County Line
Newsletter XLVII December 2003
Contents
Overview: New 2003 EMTALA Regulations
Designing
Systems for Quality & Safety: A Collaborative Approach
Malpractice
Filings against Health Care Providers, Jan 2001 - Sep 2003
Clark County
Health District Disease Statistics – October 2003
Overview: New
2003 EMTALA Regulations
By Weldon
(Don) Havins, MD, Esq.
EMTALA
(Emergency Medical Treatment and Active Labor Act) generally forbids
"dumping" of patients from emergency rooms of hospitals which
participate in Medicare. EMTALA requires
an appropriate screening medical examination (including ancillary services
routinely available to the emergency department) of anyone coming to an
emergency department to determine if the patient has an "emergency medical
condition" or is in active labor.
An emergency medical condition manifests itself by acute symptoms of
sufficient severity (including severe pain) such that the absence of immediate
medical attention could reasonably be expected to result in: placing the health
of the individual in serious jeopardy; serious impairment to bodily function,
or; serious dysfunction of any bodily organ or part. With respect to a pregnant woman who is
having contractions, the screening medical examination must determine whether
there is adequate time to effect a safe transfer to
another facility before delivery or that the transfer may pose a threat to the
health or safety of the woman or the unborn child. To transfer a patient with an emergency
medical condition, the patient must be stabilized and the transfer must be to a
facility accepting the transfer.
A patient
should not be transferred to another facility unless:
- the
individual, after being informed of the risk of transfer, in writing
requests a transfer to another facility;
- a
physician has signed a certification that based on the information
available at the time of transfer,
- the
medical benefits reasonably expected from the provision of appropriate
medical treatment at another medical facility outweigh the increased risks
to the individual and,
- in
the case of labor to the unborn child from effecting the transfer;
or, if the physician is not
physically present in the emergency department at the time an individual
is transferred, a qualified medical person has signed a certification
after a physician, in consultation with the person, has made the
determination and subsequently countersign the certification.
The
transfer must be an "appropriate transfer" to that facility. While patients may sue the hospital,
individuals do not have a private right cause of action against the physicians
involved (although physicians may be directly sued for medical
malpractice). Physicians may be fined by
the Center for Medicare and Medicaid Services, however, for EMTALA violations. Physicians may also be restricted or removed
from the Medicare program for EMTALA violations.
New final
EMTALA regulations were published in the Federal Register September 9, 2003,
with an effective date of November 10, 2003.
The most fundamental change in the new rules is the Center for Medicare
and Medcaid Services' (CMS) recognition that there is
a difference between a hospital department dedicated to providing emergency
services and other hospital facilities.
The definition of "dedicated emergency department" now applies
to hospital-based urgent care centers, and appears to encompass all hospital
labor and delivery departments.
Under the
new regulations, EMTALA obligations begin when an individual "comes to the
emergency department" of a Medicare-participating hospital that has such a
department, seeking examination or treatment for a medical condition. "Comes to the emergency department"
means, with respect to an individual requesting examination or treatment that
the individual is on the hospital property.
For purposes of this section, "property" means the entire main
hospital including the parking lot, sidewalk, and driveway, as well as any
facility or organization that is located off the main hospital campus but has
been determined to be a department of the hospital.
The new
definition of this term distinguishes between an individual who "has
presented at a hospital's dedicated emergency department, . . . and requests
examination or treatment for a medical condition, or has such a request made on
his or her behalf," and one who "has presented on hospital property,
. . . other than the dedicated emergency department, and requests examination
or treatment for what may be an emergency medical condition, or has such a
request made on his or her behalf."
The fundamental difference is that the person in the dedicated emergency
medical department only has to seek examination or treatment for any medical
condition in order to trigger EMTALA, while the person who is elsewhere in the
hospital has to be seeking emergency examination or treatment in order for
there to be any EMTALA obligation.
In both
situations, if the individual in question does not actually make such a request
(or have it made on her behalf), the request will nonetheless be considered to
exist if a prudent layperson observer would believe, based on the individual's
appearance or behavior, that the individual needs examination or treatment of
any medical condition if in the emergency department or needs emergency
examination or treatment.
