The 2003 Installation Dinner was held May 31 at the Green Valley Ranch Resort Casino. The event welcomed Dr. Ed Kingsley as the new CCMS President and inducted the newly elected officers and Board of Trustees.

The Harold Lee Feikes Memorial Physician of the Year Award was presented to Dr. Weldon (Don) Havins, MD, Esq, for his involvement in aiding lawmakers in support of physician-friendly legislation.

In honor of the event, new NSMA President Dr. John Williamson traveled from Reno to attend.

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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

Michael A Carducci, MD, Diagnostic Radiology
Russell P Jayne, MD, Ophthalmology
Robert H Odell, Jr, MD, Pain Management
Henri Wetselaar, MD, Family Practice
Paul T Wilkes, MD, Maternal/Fetal Medicine

For information on becoming a member of the Clark County Medical Society, call Marlaina Burns at 739-9989

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President’s Message

By Edwin Kingsley, M.D., 2003-2004 CCMS President

Installation Dinner Address

President Evins, members of the CCMS, and guests, I thank you for this opportunity to address you at this time of change in the leadership of our Society. When I was asked to speak tonight, I asked if there would be any objections if I played "Crocodile Rock" or something else on the piano instead of talking, you know, let my fingers do the talking, and to my surprise, everyone eagerly agreed. Then I realized why they'd rather hear me play and so I decided to talk anyway. I first want to thank my esteemed colleagues: those of the Board of Trustees and members of the Society committees with whom I have had the pleasure and opportunity to serve the members of the Society over the last five years. I would like to thank the dedicated staff members of the Society: Dr. Don Havins, CEO, Dot Freel, Deborah Barton and Marlaina Burns, all of whom work hard to make the Society successful, and with a smile. I would also like to thank Larry Matheis, Executive Director of the Nevada State Medical Association and Dr. Robert Shreck, outgoing president of the State Association, for their participation in and support of the Society this past year. I understand our new State Association president, Dr. John Williamson, is here tonight and I look forward to working with him this year. Most importantly, though, I would like to thank my wife Kathy and my family and friends who have patiently given me your help and support.

This last year we have all witnessed significant deterioration in the availability of quality medical care here in Southern Nevada. In addition, the practice of medicine is becoming increasingly difficult as a result of an increasingly hostile environment towards doctors.

1. Skyrocketing liability insurance premiums have forced many physicians to either retire early, leave the state to practice elsewhere or severely limit the scope of their practice.

2. Several medical liability insurance carriers have either quit Southern Nevada or quit business altogether. Physicians are finding it increasingly difficult to find liability insurance despite the creation of a state-sponsored carrier. In fact, several of us here tonight have come very close to closing our doors for just this reason.

3. There has been an unparalleled increase in the number of lawsuits filed against physicians. According to information obtained by the Society, from January 2001 through July 2002, an average of 30 malpractice cases were registered each month in Clark County. From July 2002, when the special legislative session addressing the medical malpractice crisis convened, through April of this year, that number jumped to 97 per month, or over 300% increase!

According to the Jury Verdict Research report published in March 2002, nationwide, the median jury award has grown 7 times the rate of inflation from 1994 through 2000. By 2002, 52% of all awards were for $1 million or more. Today, the average award is about $3.5 million. It has been estimated that medical liability costs add $60-$108 billion to the total cost of health care each year, not counting the unnecessary tests and treatments that are performed by physicians in an effort to help avoid lawsuits.

4. We have seen a dangerous decline in the number of nurses and other health care professionals who are willing to work in our hospitals and in our offices. We all know how difficult it can be admitting patients to hospitals these days, not for lack of beds but for lack of qualified nurses.

5. We are also seeing substantial cutbacks in physician reimbursement, particularly for those treating both Medicare and Medicaid patients. For example, according to the Physician Payment Review Commission and the Centers for Medicare and Medicaid Services, Medicare reimbursement will have increased by an estimated 10% from 1991 through 2004 while, over this same time frame, the Medical Expense Index will have increased by 36%. Therefore, actual Medicare reimbursement to physicians will have declined by an estimated 19%.

6. There is now an effort on behalf of the Nevada State Board of Medical Examiners to force physicians to prove their competency. The Society has spoken out strongly against this proposal because we believe that their proposed method of achieving this end has not been shown to achieve its purported purpose and would just further add to the cost of providing medical care to our patients.

Our County Society, in conjunction with the State Association, the KODIN (Keep Our Doctors In Nevada) organization, the State and County Alliances and other physician groups, has spent endless hours working with Governor Guinn and our legislators to effect positive tort reform this last year. These groups succeeded in getting a special state legislative session convened last summer which passed AB1 which was designed to help solve these problems. Unfortunately, as we now know, this bill has not only failed to give us the kind of relief we hoped for, it seems to have actually fueled the fire of lawsuits against doctors, as has been already pointed out. Therefore, many of our society members, led tirelessly by President Evins and our CEO, Dr. Havins, have been spending a tremendous amount of their time, money and energy these last three months in Carson City working with the legislators who are currently in session to try to correct the deficiencies in this bill and also to help pass additional legislation favorable to physicians. Unfortunately, as the legislative session is now winding down, we're not seeing the kinds of changes we had hoped for. In fact, as a result of a significant shortage of tax revenue for an increasingly bloated state budget, we may all soon be paying a gross receipts sales tax which will significantly add to our already high practice overhead. In addition, the state senate and assembly will be voting in the next few days on a competing proposal, "Keep Quality Medical Care in Nevada," that will also be placed on the November 2004 general public ballot to compete head-to-head with the doctors' initiative "Keep Our Doctors In Nevada" and which will make passage of our initiative much less likely. Is there anyone in this room who has not been affected by these problems? What is to be done?

