to licensure revocation for a single act of malpractice, even one where a patient has not been injured, for NRS 630 defines malpractice as a breach of the standard of care. Whether or not a physician has lost his or her license for a single act of malpractice, this statute serves as an impediment to the reporting of medical errors and to improvements in the medical care system benefiting patients in Nevada. Further, in Nevada, the standard of proof of malpractice in the context of licensure discipline, is the lower "preponderance of the evidence" standard. In the great majority of states, the standard is "clear and convincing evidence" to revoke a physician's license.
Lawyers are experts in the mechanics of malpractice actions, but most doctors do not feel at home in court. Lawyers try doctors (not the other way around) in malpractice actions on the premise that the courts are competent to determine when medical error is culpable and when patients are entitled to compensation. Because individual idiosyncrasies can never be known in advance and outcomes cannot be guaranteed, physicians believe that only they can properly judge the performance of other physicians (as lawyers believe about themselves, for reasons mentioned above).
Legal malpractice in Nevada is not even a licensure disciplinary offense for lawyers. Lawyers seem to understand that negligence is unintentional, non-reckless conduct which we are commit occasionally. Our legislators and courts somehow view legal malpractice as less onerous than medical malpractice although the unintentional conduct is essentially the same.
Fees and Fee-splitting
Both the legal and the medical professions condemn unauthorized or excessive fees. Medical ethics disagrees with legal ethics, however, regarding referral fees ("fee-splitting"). Current medical ethics regards sharing fees paid by patients as unjustified compensation, driving up the cost of medical care and encouraging patient referrals on economic rather than medical basis. Thus the American Medical Association has declared such payment as unethical. Contingent fees (conditioned on successful outcome) have also been declared unethical, although there is less universal acceptance of the prohibition currently. The AMA has expressed concern that contingency fees should be forbidden because of the danger that "the physician may become less of a healer and more of an advocate or partisan in the proceedings." 10
The lawyers Code of Professional Responsibility regards fee sharing for pure referral without performing any services as "unethical," yet payment of a professional fee for referral appears pervasive. Rule 1.5(e) of the Model Rules officially authorizes a referral fee provided the client knows and doesn't object or if the fee is "reasonable." 11 Ethical justification for legal referral fees include incentive to attorneys to refer clients with special problems to qualified specialists, and fairness to solo or small firm practitioners who do not have such specialists in their firm and would otherwise not get to share in the fee. 12 Contingent fees, too, have widespread approval in the legal system, ethically justified by arguments that they encourage clients to pursue justice in spite of uncertainty or lack of legal knowledge, motivate lawyers to advocate for poor clients thus facilitating access to legal counsel, and shift risk of an unsuccessful outcome to the attorney. 13 In countries like England and Canada, contingent fees are considered unethical and are illegal.
Summary
The medical and legal professions generally agree on what the ethical principles are (e.g., beneficence, integrity, justice), and that they ought to comply with them. The professions have distinctive different theories on the methods of discovering the truth or facts. The professions differ markedly on the ethics of fee-splitting, contingency fees, and a sexual relationship with a client/patient. The effect and significance of professional malpractice differs profoundly.
Respected law professor, Richard Wasserstrom, posits that in contrast to the physicians' scientific methodology, the adversarial system encourages the lawyer to be "competitive rather than cooperative, aggressive rather than accommodating; ruthless rather than compassionate; and pragmatic rather than principled." 14 But he asks "Why is it that it seems far less plausible to talk critically about the amorality of the doctor ... who treats all patients irrespective of their moral character than it does to talk critically about the comparable amorality of the lawyer?"
Are the ethics of one professional more moral than the other? Or are the founding principle and traditions of the respective Codes just different?
1 Luban, David, Layers and Justice: An Ethical Study in Legal
Ethics, (Deborah L. Rhode & David Luban, eds.,
2nd ed. 1995.
2 Crystal,
Nathan, Professional Responsbility, 161-163 (1996).
3 See
Luban, note 1.
4 See Luban, note 1.
5 See Crystal, note 2.
6 See Crystal, note 2.
7 Id.
8 See Crystal, note 2.
9 See Crystal, note 2.
10 Code of Medical Ethics, Principles of Medical Ethics No. II, at xiv (American Medical Association 1997).
11 See Crystal, note 2.
12 See Luban, note 1.
13 Id.
14 Wasserstrom, Richard, Lawyers
as Professionals: Some Moral Issues, 5 Hum. Rts. Q. 1, 13 (1975).