EMTALA now
unambiguously includes urgent care centers, whether located on or off the
hospital campus. Under the new rules,
EMTALA obligations applicable to emergency departments apply to these
"off-campus" sites, including maintenance of an emergency
department’s on-call requirements.
Individuals who present at these locations and request examination or
treatment for a medical condition (or have such a request made on their behalf)
must be screened under EMTALA and, if an emergency medical condition is
determined to exist, necessary stabilizing treatment must be provided prior to
transfer. An urgent care center,
however, is not required to maintain the same sophisticated level of care as
the most well-equipped emergency departments.
When an individual
presents at a part of the hospital that is not part of a dedicated emergency
department, and is attempting to gain access to the hospital for examination or
treatment of a condition that may be an emergency medical condition, EMTALA
obligations may be triggered by either:
- "An
actual request by or on behalf of the individual, based on that person's
belief that there is an emergency; or
- "Where
no explicit request is made, but a prudent layperson would believe, based
on the individual's appearance or behavior, that the individual needs
emergency medical examination or treatment."
In order
for the obligation to be triggered, hospital personnel must be aware of the
individual's existence and condition. The hospital need not maintain emergency
medical screening capabilities in every possible location, but it should set up
procedures so that hospital personnel know what to do when a person presents at
a non-emergency department seeking emergency care. Without dictating specific
procedures to hospitals, CMS indicated that either immediately transporting the
individual to the hospital's dedicated emergency department, or sending a
"trauma crew" or "crash team" of physicians and nurses out
to the individual on site, would be an appropriate response.
Existing Hospital Patients
EMTALA
ceases to apply once a patient is admitted.
CMS's definition of an inpatient follows the Medicare Hospital Manual,
section 210, which ties inpatient status with an expectation that the patient
would "remain at least overnight and occupy a bed even though it later
develops that the individual can be discharged or transferred to another
hospital and does not actually use a hospital bed overnight."
EMTALA does
not apply to existing hospital outpatients.
Such patients are protected under the hospital's policies and
procedures, and under state medical malpractice statutes, which CMS felt was
sufficient. CMS regulations now require
hospitals, under section 482.12(f)(3), with off-campus
facilities to maintain written policies and procedures to deal with medical
emergencies at off-campus facilities not equipped to provide emergency
care.
Suspension of EMTALA Obligations in Event of
National Emergency
Section 143 of the Public Health Security and Bioterrorism
Preparedness and Response Act of 2002 (Pub. L. 107-188), enacted June
12, 2002, amended section 1135 of the Social Security Act to authorize the DHHS
Secretary to temporarily waive or modify the application of certain Medicare,
Medicaid, and State Children's Health Insurance Program (SCHIP) requirements,
including requirements for the imposition of sanctions for the otherwise
inappropriate transfer of an unstabilized individual,
if the transfer arises during circumstances of a national emergency.
On-Call Physicians
The Centers for Medicare and Medicaid Services (CMS) provides hospitals flexibility to comply with EMTALA obligations by maintaining a level of on-call coverage that is within their capability. The hospital is responsible for maintaining an on-call list in a manner that best meets the needs of its patients as long as this does not affect patient care adversely. CMS does not provide any predetermined ratio of medical staff to requirements for emergency medical coverage. The new EMTALA regulations, in § 489.24(j), require the hospital's written policies and procedures to "provide that emergency services are available to meet the needs of patients with emergency medical conditions if it elects to permit on-call physicians to schedule elective surgery during the time that they are on call or to permit on-call physicians to have simultaneous on-call duties" at other hospitals. Thus, it appears that on-call physicians may schedule elective surgery during their on-call periods, and that they may be on-call at more than one hospital at the same time.
President’s Message
By Ed Kingsley, M.D.,
2003-2004 CCMS President
For
those interested in the latest technological medical advances, I recommend the
November 2003 issue of the Annals of Internal Medicine in which Andreas Michalsen and colleagues from Germany report the
astonishingly good results they obtained on patients suffering from
degenerative joint disease of the knees by using LEECHES! Yes, you read that right: attaching several medicinal leeches directly
to the knees of osteoarthritis sufferers for about 70 minutes was found to be
significantly more effective for relieving symptoms than a topical
non-steroidal anti-inflammatory drug.