Admittedly, these problems seem overwhelming. Many doctors have become cynical and so discouraged that they don't think there is anything they can personally do to help make things right. Others simply detest politics and therefore don't get involved in the political process. They just hope others will take care of these problems for them. It can be very easy to believe that we are better off just focusing our time and energy doing that which we do best - taking care of our patients. It's hard to argue with that! Unfortunately, that is simply no longer enough.

Individually, each of us would find it next to impossible to solve these problems. However, there is no question that there is strength in numbers, especially when those numbers are organized, are focused on key issues that affect doctors and their patients and are willing to put their money where their interests lie. Unfortunately, we doctors have a terrible tradition of NOT being politically active on our own behalf and we are extraordinarily stingy when it comes to contributing money to our own Political Action Committees. What are PACs? There is both a County Society PAC and a State Association PAC whose sole purpose is to help get elected or re-elected those politicians sympathetic to doctor and patient issues. Nationally, trial bar attorneys pay an average of $1,000 each year to their PACs to effect legislative changes favorable to their profession and pocketbooks while doctors contribute… how much would you guess? $25! That's 40 times more than we pay, and that's NOT because attorneys' disposable income is 40 times greater than that of physicians. They just happen to know how the political system works and they are willing to put their money where their interests lie. They seem to know better than doctors how to get the political system to work for them and their own agenda. Is it any wonder that our legislative bodies are so often controlled by the attorneys and their lobbyists? It is a well-known fact that many other professional societies and associations, such as chiropractors, optometrists and even hair dressers routinely contribute more money to their own political organizations than do we physicians.

I believe there is much we can do as doctors for our patients and ourselves. I pledge to make the following goals high priorities during my tenure this next year:

First, we need to convince our associates who do not belong to the County Society to join and those who already belong to become more active in their participation. I sincerely believe that as a County Society, we physicians can have a substantially greater influence on those who make decisions that affect the way that you and I practice medicine than trying to do it individually. I have personally seen this kind of positive influence as a result of those who have been working on behalf of the Society.

Second, we doctors must collectively wake up to the realization that unless we take the initiative to correct the problems I've outlined tonight, no one else will. It is up to us.

Third, we must be willing to contribute more money to our county and state political organizations and then become involved in helping elect and re-elect those who are most sympathetic to our cause - to improve the availability of affordable health care to Southern Nevadans and to keep our doctors in Nevada.

Fourth, even though there will be no regular legislative activity this coming year, we have exactly 18 months to get out and educate Nevada's populace about the all-important KODIN ballot initiative that will go before the voters in November 2004. There are many ways we can do this, not the least of which is to educate our own patients and encourage them to vote "yes." If passed, this initiative will correct many of the deficiencies in the current malpractice bill that was passed last summer.

Fifth, we must work with local hospital administrators and health care educators to increase the number of nurses and other health care personnel who are willing to stay and work here in Clark County. The Society has already formed an ad hoc committee, chaired by our president-elect Dr. Mike Colletti, to do just that.

Sixth, the County has already issued a statement clearly stating its opposition to state-wide physician competency testing and has recommended the formation of a panel of physicians certified in quality care to address this important issue - how should we best police ourselves and assure our patients that Clark County physicians are indeed fully competent to provide quality medical care?

I commit to you tonight that, with the help of our board of trustees, I will establish these goals as our top priorities this coming year, and will strive to make our Society an effective means for achieving meaningful solutions. I will listen to the suggestions of our members and work with our members to accomplish these goals. Together, we can achieve much. With your help and support, I truly believe we can make Southern Nevada both a better place for us in which to practice medicine and for our patients to receive the best medical care. Thank you.

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Installation Dinner Sponsors

The Clark County Medical Society would like to express our deepest thanks to our sponsors for the 2003 Installation Dinner :

Silver Sponsors

Cyriac Chemplavil, MD

Michael E Clifford, MD

Eye Care For Nevada

Platinum Sponsors

Comprehensive Cancer Centers of Nevada

Quest Diagnostics

Rainbow Medical Centers

St. Rose Hospital

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Clark County District Court Medical Malpractice Filings Against Health Care Providers

Jan 2001 - May 2003

2001 2002 2003

Jan 39 33 80

Feb 20 14 72

Mar 35 30 75

Apr 37 34 74

May 37 35 70

Jun 27 24

Jul 19 100

Aug 54 51

Sep 20 65

Oct 37 83

Nov 38 184

Dec 9 170

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CCMS Past President Provides Year-End Wrap Up

By Warren Evins, MD, PhD, CCMS Past President

Thanks to all!

This is my thirteenth and last President's column for the County Line being written in early June, 2003, to report on activities to date. I want to thank all CCMS members who have been reading the column, especially those who have given me feedback.

