Newsletter XXIX June 2002
Nevada Chief Justice changed by humanitarian experience in Haiti
Messenger Model IPA Guidelines
Applicants To Go Before Credentialing Committee
John A. Ellerton, MD, CM FACP – Candidate for Assembly District 5
Joe Hardy, MD – Candidate for Assembly District 20
R. Garn Mabey, MD – Candidate for Assembly District 2
CLARK COUNTY HEALTH DISTRICT DISEASE STATISTICS APRIL 2002
By Jeff Rogers for
the Shearing-Westfield Eye Institute
Nevada
Supreme Court Chief Justice Bill Maupin returned to
Although he
comes from a long line of physicians and had considered a medical career,
Justice Maupin broke with tradition as a young man to pursue law after hearing
an attorney deliver an inspired speech about the legal profession. Now, after
years of representing doctors and hospitals before serving as a judge, Justice
Maupin has a new appreciation for doctors, nurses, and medical technicians
after working with them in incredibly unfavorable conditions.
"I
believe this mission exemplifies what American doctors do for people every day
throughout the world," Justice Maupin said.
And
although he said nothing anyone told him to expect could have prepared him for
the emotional, physical, and psychological events of the trip, he will never
forget the positive and powerful impact American medical professionals,
including several from
"Hundreds
of people who were blind or visually impaired would arrive, be seen by these
hardworking doctors, and when they would leave … they could see. It was a
miracle," Justice Maupin said. "I am so fortunate that I was able to
play a small part in this majestic effort. I consider it one of the most
important things I have ever gotten to do."
Justice
Maupin had asked his friend Dr. Kenneth Westfield, medical director of the
Shearing-Westfield Eye Institute, if he could help by joining the doctor on one
of the missions several years ago. This was the first year Dr. Westfield agreed
to allow Justice Maupin to join himself, Dr. Tyree Carr of the Nevada Institute
of Ophthalmology, and Frances Gonzales, RN, of the
"Dr.
Westfield has been a close friend for years," Justice Maupin said.
"We are now a lot more than that; we're a family."
According
to Dr. Westfield, Justice Maupin quickly proved he was up to the task. He
checked the intraocular pressure for well over 600 people and stood in on a few
of the 70 surgeries performed in over four days. Justice Maupin adds that while
he had never poked anything in a person's eye before, he eventually became
comfortable with performing the procedure. In fact, according to Justice
Maupin, it was the human interaction between the team and their patients that
made the deepest impression on him.
"When
a language barrier prevents you from understanding why a blind, elderly woman
suddenly becomes terrified, you realize how much of the medical profession is
about true compassion," Justice Maupin said. "Then you learn that the
woman is afraid the doctors are going to take away her eyes, and it hits you.
Some of these people have never been seen by a doctor before. In my opinion,
every medical person who was there - from
Armed with
only two medical suites of equipment brought with them from the United States
and working in a hospital that Justice Maupin describes as new, but not modern
(defined as "new" 100 years ago), they worked diligently to see as
many people as possible while calming the understandable anxieties. All too
common were the reminders of how impoverished and isolated the people of Lascahobas are: a boy with a juvenile cataract, one of
several children his family picked to make the trip, which Justice Maupin will
never forget.
"It is
still an emotional experience when I think of the faces, their desperation to
receive help, yet visible fear of the unknown," Justice Maupin said.
"And then you realize doctors deal with this every day - not just in
Five
hundred pairs of eyeglasses. Twenty-five hundred
prescriptions. A handful of medical personnel.
And one Nevada Supreme Court Chief Justice who followed the advice of the
people he bonded with during the mission: wait a few weeks before you decide
whether or not to return next year. A week ago, Justice Maupin called Dr.
Westfield to tell him that he would not miss it for the world.
The Shearing-Westfield Eye Institute has already begun collecting eyeglasses for next year's mission. To donate eyeglasses, contact Sandi Zenhari, Practice Development Coordinator, at 702-362-3937, ext. 238.