Applicants To Go Before Credentialing Committee
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
· Abdolreza Raissi, MD Orthopaedic Surgery
· Aubrey A. Swartz, MD Orthopaedic Surgery
By Warren Evins, M.D., PhD, 2002-2003 CCMS President
CCMS and CCMSA Membership Dinner
Dr. Donald J. Palmisano, MD, President-Elect of the AMA will address a Joint Membership Meeting of the Medical Society and the Medical Society Alliance on Saturday, January 11, 2003. The Alliance is planning an Award Presentation to Senator John Ensign. I hope you will attend this very important dinner. The Alliance has been a very active supporter of the Initiative, "Med Mal" and Lawsuit Reform, and the election of physician friendly candidates.
Keep Our Doctors In Nevada Initiative (KODIN)
The Initiative was filed on November 5. At the time of this column's writing, it was awaiting certification. The initiative has proposed 5 key points:
1. Limit Runaway Lawyer Fees
2. Stop "Double Dipping" (expenses already covered by others)
3. Extend Payments (paid in installments)
4. Stop Exceptions (strengthens non-economic damage award limits)
5. Create "Fair Share" Liability (not joint liability, i.e. no "deep pockets")
CCMS strongly urges all physicians to support the initiative by calling 1-888-REFORM (733676) and sending in a written endorsement to:
Keep our Doctors in Nevada
P.O. Box 50154
Henderson, NV 89016
Tax ID # 47-0889225
Nevadans Deserve the Right to Vote to Stop Skyrocketing "Med Mal" Rates. KODIN also needs financial supporters, especially as it needs to defend the initiative against expected legal challenges from the Trial Lawyers. We need to be able to add your name to our list of supporters.
2002 Election
Two physician members of CCMS have been elected to the Nevada Assembly--Garn Mabey, MD, Ob/Gyn (R Assembly District 2) and Joe Hardy, MD Family Practice (R AD 20). Two physician CCMS members supported by MedPAC lost races in assembly districts where opposition party registered voters outnumbered their party's voters. Early analysis indicate that both John Ellerton, MD Oncology (D AD 5), and Lonnie Hammargren, MD Neurosurgery (R AD15) bettered the party registration difference and had substantial independent and/or crossover votes.
The new Assembly has 22 Democrats and 19 Republicans, a gain of 4 Rep seats. The Senate has remained unchanged, with 12 Reps and 9 Dems. First term Senators elected with our support include Sandra Tiffany (R Senate District 5), Barbara Cegavske (R SD 8), Dennis Nolan (R SD 9) and Warren Hardy (R SD 12) (supported by Nempac).
MedPAC endorsed or supported one constitutional (statewide) race, 23 races for Assembly, 4 races for Senate, and 7 for judicial positions. Nempac supported 2 Congressional, 2 constitutional, and in Clark county 8 Senate and 28 Assembly candidates. All were successful except 3 Assembly and 2 judicial endorsements.
2003 Nevada Legislature
In February, 2003, the Nevada State Legislature will meet for 120 days to consider their agenda. We know that this will include new taxes needed to support governmental functions, reverse the growing deficit in state finances, and medical error reporting. We want the agenda to include solutions to the medical availability crisis affecting obstetricians, surgeons, and other physicians, the KODIN Initiative, panel inclusion fees, lawsuit reforms, fairer payment for services, etc. Doctors may be socked with a new gross revenue tax, increases in business and operating taxes, further practice restrictions, public reporting of all malpractice suits when filed, mandatory contributions to a malpractice insurance pool, etc. if some officials have their way. Your officers and staff of both CCMS and NSMA are very concerned about these issues. Your membership dues and volunteer efforts are being stretched. Our tasks are daunting! Only with our members' input, advice, lobbying and the grassroots support of the community can we hope to achieve our goals.
CCMS Mini Internship
January 13 to 16, Monday through Thursday, will be our annual outreach program for elected officials, community leaders, and media representatives. They will be able to "intern" in an interactive program with a physician and his or her patients in the office, hospital, surgical center, and operating or emergency departments. A dinner review of the encounters will follow. Please call Deborah Barton at CCMS to volunteer yourself or enroll your interested intern.