And all this time you thought leeches were only good for fevers, lumbago
and, speaking of the Washington DC type, sucking more taxes out of us.
At
a meeting of the Southern Nevada Medical Industry Coalition (SNMIC) hosted by
both Sunrise Hospital Medical Center and the CCMS on November 13,
President-elect Dr. Michael Colletti moderated a discussion regarding various
activities and plans to relieve the health care availability crisis in Southern
Nevada. SNMIC is a group of Clark County
business, civic and professional leaders dedicated to improving the
availability and affordability of health care in our community. Since their objectives coincide with the
mission and vision statements of CCMS, we are actively working with them
"to help serve the needs of physicians, their patients and the health
needs of the Clark County community".
There were four "presenters" who discussed various health care
issues in Clark County. Dr. Jane
Nichols, chancellor of the University and Community College Systems of Nevada,
discussed what is being done to address Nevada's desperate nursing shortage. She reminded the approximately 60 attendees
who were there of the 2000 legislature's mandate to double state nursing
enrollment within five years and of the $11 million they set aside to
accomplish that. In fact, the three
nursing schools in Clark County are doing much better than that. UNLV's nursing
school enrollment is increasing from 192 to 264, that of the Community College
of Southern Nevada is increasing from 150 to 500 and the first nursing school
class of Nevada State College will have 80 students. Thus, total nursing school enrollment in
Clark County is increasing from 342 to 844.
Bill
Walsh, Executive Director of the Nevada Hospital Association, reminded us that
Nevada has the worst resident to (practicing) nurse ratio in the nation and
that there are currently 1300 hospital nursing vacancies. He outlined plans their association is taking
to help relieve the nursing shortage.
CCMS
member Dr. Rudy Manthei, chairman of KODIN, addressed how the medical
malpractice crisis is making health care increasingly unaffordable and thus
more unavailable. He said that doctors'
"defensive medicine" practices are costing the nation $125 billion
annually, and that if a $250,000-350,000 cap were currently in place across the
nation, health care costs could be reduced by up to $39 billion. He educated those present about the KODIN
initiative that will be going before the voters of Nevada next November and
what could be done to improve its chances of being passed and becoming
law. He also pointed out how health
insurance premium inflation, currently 13.9%, has been outstripping both
general inflation (3.1%) and national workers' earnings (2.2%) over the last
five years, also putting affordable health care out of reach for many. I strongly feel that CCMS should work
together with SNMIC to ensure KODIN passage.
A partnership with these business and civic community leaders and the
members they represent will significantly improve our ability to get our
message out to the public about the strangling costs of the medical malpractice
crisis.
The article by our CEO, Don Havins, MD, Esq., in last month's County Line contained graph information comparing medical specialist to population ratios for Clark County with the rest of the nation. There were 27 specialty categories such as allergy, anesthesia and OBGYN, and every single one of them was below the national average. Compounding that was a further decrease in that ratio for 17 of these specialties from 2002 to 2003. We all know how difficult it can be getting hospital consults for such specialties as rheumatology, psychiatry and neurology, and it is only getting worse. These three specialties aren't the only ones that are finding it increasingly difficult to justify continuing to provide care to hospitalized patients. Most of us are aware of the great difficulty several hospitals are experiencing trying to keep many physicians on their medical staffs. Much of this problem is a result of mandatory Emergency Room call coverage required of most physicians with admitting privileges. Thus, many are simply reducing the number of hospitals where they admit. This is particularly true for such hospitals as Sunrise and UMC where many are dropping their privileges and flocking to the newer suburban hospitals. In addition, many physicians find that it is simply not worthwhile to take time away from their busy office practice to see the generally sicker hospital patients. Not only is it becoming more difficult to get some specialists to see a patient in the hospital, admitting an acutely ill patient through the ER can be exasperating. ER physicians in Clark County now number 3.7/100,000 residents, less than half the 8.5 ratio nation-wide. I believe most of these problems are a direct result of the hostile medical-legal environment in southern Nevada, and, unfortunately, it's only gotten worse since AB 1 was enacted over a year ago, as so well summarized in Deborah O'Connor's article in last month's County Line. Our work is cut out for us -- we must do all we can to get KODIN passed. Stay tuned -- there will be more about that in the near future.