My term as President was a very busy, interesting, and educational year. There was one Special and one Regular Session of the Nevada State Legislature, and many issues concerning physicians and: Congress, CMS, Medicaid, workers compensation, hospitals, NSMA, the Boards of Medical Examiners, Regents, Osteopathic physicians, CCMS Alliance, nursing, medical errors and reporting, peer review, HealthInsight, Keep Our Doctors in Nevada (KODIN), AMA, malpractice, physician departures, patient access, emergency departments, and uninsured and underinsured patient care-to name a few.

Without the help of our concerned community and physician members, spouses, CCMS Alliance, our patients, and especially our Officers and Board of Trustees, we would have been far less successful. The financial contributors/members of MedPAC, NemPAC and AMPAC allowed a very successful involvement in Nevada legislative and, for the first time, judicial election races in November 2002.

Our dedicated and extremely hard working staff, led by Weldon (Don) E. Havins, MD, Esq., CEO, and Harold Lee Feikes Physician of the Year Award winner, and Dot Freel, office manager, was essential to our success. Deborah Barton, editor of the County Line and public relations coordinator who had a healthy baby girl, Katherine Grace, on June 6th weighing 7 pounds 9 ounces, (Congratulations! and Best Wishes! from us all) and Marlaina Burns, receptionist and membership coordinator worked hard for our goals. I am supremely grateful to them for their help and interest.

Larry Matheis, Executive Director, and Robert Shreck, MD, Immediate Past President of NSMA helped me extensively along the way. I spent over 2 full weeks meeting with legislators and attending sessions and hearings in Carson City. I attending hearings in the Grant Sawyer Building, Las Vegas, and watched many sessions on the internet. Scott Craigie, our Lobbyist and legislative strategist and John Ellerton, MD, were patient teachers and friends. Rudy Manthei, DO, Chairman of the Keep Our Doctors in Nevada PAC, and President of the Nevada State Board of Osteopathic Physicians, spent an enormous amount of time lobbying on our behalf. I met throughout the year one or two times a week with these dedicated advocates.

Board of Medical Examiners

The BME met on May 30th and tabled the proposed Competency Testing regulations. As I understand, they still intend to institute a competency certification program before the 2005 MD license renewals. The competency committee, headed by Donald Baepler, ScD, newly elected Secretary-Treasurer, will revise some provisions and hold discussions with radiologists and possibly other interested groups (pathologists, psychiatrists). Please contact Dr. Baepler with your input, if desired, or a request for discussion.

Installation and Awards Dinner

A very successful banquet was held at the Green Valley Ranch casino on Saturday, May 31st. Ed Kingsley, MD, was installed as our 49th President. The new Board of Trustees and Officers took their Induction oaths, administered by John Williamson, MD, NSMA President, who flew in from Reno. The Feikes Award, continuing membership awards, and member recognition occurred. Annette Mohs was installed as the CCMS Alliance President.

Nevada State Legislature

The 120 day term of the Legislature ended shortly after 1:00 a.m. on June 3rd. Senate Bill 97 (the Keep Our Doctors in Nevada initiative proposal in amendable bill form) finally was defeated. Initially, The Senate Judiciary committee, led by Senator Mark Amodei (R-Capital Senatorial district) deleted all of SB 97 and substituted some insurance regulations, etc. A floor Senate vote, led by Senators Ann O'Connell, Sandra Tiffany, Barbara Cegavske, Randolph Townsend, and Dennis Nolan, re-instated the original SB 97 bill (with all of the Republican Senators, except Senators Amodei, and Mike Schneider (D-Clark 11)).

At the session's end, all of the Assembly Democrats and Dawn Gibbons (R-Washoe 25) voted to delete the original SB 97 and place a competing referendum on the November 2004 ballot to confuse voters and try to defeat the KODIN initiative. The Senate conference committee substituted AB 1 from the Special Session as the competing referendum wording. Fortunately, in the end, the full Senate defeated SB 97, now changed to put a Legislature backed competing referendum on the ballot, by a vote of 12 to 9 with 10 republicans and 2 democrats - Senators Mike Schneider and Bob Coffin voting to defeat the competing referendum against Senators Bill Raggio, Amodei, and Mike McGinness and the other six democrats. A very close call!

Changes to liability insurance practices, and licensing and oversight activities of physicians are included in: AB320; AB453; SB122; SB250; SB292. There are new (and mostly physician friendly) license board related laws in these and in SB229, SB281, SB310, SB332, AB349, SB350, and SB387.

To assist physicians and their patients with managed care problems: AB320 includes extending the panel fee ban to networks and worker's comp; adopting a single credentialing form; requiring actual procedural payment amounts to be provided with the provider contracts or upon request; assuring continuity of care (and payments) when the physician is removed from a panel or a patient changes plans during treatment; and other contract protections for physicians. SB168 changes the worker's comp rule that punishes physicians when facilities bill the wrong insurer. AB49 requires

independent external reviews of medical denials. SB24 changes the lab law to allow non-ordering, but treating physicians to receive lab reports. AB502 requires coverage of therapy costs for cancer trials. SB50 and AB460 address tobacco control. You can read any bill (and the explanation of what happened to it) at: http://www.leg.state.nv.us/72nd/Reports.