CCMSA Holiday Greeting Card Project
The CCMS Alliance requests all CCMS members to register (for a small fee) for the annual greeting card program. CCMSA will send a card with their holiday greetings to all members.
PLEASE NOTE:
We are currently updating our fax capabilities in order to better reach all members in a prompt manner. Please notify CCMS staff at 739-9989 if you do not wish to receive faxes in the overnight hours so that we can direct faxes to you during business hours.
By Karen Schroeder,
2002-2003 CCMS Alliance President
The Alliance is busy this month getting our Holiday Greeting Card Project underway. Look for information in this bulletin and mailed to your doctor’s office for specifics. This is a great way to send holiday wishes to your colleagues AND give monies to local charities. Your donation will ensure our continued commitment to the Las Vegas community.
Recently the CCMSA board of directors agreed to add a shopping mall to our website. Any purchases made through e-commerce sites at our Alliance mall from our webpage (such as Amazon, eBay, HSN, Disney store and others) will give up to 8% of net sales to the Alliance. This new fundraiser will generate monies to be used for health related charitable endeavors. Therefore, check our website www.ccmsa-lv.org for many of your shopping needs.
Mark your calendars for January 11, 2003. We will host a dinner meeting with Clark County Medical Society; “Protect Nevada Medicine”. Our featured speaker, Donald J. Palmisano M.D., J.D. is the American Medical Association president-elect. He practices surgery in Louisiana where he was instrumental in getting a tort reform bill passed in their legislature. Our purpose for the evening is to increase membership, give Senator John Ensign our “Voice of the Alliance” award for his introducing and working in the U.S. Senate for tort reform, and sending each attendee home with an action plan of what they can do to protect medicine in Nevada. We are aligning ourselves with this quote:
“Greater the numbers, the stronger the
voice, Stronger the voice, more powerful the message.”
Author unknown
All are invited to attend this dinner meeting; specifics will follow or call CCMS office at 739-9989.
Until next month, I wish all of you a bountiful Thanksgiving.
By Weldon (Don)
Havins, M.D., J.D., CCMS CEO and Special Counsel
Last month's editorial contained a material error in the discussion of the expansion of Nevada's "Good Samaritan" law by A.B. 1 of the Special Session of the Legislature. Subsection 4 of Section 1.5 was current Nevada law and was not added or amended by A.B. 1. Subsection 4 provides that a licensed physician or dentist, retired or otherwise not practicing full-time, who gratuitously renders medical care to an indigent person is not liable for any civil damages for conduct or omission amounting to less than gross negligence or reckless, willful or wanton conduct. While this sounds reasonably protective of a retired or part-time physician who desires to volunteer to provide care to our needy citizens, a problem lies in the definition and determination of an "indigent person." Indigent person is not defined in A.B. 1 and the determination of medical indigency is currently a complicated matter, as discussed in last month's editorial. If the patient is not indigent, the retired or part-time physician (who may not carry medical liability insurance) will have no protection under the law and will be subject to full liability for his or her voluntary efforts.
Subsection 5 of Section 1.5 of A.B. 1 is an addition to Nevada law. This subsection provides that any Nevada 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 omission by him in rendering that care or assistance if the care or assistance is rendered gratuitously and in a manner not amounting to gross negligence or reckless, willful or wanton conduct. There is NO REQUIREMENT OF INDIGENCY here. For example, a physician gratuitously rendered medical care to a patient at St. Rose Hospital, Boulder City Hospital, or at UMC (or one of the outlying clinics/facilities of a nonprofit organization) is protected from "any civil damages" not amounting to gross negligence. That same physician rendering the same gratuitous medical care to the same patient in one of our for-profit hospitals (or in the physician's private office) receives no protection from civil damages for medical malpractice. This law raises the question of the equal protection of laws under the 14th Amendment of the U.S. Constitution ("No State...shall deny to any person within its jurisdiction the equal protection of the laws.") . Additionally, this law raises the issue of "deep pocket" Joint Liability when a patient in a nonprofit organization is seen by one physician gratuitously and by another physician for a fee. Moreover, this law creates potential physician concern when rendering medical care gratuitously in the nonprofit organization (for example, a nonprofit hospital where protection lies under the currently law) and then following the patient after hospitalization in the physician's private office (where no protection is afforded).