By Weldon (Don)
Havins, MD, Esq and Kelly Testolin,
MBA, Esq
A group of
Because
other specialties and physician groups may also consider forming or
participating in similar model IPAs, a few words
about the rules under which Messenger Model IPAs
function may be prudent. One of the few
available, detailed definitions of a "messenger model" IPA was
provided by the U.S. Department of Justice, Antitrust Division, in a stipulated
judgment in the case of United States v. Health Care Partners, Inc., reported
in the Federal Register, Vol. 60, No. 192, Wednesday October 4, 1995 at page
52014. The federal register may be found
using, among others, the findlaw web site at: www.findlaw.com Look under "Laws: Cases and
Codes", click on "Federal Register" under U.S. Federal Laws,
check the 1995 box (Volume 60) and enter the search terms "messenger
model" to find the above named case for the complete discussion.
The FTC and
DOJ state that "messenger model" means the use of an agent or third
party to convey to payers any information obtained from individual providers
about the prices or other competitive terms and conditions each provider is
willing to accept from payers, and to convey to providers any contract offer
made by a payer, where each provider makes a separate, independent and
unilateral decision to accept or reject a payer's offer. The information on prices or other
competitive terms and conditions conveyed to payers is obtained separately from
each individual provider, and the agent or third party does not negotiate
collectively for the providers, disseminate to any provider the agent's or
third party's or any other provider's views or intentions as to the proposal,
or otherwise serve to facilitate any agreement among providers on prices or
other competitive terms and conditions.
The agent
or third party (messenger), acting consistently with the above rules, may:
(1) Convey to a provider objective
information about proposed contract terms, including comparisons with terms
offered by other payers;
(2) solicit clarifications from a
payer of proposed contract terms, or engage in discussions with a payer
regarding contract terms other than prices and other competitive terms and
conditions, except that the agent or third party
(a) must
tell the payer that the payer may refuse to respond or may terminate
discussions at any time and
(b) may
not communicate to the providers regarding, or comment on, the payer's refusal
to offer a clarification or derision not to enter into or to terminate
discussions except to providers who requested the clarification;
(3) convey
to a provider any response made by a payer to information conveyed or
clarifications sought;
(4) convey
to a payer the acceptance or rejection by a provider of any contract offer made
by the payer, and
(5) upon
the written request of a payer, provide the individual response, information,
or views of each provider in the IPA concerning any contract offer made by such
payer.
Additionally,
the agent or third party must communicate each contract offer made by a payer
unless the offer is the payer's first offer and lacks material terms such that
it could not be considered a bona fide offer, or the agent or third party
applies preexisting objective criteria, not involving prices or other
competitive terms and conditions in a nondiscriminatory manner (for example,
refusing to convey offers of payers whose plans do not cover a certain minimum
number of people or offers made after the agent or messenger has conveyed a
stated maximum number of offers for a given time period).
The critical feature of a properly devised
and operated messenger model is that individual providers make their own
separate decisions about whether to accept or reject a purchaser's proposal,
independent of other physicians' decisions and without any influence by the
messenger. The messenger may not
coordinate individual providers' responses to a particular proposal,
disseminate to physicians the messenger's or other physicians' views or
intentions concerning the proposal, act as an agent for collective negotiation
or agreement, or otherwise serve to facilitate collusive behavior. The proper role of the messenger is simply to
facilitate the transfer of information between purchasers of physicians'
services and individual physicians or physician group practices and not to
coordinate or otherwise influence the physicians' decision-making process. For example, it would be a violation of
federal law for the messenger to select a fee for a particular procedure from a
range of fees previously authorized by an individual physician, or to convey
collective price offers from physicians to purchasers, or to negotiate
collective agreements with purchasers on behalf of physicians.
The
messenger may convey to a physician objective or empirical information about
proposed contract terms, convey to a purchaser any individual physician's
acceptance or rejection of a contract offer, canvass member physicians for the
rates at which each would be willing to contract even before a purchaser's
offer is made, and charge a reasonable, non-discriminatory fee for the
messenger's services.
In short, a
messenger model IPA is not a vehicle to avoid the prohibitions of the Sherman
Act, the Clayton Act, or the FTC Act.
Collusive acts, conspiracy to restrain trade, or actions such as
boycotts are violations of federal law.
Two recent
examples of impermissible messenger model actions, one in
In
The DOJ found that the messenger's
activities constituted illegal joint negotiations, and illegal boycotts or
threats of boycotts. Joel Klein,
Assistant Attorney General for the DOJ's Antitrust Division stated, we are resolved "to stop illegal joint negotiating
and boycotts by physicians. We will take action to stop illegal boycotts that
ultimately increase the prices consumers pay for health care." The Federation and its participants agreed to
cease the illegal activities and, fortunately, were not required to pay any
fees or fines.