(From information supplied by Larry Matheis, Executive Director, NSMA)

Annual NSMA Meeting

The Annual House of Delegates meeting of the NSMA occurred at the Atlantis Casino Resort in Reno on May 16 to 18. CCMS would have been entitled to 37 delegates, but only 10 attended. A summary of the Resolutions will be published in the August County Line. I was elected Secretary (replacing resigning Raul Meoz, MD). Lynn Horne, MD and Marietta Nelson, MD were elected AMA delegate and alternate, respectively. The Nicholas Horn Awardees were Senators Ann O'Connell and Sandra Tiffany. At the banquet, the Distinguished Physician and Community Service Awardees were William Morgan, Jr., MD and Joe Hardy, MD.

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New Members for May 2003

Congratulations and Welcome to the Clark County Medical Society

Christina A Dixon, MD, Internal Medicine, 2350 W Charleston Blvd, Las Vegas, NV 89102
Michael L Fishell, MD, Anesthesiology, 866 Seven Hills Dr #203, Henderson, NV 89052
Jason E Garber, MD, Neurosurgery, 3006 S Maryland Pkwy #265, Las Vegas, NV 89109
Karen R Goodman, MD, Family Practice, 2920 N Green Valley Pkwy #2-215, Henderson, NV 89014
David E Slattery, MD, Emergency Medicine, 901 Rancho Ln #207, Las Vegas, NV 89106

Reinstated Member

Roger Wilson, MD, Diagnostic Radiology, 2020 Palomino Ln #100, Las Vegas, NV 89106

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CMS Issues Three Proposed Rules On Increased Medicare Payment Rates

Provided by Larry Matheis, NSMA Executive Director

The Centers for Medicare and Medicaid Services (CMS) issued three proposed rules to increase Medicare payment rates for hospital inpatient care, skilled nursing facility rehabilitation care, and for rehabilitation hospitals that provide extensive therapy.

The proposed rule for increased payment rates for hospital inpatient care for fiscal year 2004 is 3.5% beginning October 1, 2003. In fiscal year 2004, Medicare expects to pay 4,800 acute care hospitals $100.2 billion, an increase of $5.7 billion over fiscal year 2003, due to payment rate and policy changes and an anticipated increase in inpatient services. Under the proposed rule, the outlier threshold would increase to $50,645, up from $33,560, in 2003, in order to limit outlier payments to 5.1% of total payments under the inpatient prospective payment system (PPS). "While this proposed rule would increase overall payments to hospitals, it also proposes a number of changes to current policies that could affect how payments are distributed," said CMS Administrator Tom Scully. CMS said it is proposing to relax the criteria for hospitals to receive add-on payments for new technologies. The proposed rule will be published in the May 21 Federal Register.

The proposed increased payment rates for skilled nursing facilities (SNFs) for fiscal year 2004 is 2.9%, which will result in nearly $400 million more in Medicare payments to SNFs. In the proposed rule, CMS has decided to retain the current classification system that establishes daily payment rates to SNFs based on the needs of Medicare beneficiaries. The decision will result in nursing homes continuing to receive an estimated $1 billion in temporary add-on payments next year. The proposed rule was published in the May 16 Federal Register.

CMS also proposed an increase of 3.3% in payment rates for fiscal year 2004 for inpatient rehabilitation hospitals that treat Medicare beneficiaries recovering from strokes, spinal cord injury, or other conditions requiring extensive therapy. CMS noted that this year to calculate changes in the price of goods and services for rehabilitation facilities, known as the market basket, it used 1997 data, compared with 1992 data for fiscal year 2003 PPS. The proposed rule was published in the May 16 Federal Register.

The Advanced Medical Technology Association (AdvaMed) said that CMS is taking positive steps in the proposed hospital inpatient rule towards fixing problems that pose barriers to patient access to new technologies. The proposed rule reduces the average threshold across all Diagnosis Related Groups (DRGs) to qualify for the add-on payments from approximately $9,900 above the mean standardized charges for DRGs to approximately $7,400. While AdvaMed said that change is helpful, it noted that it will not go into effect until fiscal year 2005.

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Letter: Physician Resigns from Medicaid Program

May 25, 2003

Charles Duarte, Administration

Nevada Division of Healthcare Financing and Policy

1100 E. William Street, Suite #102

Carson City, Nevada 89701

RE: MEDICAID REIMBURSEMENT CUTS

Dear Mr. Duarte:

It is with great regret that I resign from the Nevada Medicaid Program. Your decision to implement the drastic and unexpected reductions in payment for surgical specialists leaves me no choice. As of this date I will no longer accept new Nevada Medicaid patients through my office, nor see them in any emergency department unless it is solely a matter of life or death.

I have practiced Neurosurgery in Las Vegas for nearly fourteen years, yet for over four decades I have called Nevada my home. It has been the only state that I had seriously considered practicing medicine. For the first time, I must now reconsider this decision. Believe me, I understand your position. Fiscal concerns, diversion of funding to bail out our county hospital and trauma center, and other issues too numerous to mention have forced Peter to rob Paul. Nevertheless, our common goal must remain to provide access and quality of healthcare to all Nevadans, regardless of financial status.

Mr. Duarte therein rests the problem. By disproportionately penalizing specialists such as myself, you have begun to extinguish the opportunity for our city and state to develop into an independent and self-sustaining medical community for all Nevadans. The last minute public hearing your office arranged to express our concerns over this Medicaid issue took all physicians by surprise. There I added my voice in what we believed was a forum to present our case. We were not aware that this was merely a staged exercise, as the language for your Medicaid cuts was already hidden within budgetary legislation passed barely days later. Furthermore, our fees were reduced beginning on May 8, 2003, retroactive to any debate inclusive of our state's physicians.