2004 Mini-Internship Program
Scheduled
for February 2-5
This program offers Community Leaders (elected officials, reporters, others) the opportunity to see a day in the life of a physician.Call Deborah at CCMS 739-9989 with questions or if you would be interested participating.
New Members for October 2003
Congratulations and Welcome to the Clark
County Medical Society
- Mark I Degen, MD, DDS, Oral/Maxillofacial Surgery, 4730 S
Fort Apache Rd #390, Las Vegas, NV 89147
- Lyn A Knoblock, MD, General/Laparoscopic Surgery, 526 S
Tonopah Dr #120, Las Vegas, NV 89106
- Linda P Veneman, MD, Pathology, 4230 Burnham Ave, Las Vegas,
NV 89119
- Ty S Weller, MD, Anesthesiology/Pain Mgmt., 8480 S Eastern Ave #D, Las Vegas, NV 89123
Welcome Back to Reinstated Members
- John Andrewjeski, MD, Internal Medicine, 105 N Pecos Rd
#113, Henderson, NV 89074
- Gerald Higgins,
MD, Orthopaedics, 3121 S Maryland Pkwy #600, Las Vegas, NV 89109
- James Manning,
MD, Orthopaedics, 701 S Tonopah Dr, Las Vegas,
NV 89106
- Murray Rosenberg, MD, Family Practice, 2931 N Tenaya Wy #106, Las Vegas, NV 89128
Membership 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
- Gilberto J De La
Torre, MD, Gastroenterology
- Carmen F Jones,
MD, Pediatrics
- Carolyn A Matzinger, MD, Internal Medicine
- Sharon L Poon, MD, Anesthesiology
For information on becoming a member of the Clark County Medical Society, call Marlaina Burns at 739-9989
DESIGNING SYSTEMS FOR QUALITY & SAFETY: A
Collaborative Approach
By Robert Shreck, MD, Senior Medical
Director Nevada, HealthInsight
Las Vegas, October 21, 2003 -
"Designing a better communication system" was the theme of the
Collaborative meeting held by HealthInsight at the
Palm's Hotel and Casino last month. HealthInsight is the Quality Improvement Organization for
the states of Nevada and Utah. HealthInsight sponsors semiannual collaborative meetings of
health care providers to improve quality of care and safety for the patients
who are treated in physician's offices, hospitals, home health agencies and
skilled nursing facilities. Admission is free and CME is available to all
attendees.
The collaboratives
focus on "Human Factors" science and the need for the providers of
medical care to design better systems in order to prevent errors and violations
of protocol. Human Factors "is the science of designing tools, tasks,
information, and work systems to be compatible with abilities of human users,
both physical and mental". Human errors are a direct result of a poorly
designed system that is incompatible with the abilities of the person
performing the task. Errors can be "Planning Errors" or an
"Execution Error".
"Violations" are an intentional deviation from protocol
usually for legitimate reasons but with unintended adverse consequences.
Communications problems between
providers and to the patients were the central theme of this
collaborative. John Nance, a well-known
aviation safety expert, treated attendees to superb videotape and commentation, who drew parallels
between what went on in the aviation industry 10 to 15 years ago and the safety
concerns in medicine today. The communication problems in the aviation industry
caused many of the most severe plane crashes in our history, killing hundreds
of people at a time. Medical errors also
kill people, not hundreds at a time, but 44,000 to 98,000 per year according to
the IOM report - The 5th leading cause of death in the United States in
1998. The aviation industry lessons need
to be learned and applied to the medical industry.
Communication Structures and
Techniques were taught at the collaborative.
These included: Briefing, Debriefing, and Walk Arounds,
as well as the techniques of Verifiable Verbal Communication, the Assertive
Statement and "See It, Say It, Fix It". This was followed by a multi-tasked afternoon
exercise that pointed out the number of errors that can occur in a medical
environment when confronted with distractions and sub optimal communications.
Whether your main concern as a
physician practitioner is medical malpractice, safety for your patients, or a
more efficiently run office, these collaboratives are
a MUST DO.
Call HealthInsight at 385-9933 to find out more about our collaboratives, diabetic registry, and other tools to HELP you with your office practice and eliminate those costly errors that even Doctor humans make.