The
messenger agent for the Delaware Federation of Physicians and Dentists
attempted to negotiate fees with Blue Cross and Blue Shield of Delaware (Blue
Cross). When Blue Cross declined to deal with the agent, the Delaware
Federation increased its efforts to persuade doctors to deal with Blue Cross
only through the Delaware Federation organization. Ultimately all member orthopedists terminated
their contracts with Blue Cross. The DOJ charged that the Delaware Federation
misused a "messenger" arrangement to facilitate illegal collusion by
doctors to maintain high fee levels.
In both of
these cases, the DOJ admitted that a "messenger-model" arrangement,
when implemented with adequate safeguards, may aid in the transmission of
information between health insurance plans and doctors. The streamlining of transmission of information
between plans and providers may ultimately benefit consumers, the DOJ
stated. However, a
"messenger-model" may not be misused to strengthen the bargaining
power of those it serves, and its activities may not rise to the level of
illegal joint activity or boycotts.
In 1996,
the DOJ and FTC issued Antitrust Guidelines for physician networks utilizing
messengers; specifically:
(1) Messenger of the network, not
affiliated with any participant, obtains from each participant a fee schedule
or conversion factor that represents the minimum payment that participant will
accept from a payor. The Messenger is authorized to
contract on the participants' behalf with payors
offering prices at this level or better. The Messenger does not negotiate
pricing terms with the payor and does not share
pricing information among competing participants. Price offers that do not meet
the authorized fee are conveyed to the individual participant.
(2) The same as (1), above, with
the added feature that the Messenger is authorized, for a specified time, to
bind the participant to any contract offers with prices equal to or better than
those in a contract that the participant has already approved.
(3) The same as (1), above, except
that, in order to assist payors in developing
contract offers, the Messenger takes the fee authorizations of the various
participants and develops a schedule that can be presented to a payor showing the percentages of participants in the
network who have authorized contracts at various price levels.
The Guidelines warn against the
sharing of fee-related information among the participants. The key issue in any
"messenger-model" arrangement is whether the arrangement creates or
facilitates an agreement among competitors on prices or price-related
terms. The Guidelines also present the
following example of a "messenger-model" function that the DOJ and
FTC view as a "per se unlawful price agreement:
The agent
is hired to negotiate with payors on behalf of the
participants. The agent does not disclose to the payor
the prices the participants are willing to accept, but attempts to obtain the
best possible prices for all of the participants. The resulting contract offer
is then relayed to each participant for acceptance or rejection.
The
"messenger-model" approach is sometimes used as a transition model,
as IPA's move toward capitation and other risk-sharing
arrangements. An IPA whose participants
share financial risk has a great deal more flexibility under the DOJ and FTC
Guidelines for sharing of information and negotiating, as a group, with payors. However,
such IPA's
usually face much more significant size limitations (e.g,
the number of participating providers) than do "messenger-model"
IPAS. Many mature IPAs
continue as "messenger-model" entities, finding this model produces
acceptable results.
Given the DOJ's and FTC's active scrutiny of "messenger-model" type arrangements, it is crucial that messenger model IPAs comply with the guidelines. It appears the DOJ will actively enforce antitrust laws when "messenger-model" activities are used, or are perceived to be used, as a shield for unlawful collusive behavior.
By Raj Chanderraj,
M.D., 2001-2002 CCMS President
The Malpractice Liability Coverage
affordability crisis is growing and has come to directly affect patient care.
Although the Obstetricians and Gynecologists are in the forefront, we will soon
see the
The past year has been very
turbulent for physicians. There are several physicians whose lives have been
affected adversely by the present crises. We empathize and feel for them and
their families. But out of this tragedy, a sense of unity among the physicians
has emerged and hopefully will gain momentum and gather strength that will
enable us to achieve our goals with Malpractice Liability, Reimbursement, and
Health Care to our patients. I think the present situation should be used as a
catalyst for all of us to shred our reluctance to participate in the democratic
process of our community and take an active role in becoming the architects of
our own destiny. There are still significant numbers of us who are constantly
critical of the leadership. I ask of them to help if you can and contribute to
our growth by participating in Organized Medicine, rather than being a
hindrance.