Subsection 5 may be viewed as a wonderful advance in the application of the Good Samaritan law. As more and more of our Nevada citizens are unable to afford or to obtain medical insurance, medical bills will become increasingly devastating to their financial survivability. Medical care rendered gratuitously will not only be appreciated, as it is now, but will become critically necessary to maintain the health of many of our uninsured Nevadans.
As exemplified in the above hypothetical, the direct effect on a physician rendering gratuitous medical care in the nonprofit and in the for-profit organization is the same - no remuneration expected or received. The indirect effect of rendering such medical care gratuitously is that the physician incurs no significant liability for damages at the nonprofit organization compared to being subject to potentially devastating personal liability at the for-profit organization, including the physician's office. Would it not be more fair, practicable, and reasonable to apply the same standard of liability to all providers of health care rendering professional services gratuitously?
Considering such a change in our statutes, some attorneys would argue that public policy, as well as the Nevada and U.S. Constitution preclude the state from stripping an injured patient of his or her right to seek financial redress for negligently caused injury. Others would argue that such a law would be rationally related to a legitimate governmental interest of encouraging the provision of free medical care to the uninsured by licensed health care professionals. Ultimately, our courts decide the Constitutionality of such laws.
Inducing legislative enactment of a law providing for protection from any civil damages for licensed health care professionals rendering medical care gratuitously lies, of course, with our elected Legislators and our Governor. There are many new and established Legislators who would see the wisdom and compelling public policy benefits of such an expansion of the Good Samaritan law. The Majority Leader of the Senate, Senator Bill Raggio (R), and the Majority Leader of the Assembly, Assembly-woman Barbara Buckley (D) are brilliant attorneys with profound knowledge of law and of legislative legerdemain, whose efforts expanded the Good Samaritan law.
They will defend this amended law and we will support them.
Uninsured patients often seek medical care in expensive, tax dependent public facilities, such as UMCs' emergency room, simply because they cannot afford medical care elsewhere and they know they will receive "free" medical care at that facility. The Nevada taxpayer serves as the payor of last resort. There are no "free" medical costs. If the leadership of both Houses and a sufficient number of Legislators, along with the Governor, conclude that such a law will reduce pressure on our scarce tax resources, expansion of Nevada's Good Samaritan law will become a possibility. Such a law would be easily interpreted by health care providers: medical services rendered gratuitously receive substantial liability protection; medical services rendered with an expectation of remuneration are not so protected.
Perhaps a bill containing legal malpractice protection for attorneys rendering pro bono services would make expansion of the Good Samaritan law more palatable.
January 11
· ‘Protect Nevada Medicine’ Dinner at the Monte Carlo featuring speaker Donald J. Palmisano, MD, President-elect of the American Medical Association. Call 739-9989 for information.
January 13 to January 16
· CCMS Mini-Internship Program. Please call Deborah Barton at 739-9989 for details.
March 7 to March 8
· Nevada Board of Medical Examiners meeting at Embassy Suites on Paradise Rd. in Las Vegas.
· CLOSING OFFICE: (12-31-02) Medical/Office Equipment/Funtinture for sale. Wooden treatment tables - 1 with stirrups, goose neck lamps, physician’s scale, professional and utility stools, chrome paper towel dispensers, IV stand, etc. Call Dr. Lee or Carol 384-4540.
· ESTABLISHED INTERNAL MEDICINE Practice for sale. Call 204-8109.
· FOR SUBLEASE - Summerlin Medical Center Convenient first floor suite includes 6 exam rooms - 3 furnished, 2 empty, 1 procedure room, and 1 extra Dr.’s office. Over 2500 sq. ft. All brand new furniture & medical equipment. Call Esther at 304-0800.
· EQUIPMENT WANTED: Nevada Coalition Against Sexual Violence seeks a used exam table with stirrups/good condition. Tax deductible. Contact Jodi Tyson (702) 940-2033.
· 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 (702) 459-5500.
· GYN WANTED TO SHARE VIP OFFICE in Green Valley by Anthem/Seven Hills. Office & exam rooms at minimal cost -- in truly elegant setting. Ideal for new practice or to lower overhead costs. Call 419-8256.
· FOR LEASE - MEDICAL OFFICE Del Webb Medical Plaza in Green Valley. Approx. 2335 sq. ft., turn key with four exam rooms, one procedure room, and nice decor. Call Connie at 702-951-0770.