CEO Editorial
By Weldon (Don) Havins, M.D., Esq., CCMS
CEO and Special Counsel
In these sometimes trying and
frustrating times in medical practice, we long for "the good ol' days". If
we look back a mere 100 years, this was life in America:
- The average life
expectancy in the US was forty-seven (47).
- Only 14 Percent
of the homes in the US had a bathtub.
- Only 8 percent
of the homes had a telephone.
- A three-minute
call from Denver to New York City cost eleven dollars.
- There were only
8,000 cars in the US and only 144 miles of paved roads.
- The maximum
speed limit in most cities was 10 mph.
- Alabama,
Mississippi, Iowa, and Tennessee were each more heavily populated than
California. With a mere 1.4 million residents, California was only the 21st
most populous state in the Union.
- The American
flag had 45 stars. Arizona, Oklahoma, New Mexico, Hawaii and Alaska hadn't
been admitted to the Union yet.
- The population
of Las Vegas, Nevada was 30.
- The average US
worker made between $200 and $400 per year.
- A competent
accountant could expect to earn $2000 per year, a dentist $2,500 per year,
a veterinarian between $1,500 and $4,000, and a physician between a $1,000
and $6,000.
- More than 95
percent of all births in the US took place at home.
- The five leading
causes of death in the US were:
1. Pneumonia and influenza
2. Tuberculosis
3. Diarrhea
4. Heart disease
5. Stroke
- One in ten US
adults couldn't read or write.
- Only 6 percent
of all Americans had graduated from high school.
- Marijuana,
heroin, and morphine were all available over the counter at corner
drugstores. According to one pharmacist, "Heroin clears the
complexion, gives buoyancy to the mind, regulates the stomach and the
bowels, and is, in fact, a perfect guardian of health."
- There were only
about 230 reported murders in the entire US.
- Suing a doctor
for malpractice - what's that?
Professional liability insurance for medical malpractice was not
available.
Nurse
Anesthetists' scope of practice encroachment continues
In the past month, three states
dropped a discretionary federal requirement that physicians supervise nurse
anesthetists. Ten (10) states now have
dropped the supervision requirement since federal law gave governors the option
to do so two years ago. The three new
states eliminating anthesiologists' mandated
supervision are Alaska, North Dakota and Washington. They join Iowa, Nebraska, Idaho, Minnesota,
New Hampshire, New Mexico and Kansas.
The governors of Colorado and Montana are exploring the possibility of
dropping the requirement, says Mitch Tobin, spokesperson for the nurse
anesthetists' association.
The American Society of
Anesthesiologists defends the supervision requirement, saying nurse
anesthetists do not have the training to work alone. But the American
Association of Nurse Anesthetists asserts that nurse anesthetists' record of
adverse events is no different from that of anesthesiologists. State governors, meanwhile, are worried about
the effects of a growing nationwide shortage of anesthesiologists.
In his letter informing CMS of his
decision to drop the supervision requirement, Alaska Gov. Frank Murkowski wrote
that there is a shortage of anesthesiologists in rural areas of the state. "I believe not exercising this exemption
may severely limit the ability of rural hospitals to treat emergencies and
provide other services requiring anesthesia care to Medicare patients,"
Murkowski writes in the letter.
The association reports that states
that have dropped the requirement are taking full advantage of their new
status. In Iowa, for example, 91 of 118
hospitals in the state rely solely on nurse anesthetists to provide anesthesia
care, AANA reports, citing a letter this July from Iowa Gov. Thomas Vilsack to the governor of an unnamed state. "Iowa has proven the intent of the
opt-out change is a complete success in practice," Vilsack
states in the letter.
As far as we are aware, Governor Guinn has not considered following these other states' policy.
One
state considers moving medical malpractice cases out of the courts
Massachusetts' Governor Romney
reports he is contemplating processing medical malpractice claims in a workers'
compensation like system and eliminating trial court litigation, at least for OBGYNs. Whereas
medical malpractice cases generally have no limit on economic damages (and, in
most states on non-economic damages also), the tribunal in workers
compensation-like settings would settle cases based on a pre-established
schedule of values for each type of injury.