My term as the President is
complete. I hope I lived up to your expectations. I am sure my successor, Dr. Evins, will continue to lead us through these turbulent
times. I thank you all, especially the board members, committee chairs and
members, for your contributions to help me fulfill my responsibilities. I am
grateful for Dr. Havins' valuable assistance and guidance. I deeply appreciate
the assistance of Dot … and Deborah … at the Medical Society, without whose
help my ability to function would have been severely limited.
Good Luck and Best Wishes.
If you have any pertinent information
about the following membership candidates, please contact:
Paul Casey, MD Ophthalmology
Carlos W. DeAraujo, MD Oncology/ Hematology
Syed Akbarullah, MD, Internal Medicine, 7200 Cathedral Rock #140, Las Vegas, NV 89128
Marsha Matsunaga-Kirgan, MD, Ob-Gyn, 2040 W. Charleston Blvd. #200, Las Vegas, NV 89102
Lisa Roberts, MD, Ob-Gyn,
Jerome Ziarko, DO, Family Practice,
HOPEFULLY AWAKENED
The significance of March 4th
remains unclear in the minds of many physicians in
What is he talking about?
This was the first trip for many
physicians to the legislative hearing rooms and their first opportunity to
observe governmental processes in action.
I hope they do not forget these lessons and will answer the call during
the legislative session.
But most of all this is our
opportunity to develop, advocate, and participate in fundamental reforms in the
health care system. Many of the
solutions needed will have to be national, but the
ideas, the laboratories to test them; the nidus for
development can be our efforts in the state.
Tort reform goes without
saying. But this reform does not stand
alone. It must be part of a bigger
effort to make our health care system better.
Insurance reform, both in relation to malpractice and health insurers,
must be pursued. Medical error reporting
programs must be developed, and advocated, by the medical community. Medicaid reform, ideas to improve nursing
education and alleviate the shortage, and improvements in public and mental
health programs, must all be part of our efforts.
These times have created a special
opportunity for physicians to work together.
This cooperation is necessary for and essential to the success of our
effort.
While we work on our specific
concerns, we must not be ignorant of the general problems of our local area,
many of which are related to the continuing population influx. In fact, I believe that many of our problems and
our patients' problems are one of the effects of this sustained growth. Physicians are impacted by much of what is
accomplished in the legislature. Once
more, we are presented with an opportunity; to be involved in the political
system as it affects everyone's lives.
We must not abandon our role in keeping
Ours is a privileged position. We must use that privilege to maintain the
joy that is medicine. We must use that privilege to advocate for our patients
and for our society, to ensure the best health care for all citizens.
Hopefully we are awakened to the process. Hopefully we are awakened to the opportunities. Hopefully we are awakened.
Contributions:
John Ellerton for State Assembly
IT'S A RACE AND I'M RUNNING
Assembly
District 20 is newly created by reapportionment. It consists of the River
Cities from
I was
elected to the City Council of Boulder City 3 years ago. I currently serve as
the mayor pro tem of
As
physicians, we are not alone in this insurance dilemma. Contractors and
business owners are our natural allies for tort reform. The insurance companies
themselves are worried as their claims have increased without the premiums to
support them. Our litigious society has discovered the legal lottery. Jury
awards need to be reigned in by regulation. Parameters that will help the
injured without putting people at risk of losing their physicians are urgently
needed.
As
physicians, we have been trained to ferret out the best way to solve problems.
Feeling that others will obviously agree with us, we give them the option to do
what we suggest. We are taken aback when they choose a different course.
Right now,
we are in a battle of words and opinions that won't be won just because we are
right. We must play the "political game." We must ask each and every
candidate or incumbent specifically on each and every point how they will vote.
We, as physicians, must tell them our opinion and why. We must either sway them
to commit to vote for global and specific tort reform or tell them we will
campaign with money and man-hours for someone who will. We must become
individually and collectively lobbyists. We then must tell our patients to do
the same by putting in their hands letters to be sent or phone numbers to call.
This
legislative session is critical to accomplish all that we can in the way of
tort reform. People are on the side of the doctors. We must focus on the
reality that this is an issue of providing access to care, not to protect the
doctors' alleged lifestyle. We lament the woes of mothers, children and trauma
patients. Our hands, trained to heal and to comfort, are shackled with the
financial fetters of insurance payments.
As a native
Contributions:
Elect Joe Hardy
1357
When I
first announced that I was running for the Nevada Assembly, people would ask me
why. The main reason is that I truly feel I can make a difference and that I
represent the ideals and values of those people who live in Assembly District
2.