I have read your explanations as to why these cuts singling out surgical specialists were necessary. You state that the reimbursement for Medicaid for many procedures was artificially elevated due to "new procedures gaining acceptance." Mr. Duarte, the majority of the procedures targeted with the deepest cuts are common procedures, many available for over 50 years. Yes, there are procedures that were less common or non-existent in Nevada just a few years ago. They are available now through many of our surgeons learning to perform them at our own expense, or spending additional years of fellowship training. These surgeries nevertheless, carry no less risk nor require no less expertise. Without our specialists' commitment and dedication, the opportunity for any sophisticated treatment in Nevada becomes nonexistent.

It is also no secret that the cost of doing business for every physician has gone up drastically. Along with usual cost of living increases that I do not receive from insurance payers, so I must increase my payroll and overhead to navigate the pathways not of complex medicine, but complex medical bureaucracy. New this year - the costs of new federally mandated privacy protection and of course my outrageous malpractice premiums. Nevada is a small state. We do not have the volumes of patients necessary to counterbalance lower reimbursement.

Furthermore, we have not yet had any malpractice premium relief, at least in my specialty. What is particularly disconcerting is that there still remain exceptions to the $350,000 malpractice cap recently enacted. The most common reason mentioned for these exemptions is how to potentially compensate for a "brain damaged child." As a large number of children are seen by our state's

Neurosurgeons through the Nevada Medicaid Program, I am now placed in double jeopardy by assuming their care - uncapped liability compensated below my break-even point.

Thus the viability of any Nevada pediatric sub-speciality practice is questionable, due to these uncertainties and now limited reimbursement. Fallout of course will spread far beyond our Medicaid pediatric population. All children now become innocent victims of your decision. Neither Las Vegas nor Nevada will ever have a dedicated pediatric hospital or a full time pediatric neurosurgeon.

I now join the legion of colleagues, particularly in pediatric subspecialties, no longer part of the Nevada Medicaid Program. Both adults and children will be forced to go outside of Nevada to obtain care currently available here. If the goal of the Medicaid Program is to make those individuals independent of the public dole, then you propose to do so by taking families away from their ability to consistently become self-sufficient and gainfully employed. Dollars that could be reinvested in Nevada will flow out of our state and resources already paid for will become dormant and depreciated. Costs for emergency room visits will rise due to inconsistent and poorly coordinated care. Nor can the emergency departments themselves substitute for or serve as the conduit for specialty care. To do so will only add to the problem.

Look towards Utah and see the future of our state's Medicaid program. For many reasons including poor reimbursement, medical specialists have withdrawn from the Utah Medicaid Program throughout the state. Now, Utah Medicaid patients cannot find medical and surgical specialists in all but a few communities. The progression of their care grinds to a halt. Physicians become caretakers and not healthcare providers. Patient's anger and frustration becomes evident and degrades what little resources are left.

I would be happy to listen and participate in a meaningful discussion with you and the members of your office. You have stated that you would reassess our compensation if the situation became severe enough. I would implore you not to wait until the distance between your office and the medical community is insurmountable. Without due consideration Mr. Duarte, we will continue to lose physicians without replacing them, place our neighbors in jeopardy, and disproportionately deny more than those without means accessibility to anything greater than just basic healthcare.

I await your answer.

Sincerely,

BENJAMIN H. VENGER, M.D.

Managing Partner

Western Regional Center

For Brain and Spine Surgery

cc: Governor Kenny Guinn

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CEO Editorial

By Weldon (Don) Havins, M.D., J.D., CCMS CEO and Special Counsel

LOOMING CRISIS IN THE JUDICIARY

District Court Judge James Hardesty (Reno), president of the Nevada District Judges Association and Chief Judge of the Second Judicial District Court recently wrote Senator Randolph Townsend about the "alarming" increase in the number of medical malpractice suits filed in Nevada District Courts in Reno and Las Vegas. Judge Hardesty stated that there would be "roughly twice as many cases" in Washoe County in 2003 than was seen in the years 2000 and 2001. In Clark County, Judge Hardesty notes that there will be more than twice as many cases of medical malpractice filed in Clark County than cases filed in 2000 and 2001.

This increase in the number of medical malpractice cases "presents a serious problem for the District Courts." AB 1 shortened the time for these cases to be tried. Cases filed before October 1, 2005 must be tried within 3 years of the date of filing or be dismissed. Cases filed after October 1, 2005 must be tried or dismissed within two years from the date of filing. Additionally, all cases are now subject to a mandatory settlement conference before a District Court Judge who is not the trial judge. Under the prior law, mandatory settlement conferences were only required when the Medical Dental Screening Panel found a reasonable probability of malpractice by the physician or dentist.

All of this implies preference in handling these medical malpractice cases. Jury trials in criminal cases, cases involving litigants over the age of 70, mechanics lien claims, and construction defect cases are also required preferential treatment under Nevada law. How much preference can be provided?

"The combination of increased case filing in medical malpractice cases, shortened time for trials and 4 to 5 times as many settlement conferences has created a looming crisis for the judiciary," states Judge Hardesty.

To the crisis in affordability and availability of professional liability insurance, the impending crisis in access to medical care in certain specialties, the critical nurses shortage, and the availability of hospital beds, we can now add the "looming crisis for the judiciary" in meeting legislative mandates under current Nevada law.