As did workers compensation, this system would reduce the number of multimillion-dollar
awards, speed the time from injury to financial recovery, and probably
accommodate more injured patients that our current system - this all according
to a report written in November by Robert Pozen, the
Massachusetts governor's Chief Economic Adviser. Mr. Pozen's report
notes that the system would require legislative approval and would start as a
pilot program, to be developed in conjunction with the Harvard School of Public
Health. The pilot would be open to only
a few hospitals, one specialty (OB/GYN), and to plaintiffs who agree to use the
system.
The report continues that the new
malpractice claims system would give physicians incentives to reduce
errors. Malpractice insurers would be
able to create risk ratings for physician groups in addition to individual
physicians. This is intended to
encourage doctors to work together to reduce medical errors. The report concludes, "systemic changes to the procedures currently in place to
compensate patients for injuries suffered from questionable medical practices
are necessary in order to provide long-term stability to the healthcare
delivery system."
A brief, unscientific survey of Clark County medmal plaintiff attorneys resulted in pejoratives and colorful metaphors of universal, vehement opposition to such a pilot program in Nevada. Sentiments such as "when hell freezes over" and "over my cold dead body", along with the expected, "robbing innocent injured victims of their right to recover for their injuries caused by careless doctors" were common. Mention of the KODIN (Keep Our Doctors in Nevada) Initiative drew similar derisive and contemptuous comments. One can predict 2004 will not be a tranquil year in either Massachusetts or Nevada.
Clark County District Court Medical Malpractice
Filings against Health Care Providers
Jan 2001 –
Oct 2003
2001 2002 2003
Jan 39 33 109
Feb 20 14 88
Mar 35 30 148
Apr 37 34 101
May 37 35 108
Jun 27 24 98
Jul 19 100 97
Aug 54 51 63
Sep 20 65 85
Oct 37 83 114
Nov 38 184
Dec 9 170
Minutes Synopsis
(Members can receive a full copy of meeting minutes by calling 739-9989.)
CLARK COUNTY MEDICAL SOCIETY BOARD OF TRUSTEES MEETING
Tuesday, October 21, 2003; 6:00 P.M.
Action Items
- The
minutes from the September 16th Board meeting were approved as revised.
- Dr.
Steinberg reported the revenue for the first three months of this fiscal
year was higher than last year at this time and due primarily to the water
district rebate. Expenses are flat
compared to last year at this time.
Committee Reports
- Deborah
Barton reported the Community Relations/ Community Health Committee
discussed Jay Levy, HIV/AIDS expert, will be presenting a CME activity at
Sunrise Hospital on November 17 at 6:00pm. The committee is also looking
to expand public information campaigns, antibiotic awareness and
immunization programs. The
Mini-Internship dinner is being planned for early February. The Board will have CCMS request joint
sponsorship of the Nevadans for Antibiotic Awareness Group, and recommend
NSMA also request joint sponsorship. .
- The
board approved the following applicants for membership: Mark Degen,
MD, Oral/Maxillofacial Surgery; Lyn Knoblock,
MD, General Surgery/Laparoscopic Surgery; Ty
Weller, MD, Anesthesiology/Pain Mgmt; Linda Veneman,
MD, Pathology.
Alliance Report
- Annette
Mohs reported the CCMS Alliance has started
their greeting card project. Their
goal is to provide ten $1,000 scholarships to nursing students and hope to
donate funds to the Women's Development Center and to ALS medical research. The Alliance also plans to design bumper
stickers and business cards with a message to vote for the KODIN
initiative petition.
UNSOM Report
- Dr.
Harter announced the full accreditation of the General Surgery residency
program at the University of Nevada School of
Medicine.
Scholarship Fund Report
- Dr. Ellerton's assistant will set up a meeting of the
Scholarship Fund Corporation Board of Directors within the next three
weeks. Dr. Ellerton had submitted a
letter authorizing Dean Wittier to write checks to the 4 medical students
awarded scholarships last year, but does not know why those checks did not
get written and sent to the School of Medicine. Dr. Ellerton stated he will make sure
those 4 students receive their scholarship checks promptly.
NSMA Report
- Larry
Matheis reported NSMA would be reviewing NBME's proposed regulations at the NSMA Council
meeting tomorrow. NSMA's request for certain specialists to volunteer
members to the Medicare Advisory Committee resulted in many qualified
applicants for those positions. Dr.