I was
fortunate to have had a great childhood. My father was a family physician in a
small town in
One of my
other heroes was a neighbor. His name was Melvin Hammond. He served in the
Idaho State Legislature for years. I was close to his family since his
daughters were my age. He left a lasting impression on me concerning the
importance of public service.
Since our
city was small, I had many opportunities to shake hands with the Governor,
After high
school, I attended college, which was interrupted by a two-year mission for my
church to
I feel
confident that I will win my race. Politics is harder than I thought. I feel
like I am in my residency again - the days are long and there is always
something to do. I have already knocked on many of the doors of those who live
in Assembly District 2. Asking for political donations is still awkward. Still,
I am enjoying the experience and it truly is fun.
Therefore,
what will I do when elected? I certainly will do my best to make medical tort
reform a reality. It will not be easy. Nevertheless, without it, many
physicians will leave. As I have walked and talked with people, I sense that
the public is supportive of physicians like never before. The attitude that we
are a group of rich people just watching out for ourselves is fading. In my
opinion, there will be meaningful tort reform.
There will
be other important issues. I personally hate the way the Medicaid system works
now and I will do my best to change it. Taxes will be discussed. As our state
grows, so does our budget. Our state needs to provide basic functions, but I am
not one who enjoys paying taxes so my vote will be to keep it to a bare
minimum.
I
anticipate a tough primary but I will prevail and next year at this time, you
can call me in
Contributions:
R. Garn Mabey, M.D.
By Benjamin H. Venger, MD, FACS, The
Dear Mr. Myers,
We of the
medical community appreciate your recent guest column in the Clark County
Medical Society County Line. Your
thoughts on the Malpractice Insurance Crisis, which threatens every resident of
The Problem
I cannot
address the underwriting policies of
Yes, an
exodus of physicians will occur, while others are forced into early
retirement. Unlike the laws of supply
and demand, the fewer remaining doctors cannot raise their fees to compensate
for the hypothetically increased demand.
In reality, we face regular reductions in our compensation. That, coupled with the increased cost of our
overhead (part of which now includes increased Malpractice insurance rates, and
an additional lump sum payment for tail coverage), has made it more difficult
for the remaining doctors to keep their doors open. Currently, the situation has also made the
recruiting of new talented physicians to our community more complicated, and in
some cases impossible, to meet the demands of one of the fastest growing
regions in our nation.
The Medical-Legal Screening Panel
What about
frivolous lawsuits? No one disputes that
they exist, and add cost to both the medical liability milieu and the
courts. Recent articles in the newspaper
have suggested that Malpractice insurance carriers have not settled cases in a
timely manner before trial, and then incur a greater award being levied by
jury. Who determines what is real malpractice versus non-meritorious allegations? Perhaps when NMILC existed, the medical legal
screening panel (comprised of three physicians and three lawyers, all with an
equal vote) made decisions that carried some weight within the judicial
system. Weakened by legal challenge, the
panel is now merely a formality on the road to jury trial.
Even the
composition of the panel remains suspect.
Can a dermatologist, pediatrician, or family physician determine if some
error in judgment was made addressing complex questions of management in
dissimilar fields (such as Neurosurgery)?
Although a doctor can go to the medical library and research a topic,
should that suffice for a residency in a specific specialty and years of
clinical practice?
What really
is the role of the attorneys on the panel?
Many of the "Medical Malpractice" weekend courses and seminars
I see advertised in the legal journals and like publications barely scratch the
surface of the rapidly advancing body of medical knowledge. The majority of the
time spent in panel deliberations of malpractice is not questions of error,
timing of intervention, etc. Rather, it
is spent trying to explain the medical issues in layman terms to the attorneys
assigned to the case. The cases become
backlogged. Some panels have had to set
a time limit to decide whether a case has merit or not. Is this fair to the accused physician or
plaintiff? What if juries had only a
certain time to render a verdict?
By the way,
it would be interesting if I could serve on many of the panels and oversight
committees of the Nevada Bar. As a novice to the legal field, I would find the
"education" fascinating. Of
course, not being formally trained in or practicing law, I am relatively
unfamiliar with the complexities of the
To what
degree should my amateur input weigh in assessing allegations of legal
negligence, when a lawyer's reputation, future practice and malpractice
premium, hang in the balance? Perhaps
the role of the lawyers on the medical legal screening panel could be, to
decide what sanctions or fines should be assessed against attorneys who file
frivolous lawsuits, or just "sue everybody" without taking the time,
effort, or money, to determine who is at fault.