MEDICAL LIABILITY DICTATING MEDICAL CARE?

In a recent Journal of Obstetrics of Gynecology (the "green journal"), OBGYNs at Boston's famous Brigham and Women's Hospital examined the effect of Cesarean deliveries and the costs of liability lawsuits. Specifically, 205,241 births resulted during the study period. From these, 91 lawsuits were initiated with costs totaling $49,822,976. Among the cases in which the route of delivery may have affected the outcome, the authors estimated $42,474,774 might have been saved if 69 cases had delivered by planned cesarean section, and $361,524 in liability costs might have been saved if five patients had delivered vaginally rather than by cesarean. In only 17 of the 91 cases, with costs of $6,986,678, was the route of delivery irrelevant to the outcome.

The authors estimated that insurers' costs for a model of universal cesarean section delivery would be $8,794,298, or a potential savings of $41,028,678 (82%). Thus, a policy of 100% cesarean section deliveries could reduce professional liability costs by 82%. Should patients be subjected to "medically unnecessary" surgery simply to reduce, however substantially, medical liability costs? Remember, these medical liability costs concern more than just the dollars paid by insurers. Medical liability assessed against a physician can have devastating consequences on the future availability of insurance to a particular physician. Lack of insurance in Clark County essentially renders a physician unable to practice medicine due to the requirements of insurance plans and managed care plans.

More than one Clark County obstetrician has stated that cesarean sections should be performed now for the most minimal, even trivial, indications. This all may be one of the first indications of medical liability concerns trumping the standard of care.

THE CONSTITUTIONALITY OF MEDICAL LIABILITY TOTAL DAMAGES CAPS

In 1998, the Nebraska State Legislature promulgated a law limiting recoverable damages in medical malpractice action to $1,250,000. This limitation is per injury, no matter the number of plaintiffs, no matter the number of defendants. When baby Colin Gourley and his parents sued for alleged injuries caused by negligence during delivery, the district court determined the total damages limitation, which would have reduced the jury verdict of $5,625,000 to $1,250,000, to be unconstitutional because it denied the plaintiffs of the equal protection of the law, and a right to a jury trial. The defendants, Nebraska Methodist Health System, Inc., and Michele Knolla, MD, the obstetrician, appealed the District Court ruling. The case is cited as Gourley v. Nebraska Methodist health Sys., 265 Neb 918, filed May 16, 2003.

On Friday, May 16, 2003, the Nebraska Supreme Court held CONSTITUTIONAL Nebraska's 1998 law limiting recoverable damages in medical malpractice actions to $1,250,000. The Nebraska Supreme Court ordered the verdict reduce from $5,625,000 to $1,250,000.

The next time you hear someone pontificating on the constitutionality or unconstitutionality of a law or proposed law, keep in mind that constitutionality or unconstitutionality is determined by the majority of the justices of the supreme court of the state, and only by the justices of the supreme court of that state. As the debate on the KODIN Initiative intensifies, remember that only the Justices of the Nevada Supreme Court, and no one else, will determine the constitutionality of any particular provision or law.

THIRTEEN STATES PUSH TO LIMIT LAWYERS' CONTINGENCY FEES

Lawyers in 13 states (Alabama, Arizona, California, Colorado, Maryland, Mississippi, New Jersey, New York, Ohio, Oklahoma, Texas, Utah and Virginia) have begun a coordinated campaign to limit contingency fees lawyers routinely take from their clients, no matter how hard or long the plaintiff attorney works on the case. Ethical rules in most states require lawyers to charge only "reasonable fees". Typical contingency fees in Nevada medical malpractice cases run 40%, with some attorneys contracting to take one-third of an award or settlement (plus costs, of course), particularly if the case doesn't go to trial. Ethical rules for lawyers are established not by legislatures, but by bodies responsible for ethics rules, often the state supreme court or the state bar association.

The new proposal would limit contingency fees in many cases to 10% of the first $100,000 of a settlement, and 5% of anything more. Common Good, an advocacy group pushing for the change, filed all the cases within the last couple weeks (except the petition in Texas, which was filed several months ago). The proposal would require the plaintiff's lawyer to send a letter to the defendant at the start of a case, describing the injury and why the defendant was liable for it. The defendant would not be required to make a settlement offer, and the plaintiff would not have to accept the settlement offer, if made. But if the defendant did make an offer and the plaintiff accepted it, his lawyer would be entitled to no more than 10% of the first $100,000 and 5% of anything more.

If the plaintiff's lawyer did not send the letter, the plaintiff lawyer's fees would be capped at those levels, no matter how long or hard they worked on the case.

Nancy Udell, general counsel for Common Good, stated that the proposal would encourage defendants to make larger early settlement offers. One of the reasons for this, she proffers, is that defense lawyers are paid by the hour and have incentives to prolong cases. Needless to say, the proposal has not been greeted with particular enthusiasm by plaintiffs' attorneys.

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Proposed Competency Re-Licensure Regulation Results

The Nevada Board of Medical Examiners, meeting May 30th, tabled consideration of the proposed competency regulations. The chairman of the committee, Don Baepler, PhD, will revisit the issue at the board meeting on September 27 or at the following board meeting usually held in December.