Evins reported NSMA sponsored a proposal for
banning antibiotic use in animals for non-disease treatment and that NSMA awarded
scholarships to medical students attending medical schools out of Nevada.
AMA Report
- The
AMA annual meeting will be in December.
Dr. Marietta Nelson invited Board members to inform her of any
issues they feel she should bring to that meeting. The Board will receive a report after
the meeting.
President's Report
- Dr.
Kingsley stated the Nevada Association of Women Business Owners (NAWBO)
has asked CCMS to submit a nominee to receive a "Women of Distinction
Award". The Board members
voted to direct Staff to fax broadcast a request to the membership to
nominate candidates for this award.
Dr. Kingsley announced the Touro
Osteopathic Medical School will open a satellite school of from 45-90
students beginning Fall 2004.
- Administrative
Report
- Dr.
Robert Shreck, the Senior Medical Director of HealthInsight,
asked for help in increasing physician attendance at the risk management collaboratives held by HealthInsight. Dr. Shreck was invited to write an
article regarding the importance and benefits of attending HealthInsight seminars.
New Business
- Jack Seddon of the Federation of Physicians and Dentists
Union, which is a member of the AFL-CIO, presented information on the
union he represents. The Board
decided to publish information in upcoming editions of the County Line.
- Dr.
Havins discussed how the Bylaws of both CCMS and NSMA currently state an
applicant must be licensed by the Nevada Board of Medical Examiners or the
Nevada Board of Osteopathic Medicine.
No Board member was opposed to a resolution being written to change
the NSMA Bylaws and CCMS Bylaws to permit non-licensed MDs or DOs to apply for membership. NSMA Bylaws may only be amended at the
Annual NSMA meeting. The CCMS
delegation may propose amendments to NSMA Bylaws at that meeting.
The next board meeting will be Tuesday, November 18, 2003 at 6 pm.
CME Calendar
Cardiovascular
Consultants 691-9154
Clark County Medical
Society 739-9989
St. Rose
Hospital 616-5832
Southwest Medical
Associates 242-7347
- 12/11
- “Wound Care: Past, Present and Future”
Summerlin
Hospital 233-7572
Sunrise Hospital 731-8210
- 12/1,
12/15 - “Cancer Conference,” 12:15 p.m.
- 12/2
- “Communication Between Physicians and Nurses,”
12:30 p.m.
- 12/5
- “Fetal Cardiology,” 7:30 a.m.
- 12/5
- “Oral Agents,” 12:15 p.m.
- 12/12
- “Pediatric Pathology,” 7:30 a.m.
- 12/12
- “Eye Diseases,” 12:15 p.m.
- 12/16
- “SAD,” 7:30 a.m.
UMC 383-2604
- 12/4,
12/11, 12/18, 12/24, 12/31 - “Tumor Boards,” 12:15 p.m.
- 12/5
- “Psychological Effects of Aging,” 7:30 a.m.
- 12/12
- “Evidence-Based Treatment of Glaucoma,” 7:30 a.m.
- 12/19
- “What is New in the Management of Severe Sepsis,” 7:30 a.m.
Valley Hospital 388-4847
- 12/9
- “Gastroesphogeal Reflux Disease,” noon
*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 each month.