Dr. Rotten Apple
I am in a
unique position to address the problem of Dr. Rotten Apple. Although not a Neurosurgeon, Dr. Rotten Apple
practiced spine surgery, as do my Neurosurgical collegues
and I. Dr. Rotten Apple began as a
doctor in training for a large group of spine surgeons in
Dr. Rotten
Apple and colleagues then opened a "branch office" in
The answer
is through referrals by some attorneys who shared Dr. Rotten Apple's vision of
financial reward. Through frequent
poorly planned surgeries, numerous repeat procedures for dubious indications or
for complications, and of course through inflated medical charges, Dr. Rotten
Apple's compensation and that of his legal supporters grew. He soon thereafter
left
The problem
of Dr. Rotten Apple became obvious to our medical community, especially those
who practice spine surgery. Many,
including myself, complained through the established channels of hospital
committees and medical societies and boards.
The result: highly paid attorneys attacking those practitioners who were
concerned enough to speak out. When
threatened with litigation myself, I consulted Mr. Neil Galatz,
the same attorney whom you praised in your letter. Mr. Galatz's advice
to me was that unless I was willing to spend considerable time, effort and my
personal money, with the risk of punitive damages, I should stop all efforts to
spotlight Dr. Rotten Apple.
For nearly
six years Dr. Rotten Apple became one of the busiest spine surgeons in
Care to help in the solution?
You have
suggested that physicians "ban together as a critical mass" to
address the Malpractice Crisis. Perhaps
we could take the lead from the Nevada Trial Lawyers Association (NTLA). Your organization seems to now have also
banded together, to attempt to assure that along with a right to health care,
patients also have the greatest latitude and of course the opportunity, to
sue.
There is
one thing I do not see happening however.
The NTLA is quick to point the finger at insurance companies, hospitals,
physicians, and anyone but themselves.
The NTLA and its members must also accept some responsibility for Dr.
Rotten Apple, as well as our current Malpractice mess. You and your colleagues must offer to be part
of the solution. Without this, any
attempt to mitigate the crisis, and prevent a recurrence, will fail.
To compare
the situation today with the "Malpractice Crisis" of the mid-1970s is
ludicrous. Even adjusted for inflation,
malpractice rates then were a fraction of what is proposed now. In the 1970s physicians, not managed care,
directed and determined how patients would be treated. Medicare and Medicaid had just begun, and
were well financed by the government.
Now
compensation from these federally regulated programs has dropped to the point
that many physicians will no longer accept new patients enrolled in either, or
are of an age that they would be so insured within the near future. This is not to mention the rising costs
office staff (including those hired just to fill out the mountains of paperwork
and forms generated by managed care and the Medicare/Medicaid programs),
increased rent and other fixed expenses, and the many credentialing fees (some
as high as $300 per physician annually for each separate insurance company)
that we are forced to pay to just participate in an insurance plan, with no guarantee
of any patients. All of these, along with the cost of malpractice insurance,
are now mandatory to allow a doctor the opportunity work for less overall money
each year.
Now you
propose we "form our own insurance company" as the solution to the
problem. I will admit that your
suggestion has merit. This however is a
complicated and expensive undertaking.
The Governor has offered a temporary plan as a stopgap measure. Other more permanent plans are on the drawing
board, but they really do not substantially lower our annual premiums. Few, if any, address the lump sum tail
coverage (some well into six figures) each physician may need to pay to protect
his or her personal assets, and retirement savings, from lawsuits yet to be
filed in the interim. Furthermore, there
is talk of an additional assessment for "start-up fees" for such a
company. We as the insured physicians
have been asked to cover this also.
Retaining
and recruiting competent and responsible physicians is paramount to the health
care of
Without
question, this community has well intentioned, talented, and honest
representation, on both the plaintiff and defense bars. Mr. Myers, I would offer you or any of your
colleagues, a seat at the table if you are willing to meaningfully contribute
to a solution. It is time for the best
of the legal profession to step forward and work jointly with us, rather than
against us, to facilitate an end to this crisis. There is too much at stake here, for our
families, our community and state, and for ourselves. We cannot allow a rotten apple from any
barrel to ruin the entire crop.