· OFFICE SPACE AVAILABLE at St. Rose Siena Campus Del Webb Medical Plaza. Seeking a second physician to share 2000 sq. ft. office. Please call Patricia at 260-7707.
· MEDICAL OFFICE SPACE For Lease/Time Share - New building, ready to move in, fully furnished, approx 1200 sq. ft. on a busy street in Green Valley, ideal for pediatric subspecialties. Call Sherrie 898-6400.
· PLACE YOUR AD IN COUNTY LINE. Members receive a 40 word ad for FREE! Call Deborah at 739-9989 for details and rates.
Cardiovascular Consultants 691-9154
Clark County Medical Society 739-9989
Future Programs Planned:
Southwest Medical
Associates 242-7347
Sunrise Hospital 731-8210
UMC 383-2604
Valley Hospital 388-4847
*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
10/2001 10/2002 2001 2002
VACCINE PREVENTABLE DISEASES
DIPTHERIA 0 0 0 0
HAEMOPHILUS INFLUENZA 0 3 3 8
(invasive)
HEPATITIS A 1 2 44 19
HEPATITIS B 2 5 30 38
INFLUENZA 0 0 28 59
MEASLES 0 0 1 1
MUMPS 0 1 3 4
PERTUSSIS 1 0 4 22
POLIOMYELITIS 0 0 0 0
RUBELLA 0 0 0 0
TETANUS 0 0 0 0
SEXUALLY TRANSMITTED DISEASES
AIDS 30 31 146 221
CHLAMYDIA 356 398 3379 3785
GONORRHEA 146 189 1508 1447
HIV 35 16 126 150
SYPHILIS 1 0 3 7
(Primary & Secondary)
SYPHILIS (Early Latent) 0 2 5 6
ENTERICS
AMEBIASIS 0 4 3 18
BOTULISM-INTESTINAL 0 0 0 0
CAMPYLOBACTERIOSIS 6 13 118 101
CHOLERA 0 0 0 0
CRYPTOSPORIDIOSIS 0 0 4 2
E. COLI O157:H7 1 2 6 13
GIARDIASIS 15 18 111 94
ROTAVIRUS 35 8 411 345
SALMONELLOSIS 4 18 114 154
SHIGELLOSIS 2 0 53 27
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 6 22 35
ENCEPHALITIS 0 0 0 2
HANTAVIRUS 0 0 0 0
HEMOLYTIC UREMIC
SYNDROME (HUS) 0 0 0 0
HEPATITIS C 0 0 0 3
HEPATITIS D 0 0 0 1
LEGIONELLOSIS 1 1 4 4
LEPROSY (HANSEN'S DISEASE) 0 0 1 0
LEPTOSPIROSIS 0 0 0 1
LISTERIOSIS 1 0 5 0
LYME DISEASE 0 0 2 0
MALARIA 1 0 3 3
MENINGITIS,
ASEPTIC/VIRAL 12 9 64 84
MENINGITIS, BACTERIAL 2 1 17 21
MENINGOCOCCAL DISEASE 0 0 6 14
PLAGUE 0 0 0 0
RABIES (HUMAN) 0 0 0 0
RELAPSING FEVER 0 0 0 0
RSV (RESPIRATORY 44 73 1342 1902
SYNCYTIAL VIRUS)
ROCKY MOUNTAIN SPOTTED 1 0 1 2
FEVER
TOXIC SHOCK SYNDROME 0 0 0 1
TUBERCULOSIS 7 5 60 50
TULAREMIA 0 0 0 0
(MICROSPORDIA SPP.) N/A 1 N/A 1
REPORTED AS UNUSUAL ILLNESS
*Numbers include confirmed and probable cases
Campbell Court 364-0909
Clark County Credit Union 228-2228 www.ccculv.org
Colonial Bank 304-3716 www.colonialbank.com
Conomikes 800-421-6512 www.conomikes.com
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
KUNV 91.5 FM 869-6623
Medical Association of Billers 240-8519 www.e-medbill.com
Nevada State Bank 631-7962 www.nsbank.com
Norfolk Medical Group 888-808-6690 www.nmhs.org
Raymond James Financial Services 383-5092 www.financialprudence.com
Shred-it 25-SHRED (257-4733) www.shredit.com
WestPark Plaza Rainbow Complex 250-9305