Clark County Health District Disease Statistics* -
October 2003
DISEASE CASES REPORTED YEAR TO DATE
Oct 2002 Oct 2003 2002 2003
VACCINE PREVENTABLE DISEASES
DIPTHERIA 0 0 0 0
HAEMOPHILUS
INFLUENZA 0 0 8 8
HEPATITIS A 3 1 21 14
HEPATITIS B 5 5 39 55
INFLUENZA 0 0 59 47
MEASLES 0 0 1 0
MUMPS 1 0 4 2
PERTUSSIS 0 5 22 20
POLIOMYELITIS 0 0 0 0
RUBELLA 0 0 0 0
TETANUS 0 0 0 0
SEXUALLY TRANSMITTED DISEASES **
CHLAMYDIA 398 358 3785 3904
GONORRHEA 189 230 1447 1668
SYPHILIS (Primary & Secondary) 0 0 7 7
SYPHYLIS
(Early Latent) 2 1 6 19
ENTERICS
AMEBIASIS 4 2 18 14
BOTULISM-INTESTINAL
(Infant) 0 0 0 1
CAMPYLOBACTERIOSIS 13 11 102 84
CHOLERA 0 0 0 0
CRYPTOSPORIDIOSIS 0 0 2 5
E. COLI
O157:H7 2 1 13 17
GIARDIASIS 19 17 98 81
ROTAVIRUS 8 4 345 473
SALMONELLOSIS 18 14 153 102
SHIGELLOSIS 0 4 27 47
TYPHOID
FEVER 0 0 0 0
YERSINIOSIS 0 0 0 0
OTHER
ANTHRAX 0 0 0 0
BOTULISM
INTOXIFICATION 0 0 0 0
BRUCELLOSIS 0 0 0 0
COCCIDIOIDOMYCOSIS 6 2 35 29
ENCEPHALITIS 0 0 2 2
HANTAVIRUS 0 0 0 0
HEMOLYTIC
UREMIC 0 0 0 0
SYNDROME (HUS)
HEPATITIS C 0 0 3 3
HEPATITIS D 0 0 1 0
LEGIONELLOSIS 1 0 4 4
LEPROSY (HANSEN'S DISEASE) 0 0 0 0
LEPTOSPIROSIS 0 0 0 0
LISTERIOSIS 0 0 1 3
LYME
DISEASE 0 0 0 3
MALARIA 0 0 3 1
MENINGITIS,
ASEPTIC/VIRAL 9 17 84 118
MENINGITIS,
BACTERIAL 2 1 22 20
MENINGOCOCCAL
DISEASE 0 0 14 6
PLAGUE 0 0 0 0
PSITTACOSIS 0 0 0 0
Q FEVER 1 0 1 0
RABIES
(HUMAN) 0 0 0 0
RELAPSING
FEVER 0 0 0 0
RSV
(RESPIRATORY 35 3 1829 1352
SYNCYTIAL VIRUS)
ROCKY
MOUNTAIN 0 0 2 0
SPOTTED FEVER
TOXIC SHOCK
SYNDROME 0 0 1 2
TUBERCULOSIS 8 8 45 45
TULAREMIA 0 0 0 0
UNUSUAL
ILLNESS 0 0 0 2
* Numbers
include confirmed and probable cases
** For
HIV/AIDS statistics please call the Clark County Health District Office of AIDS
at 759-0730.
Classifieds
·
NEW 1200 SQ FT, on the main street, high
traffic. Next to pediatrics & dentist office, 4 exam rooms, nurses’
station, doctor’s office, breakroom. Ready to move
in. Call Robin at 898-6400.
·
Nevada Physicians and Imaging seeks two B/C, NV
licensed Radiologists for busy East and West outpatient facilities. Experienced
in CT, Dexa scans, Flouroscopy,
MRI, Mammography, Nuclear Medicine, Ultrasound and general radiology
procedures. M-F, no call or weekends. E-mail CV to: Jfaulkner@PIPA-NV.com or
fax to (702) 933-1307.
· WANT TO ADVERTISE? CALL 739-9989 for classified or display advertising information. CCMS members receive a free classified ad (up to 40 words) up to three times a year. Call Today!
County Line Advertisers
Bank of Commerce 949-9800 www.bankofcommerce-nevada.com
C D Smith Co. Medical Supplies 871-1877 www.cdsmithco.com
Christopher Commercial 243-2800 www.christophercommercial.com
Commercial Associates 220-4007 jwoodyard@commercialassociates.com
Consolidated Laboratory Services 933-4522
Desert Radiologists 598-1006 www.desertrad.com
Hutchison & Steffen, Attorneys 385-2500 www.hsnvlaw.com
Jan Bernard Realty 838-0333
Medical Group Management Association 697-5471 ext. 134
Medical Liability Association of Nevada (MLAN) 804-7333 www.mlan.org
Nevada Mutual Insurance Company 798-6001 www.nevadamutual.com
Practice Management Group Inc. 1-800-342-3485 www.pmgla.com
Red Rock Radiology 731-2888 www.redrockradiology.com