Dr Venger
is a board certified Neurosurgeon whose family has resided in
President Elect – Edwin Kingsley, MD Oncology
Secretary – Kevin Hyer, MD Diagnostic
Radiology
Delegate Chair –
Trustees
Michael Colletti, MD Rheumatology
Michael Gross, MD Nephrology
Jerry Jones, MD Ob-Gyn
Eugene Speck, MD Infectious Disease
David Steinberg, MD Radiology
Nominating Committee
Richard Diskin, DO Dermatology
Raj
Howard Hoffman, Jr., MD Pathology
Raul Meoz, MD Radiation Oncology
Frank Nemec, MD Gastroenterology
Ronald Slaughter, MD Pathology
Cardiovascular
Consultants 691-9154
Southwest Medical
Associates 242-7347
Some courses also approved for nursing CEUs.
6/13 - “Geriatrics in Primary Care,”
6/19 - “Ethics of End of Life Care,”
7/11 - “The Gastroenterologist and Primary Care
Partnership,”
UMC 383-2604
6/11 - “The Use of Intravenous PPI’s,”
6/25 - “Update on Asthma,”
7/9 - “Vaginal Births After Cesarean Sections(V-Bacs),”
7/23 - “Making the Valley Hospital Web site Work For You and Your Patients,”
*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
4/
2001 4/2002 2001 2002
VACCINE
PREVENTABLE DISEASES
DIPTHERIA 0 0 0 0
HAEMOPHILUS
INFLUENZA 0 0 1 3
(invasive)
HEPATITIS A 1 0 29 9
HEPATITIS B 2 5 11 12
INFLUENZA 0 6 28 57
MEASLES 0 0 0 0
MUMPS 1 1 1 1
PERTUSSIS 0 0 1 0
POLIOMYELITIS 0 0 0 0
RUBELLA 0 0 0 0
TETANUS 0 0 0 0
SEXUALLY
TRANSMITTED DISEASES
AIDS 19 28 60 82
CHLAMYDIA 311 436 1255 1546
GONORRHEA 150 153 564 544
HIV 10 27 40 56
SYPHILIS 0 3 1 4
(Primary & Secondary)
SYPHILIS
(Early Latent) 2 0 5 3
ENTERICS
AMEBIASIS 0 2 0 7
BOTULISM-INTESTINAL 0 0 0 0
CAMPYLOBACTERIOSIS 10 12 41 32
CHOLERA 0 0 0 0
CRYPTOSPORIDIOSIS 1 0 1 2
E. COLI
O157:H7 0 3 0 4
GIARDIASIS 11 3 36 26
ROTAVIRUS 17 66 263 256
SALMONELLOSIS 8 11 42 52
SHIGELLOSIS 4 1 12 1
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 3 4 10 10
ENCEPHALITIS 0 0 0 1
HANTAVIRUS 0 0 0 0
HEMOLYTIC
UREMIC
SYNDROME
(HUS) 0 0 0 0
HEPATITIS C 0 1 0 1
HEPATITIS D 0 0 0 1
LEGIONELLOSIS 1 0 2 0
LEPROSY
(HANSEN'S DISEASE) 0 0 0 0
LEPTOSPIROSIS 0 0 0 0
LISTERIOSIS 2 0 3 0
LYME DISEASE 0 0 0 0
MALARIA 0 0 1 1
MENINGITIS,
ASEPTIC/VIRAL 6 2 15 20
MENINGITIS,
BACTERIAL 1 2 9 11
MENINGOCOCCAL
DISEASE 1 2 4 10
PLAGUE 0 0 0 0
RABIES
(HUMAN) 0 0 0 0
RELAPSING
FEVER 0 0 0 0
RSV
(RESPIRATORY 103 140 1170 1593
SYNCYTIAL VIRUS)
ROCKY
MOUNTAIN SPOTTED 0 1 0 1
FEVER
TOXIC SHOCK
SYNDROME 0 0 0 0
TUBERCULOSIS 9 9 25 17
TULAREMIA 0 0 0 0
*Numbers include confirmed and probable
cases
June 1 – Clark
County Medical Society Installation Dinner and Awards Program at the Las Vegas
Country Club with registration and cocktails at 6, followed by dinner and
program at 7. Call CCMS at 739-9989 for details.
June 2 – Sunrise
Hospital Cancer Survivors Day Celebration from
June
8 – Down Syndrome Organization of
June 13 – Nevada
Medical Group Management Association meeting at
June
24 – D.A.R.E. Charity Golf Tournament at the