Those interested in following this matter should contact Dr. Baepler through the NBME. Interested persons should request being placed on the NBME mailing list by writing to:

Nevada Board of Medical Examiners

1105 Terminal Way, Suite 301

Reno, NV 89502

Placement on the mailing list is valid for 6 months and must be renewed every 6 months. Those individuals on the mailing list receive agendas of board meetings and proposed regulatory changes.

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Referral Tallies

The following referrals were provided to CCMS members in the second quarter of 2003 (through June 15)

Specialty Referrals

Addiction Medicine 1

Allergy 1

Anesthesiology 5

Cardiology 6

Cardiovascular Surgery 2

Colon & Rectal Surgery 3

Dermatology 7

Diagnostic Radiology 0

Endocrinology 8

Family Practice 20

Gastroenterology 7

General Surgery 6

Geriatrics 6

Gynecologic Oncology 1

Hematology 3

Infectious Medicine 2

Internal Medicine 25

Nephrology 0

Neurology 9

Neurosurgery 0

Ob-Gyn 40

Oncology 7

Ophthalmology 3

Oral/Maxillofacial Surg. 1

Orthopaedic Surgery 16

Otolaryngology 7

Pain Management 5

Pathology 0

Pediatrics 3

Ped. Psychiatry 0

Ped. Surgery 0

Physical Med/Rehab 2

Plastic Surgery 5

Preventative Medicine 0

Psychiatry 6

Pulmonology 5

Radiology 0

Rheumatology 5

Urology 7

Vascular Surgery 0

Totals 224

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Minutes Synopsis

(Members can receive a full copy of meeting minutes by calling 739-9989.)

CLARK COUNTY MEDICAL SOCIETY BOARD OF TRUSTEES MEETING

Tuesday, May 20, 2003; 6:00 P.M.

Action Items

The minutes from the April 15th Board meeting were approved.
Dr. Ashton reported the financial status of CCMS is better than was anticipated at the beginning of the year, mostly due to reductions in expenses.

Committee Reports

Deb Barton reported RSVPs for the Installation dinner are trickling in. Thus far, 53 have reserved seats but more are expected to reserve closer to the deadline. Posters were placed in the hospitals.
The following applicants were approved for membership: Christina Dixon, MD, Michael Fishell, MD, Jason Garber, MD, Karen Goodman, MD and David Slattery, MD Dr. Evins reported he was in Carson City last week. He stated the Assembly replaced the contents of SB97 with a bill written by the trial lawyers association. This bill would establish a competing referendum proposal on the ballot for 2004 which would confuse voters. CCMS sent a fax broadcast out asking doctors to call their legislators and urge them not to pass this amended bill.
Dr. Evins informed the board that Rudy Manthei, the KODIN President, had chest pains last week which resulted in the need for him to undergo angioplasty.
Dr. Chemplavil announced Dr. Evins was elected as the Secretary of NSMA at the annual meeting. Dr. Lynn Horne was elected as the new AMA Delegate. Dr. Marietta Nelson was elected as the AMA Alternate Delegate. The formal list of resolutions will be published in the County Line newsletter.
Dr. Kingsley reported the Competency Testing ad hoc committee wrote a position paper which was presented at the NBME workshop on April 30. Around 60 physicians attended the workshop, all with negative testimony given on the proposed new re-licensure regulations. The NBME will make their decision at their board meeting on May 30 at 4:30pm. This meeting will be video-conferenced to the Contractor's Board office in Henderson.
Dr. Ellerton stated 25 pages of amendments on AB320 were released today. The bill now contains elimination of panel fees for all insurance companies, and AB 320 contains insurance reforms. Dr. Havins reported on other bills of physician interest. SB250 has not yet passed the Senate. SB350 which stops dentists from being sent for felony prosecution for displaying their earned "M.D." passed both houses unanimously and was signed into law as an emergency measure by the Governor (became effective upon the Governor's signature). SB332 which contains provisions regarding displaying earned M.D. degrees by physicians is still in the Assembly. Dr. Evins noted the northern physicians have a concern regarding lab results not being provided to treating physicians by the lab (lab results can only be provided to the patient and the ordering physician). A bill rests in the legislature which, if enacted, will cure this inconvenience.
Dr. Colletti made contact with the Community Nursing Committee and signed up to be involved in the committee's deliberation.
Dr. Evins reported Karen Schroeder was installed at the Annual meeting in Reno as the Alliance President-Elect. Karen Schroeder presented the Alliance's annual report. The CCMS Alliance collected over $18,000 during the past year, all of which was distributed to the community in a variety of projects.
Dr. Ellerton reported he has callers giving reminders that scholarships are given to medical and nursing students at UNLV and Community College. Criteria are first time students which are from Clark County. The Scholarship Fund traditionally gives out 12 scholarships of $1,000 each.

President's Report

Dr. Evins announced the winners from the election ballots. Dr. Evins reminded the board members of the Installation dinner scheduled for May 31. He announced Dr. Havins won the Harold Lee Feikes MD, Memorial Award. Dr. Joe Hardy won the NSMA Community Service Physician of the Year award which was presented at the NSMA Annual meeting. Senators Ann O'Connell and Sandra Tiffany won the Nicholas J. Horn award.

Administrative Report

Dr. Havins reported Darlene Galleron, Washoe County Medical Society's Executive Director, asked for and received a letter from the Insurance Commissioner stating they could, as an association, apply for group health insurance. They are obtaining proposals. CCMS will follow this along to determine the viability of this as a member benefit for CCMS.

New Business

Dr. Evins announced Dr. Joe Hardy's bill, A.B. 404, is stuck in the Ways and Means committee. Dr. Hardy asked CCMS to endorse this bill and fax broadcast a request to contact committee legislators. The bill would allow the Nevada Health Centers to employ four OB physicians who would then be covered by the $50,000 liability cap. After discussion, the board determined there was not enough information regarding the bill to endorse it by the Friday deadline.
Dot Freel suggested converting the grass on CCMS property to desert landscaping in order to save on water and maintenance fees. Dr. Evins had suggested staff call the water district to determine if CCMS would qualify for the water conservation rebate. Dot Freel met with Roy Thomas who offered CCMS a contract to do this conversion. Mr. Thomas stated water bills are expected to rise 39% in August. CCMS is currently using approximately one million gallons of water per year. Converting would change water usage to approximately 300,000 gallons a year. Staff was directed to go forward with this water conservation program conversion.
Per the bylaws, the Board of Trustees was to review and establish the dues at the May board meeting for the upcoming year. Dr. Jones moved to change the dues for Physician Assistants from $50 to $150, $75 to NSMA and $75 to CCMS. The motion was seconded and passed unanimously.
Dr. Steinberg moved to increase the CCMS dues portion for membership from $350 to $400. Dr. Ellerton seconded the motion. The motion did not obtain a majority vote.
There was a motion to increase the dues for residents from $30 to $50, $20 to CCMS, $30 to NSMA. The motion was seconded and passed unanimously.
At the NSMA Annual meeting, a resolution was passed to decrease NSMA dues to half price for all new members for the first year of membership. The board agreed to decrease CCMS dues for all first time new members' to half price.
The next meeting will be Tuesday, June 17, 2003 at 6 PM.

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Alliance Message

By Annette Mohs, 2003-2004 CCMS Alliance President

Greetings from the Clark County Medical Society Alliance (CCMSA). As the Alliance's new President, I would like to say a few words to you all with regard to our organization.

The Clark County Medical Society Alliance is an organization solely comprised of the spouses of physicians here in Southern Nevada. I wish to invite every eligible medical spouse to join the Alliance, and I hope that you will encourage your wives and husbands to consider participating. Let me tell you why this is important.

One of our key functions is to promote goodwill through charity and volunteerism. We feel that this reflects positively on the medical community as a whole. There has never been a time when engendering goodwill toward medical practitioners has been more important. The ongoing medical liability crisis appears to continue unabated, and those who oppose liability reform are likely to paint physicians in as bad a light as possible to further their cause.

With your help and donations, the Alliance gave over $19000.00 to Southern NV charities this year. The Annual Holiday Greeting Card Project is only a $50 donation on your part. Last year it provided for 3 nursing scholarships, and monies were given to several charities such as Shade Tree, Families for Effective Treatment of Autism and the Women's Development Center. All of these charities are told the funds have been donated by our generous physicians’ families.

The Alliance also supports and works with the Clark County Medical Society. Last year we interviewed political candidates to discern which candidates were pro-doctor. We worked with the physician taskforce and the Keep Our Doctors in Nevada Initiative Committee collecting postcards and signatures. We arranged with the Society the Protect Nevada Medicine Dinner and asked Dr. Palmisano, the AMA president elect to come speak.

If your spouse has not considered Alliance membership before, now is the time. We need the support of every physician's spouse. We understand you may be too busy to be an active member, but still please be a member. Our $65.00 dues enables the CCMSA to continue to address public health issues, advocate sound legislation, and support you, our local medical community.

Please do not hesitate to contact me at 248-9624 for further information. Thank you, Annette Mohs

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CME Calendar

Cardiovascular Consultants 691-9154

Clark County Medical Society 739-9989

7/19 - “The Physician as an Expert Witness,” 8:45 - 11 a.m., 2 CME hours

Future Programs Planned

August - “Patient Consent and Rights,”

“End of Life”

September - “Health Care Fraud and Abuse”

St. Rose Hospital 616-5832

Southwest Medical Associates 242-7347

7/10 - “Pain and Addiction Challenges and Controversies”

Sunrise Hospital 731-8210

UMC 383-2604

Valley Hospital 388-4847

7/8 - “Immunizations for Children and Adults,” noon

7/22 - “Osteoporosis,” noon

8/12 - “Length of Stay and Costs,” noon

8/26 - “Radiation Oncology Relating to Breast and Prostate Cancer,” noon

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.

*Special Note: CCMS members can receive free CME courses on the internet with World Medical Leaders.

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CLARK COUNTY HEALTH DISTRICT DISEASE STATISTICS* - May 2003

DISEASE CASES REPORTED YEAR TO DATE

May 2002 May 2003 2002 2003

VACCINE PREVENTABLE DISEASES

DIPTHERIA 0 0 0 0

HAEMOPHILUS INFLUENZA 1 0 4 2

(invasive)

HEPATITIS A 0 2 9 6

HEPATITIS B 7 4 19 25

INFLUENZA 2 2 59 47

MEASLES 0 0 0 0

MUMPS 0 0 1 0

PERTUSSIS 1 2 1 5

POLIOMYELITIS 0 0 0 0

RUBELLA

Contents

Dr. Kingsley installed as president at 2003 Installation Dinner