Clark County Medical Society

County Line

Newsletter XL     May 2003

 

Contents

Election for 2003-2004 Trustees, Officers accepting ballots through May 16

President’s Message

New Members

Membership Applicants

In Memorium

The “Gross Malpractice” Exception to the A.B. 1 Damages Cap

Letters to the NSBME Re: Proposed Competency Testing

Deadline is now for federal HIPAA regulations: Confusing debut for privacy rule

Dr. Rudy Manthei Responds to Senate Judiciary Amendments to Senate Bill 97

Calendar of Events

Malpractice Filings

Alliance Message

Minutes Synopsis

CEO Editorial

CME Calendar

Clark County Health District Disease Statistics – March 2003

Classifieds

County Line Advertisers

 

 

 

Election for 2003-2004 Trustees, Officers accepting ballots through May 16

By Deborah Barton, CCMS Public Relations Coordinator

            Official Voting Ballots for the 2003-2004 Board of Trustees and Nominating Committee were placed in the mail on April 18. The candidates on this ballot were either selected by the Nominating Committee or were submitted by write-in on the Nominating Slate.

            Voting Ballots will be accepted at the CCMS office, 2590 East Russell Road, until 5 p.m. on Friday, May 16. Only original ballots will be accepted, so please mail or deliver your votes by the deadline.

 

President Elect (One To Be Elected)

 

Secretary

 

Delegate Chair

 

Trustees (Five To Be Elected)

 

Nominating Committee

 

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President’s Message

By Warren Evins, M.D., PhD, 2002-2003 CCMS President

Senate Medical Liability Reform Bill Fails

            Last month, I wrote about the defeat of the Keep Our Doctors in Nevada (KODIN) Initiative Proposal in the Senate Judiciary committee, chaired by Senator Mark Amodei (R-Capitol Senatorial District).  Unfortunately, I have the sad duty of reporting the defeat of SB 97, the amendable form of the KODIN Initiative in bill format.  I was in Carson City on April 10, 2003, attending the Senate Judiciary committee meeting, when the committee, by a 4 to 3 vote, deleted the entire contents of SB 97.  (I think that 3 voted to eliminate the bill entirely.)   New provisions were added to the now completely changed SB 97 to penalize insurance companies if they don't readily agree to physician requests to negotiate settlements within policy limits.  Other changes were to add physician's assistants and dentists to the definition of "health care provider" and to have the pre-trial screening/conference with a district court judge.  These changes allowed the committee to call the bill a "fine tuning" of the AB-1 law passed during the July, 2002 Special Legislative Session.

            Also present at the Carson City Senate Judiciary committee meeting were Larry Matheis, NSMA Executive Director, Scott Craigie and his assistant, Michael Hackett, NSMA and KODIN's lobbyists, and Kerri Earley, a defense attorney representing us.  No one, however, was allowed to address the committee, although Senator Dennis Nolan left the committee desks and conferred with us prior to voting.  The committee's meeting had been postponed from the previous day at the last moment, when all of us and Rudy Manthei, DO, Chairman of KODIN were also present.  John Ellerton, MD, arrived a little later that day. 

 

Other Legislative Notes

            Several bills remain pending in the Legislature that affect physicians directly or indirectly.  These include: elimination of excessive physician paneling fees, continuity of care, contracting and prompt payment issues, requiring the availability of payment schedules before physicians sign contracts, use of a single standardized credentialing form, re-establishment of the Medical Dental screening panel chaired by a paid administrative law judge (the frequency of med mal claims has skyrocketed since the panel's elimination), new regulations for professional liability (med mal) insurers, issues related to the licensing and oversight of physicians, and changes for the Board of Medical Examiners.

            I continue to represent CCMS at the weekly meetings of the KODIN committee and of NSMA's Legislative Core Group.  The Core group discusses pending legislation affecting physicians.  NSMA publishes periodic (usually 4 to 8 times a month) email legislative updates.  You can subscribe to these email updates by contacting NSMA.

            I was delighted to talk with some of our Senators in Carson City who support us: Senators Ann O'Connell, Sandra Tiffany, Barbara Cegavske, Dennis Nolan and Warren Hardy.

 

CCMS Elections

            The election of the 2003-2004 Officers and Trustees of CCMS ends May 16, 2003.  I hope everyone sends in their ballots.  Please note: the original ballot with blue letterhead must be returned by mail or hand delivered to CCMS. No faxed ballots will be accepted. Several positions are contested by petition candidates.  Please vote wisely.

 

Installation Dinner

            The new Officers and Board of Trustee members will be installed at a banquet to be held Saturday night, May 31, 2003, at the Green Valley Ranch Hotel and Casino at I-215 and Green Valley Parkway.  We will install Ed Kingsley, MD, oncologist, as the 2003-2004 President of CCMS.  All terms start July 1st.  CCMS will present the Harold Feikes Award and other membership awards.  I don't expect that State Legislators will be able to attend, as this will be the final, usually very hectic week-end before the Session ends on Monday, June 2nd.

 

NSMA Annual Meeting

            A small group of delegates, representing CCMS, will attend the NSMA Annual House of Delegates meeting in Reno from May 16 to 18, 2003.  CCMS members constitute greater than 60% of NSMA’s membership. CCMS is down about 100 members from last year.  CCMS is entitled to 36 delegates, but as of April 15th, only 9 delegate attendees have confirmed.

 

CCMS Member Photo Directory

            The 2003 edition of the CCMS Membership Photo Directory debuts this summer.  Please inform our office if you desire changes in your practice location, phone or fax numbers, email address (for CCMS use only), or other information.  All members who are current in their dues receive a complimentary copy

 

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New Members for March 2003

Congratulations and Welcome to the Clark County Medical Society

 

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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

 

 

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

 

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In Memorium

 

The Clark County Medical Society is saddened to announce the passing of Dr. Avron “Bud” Genser on Tuesday, April 15, 2003. Dr. Genser was born June 21, 1928 and was a 19 year resident of Las Vegas.

 

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The “Gross Malpractice” Exception to the A.B. 1 Damages Cap

An Inappropriate Windfall Which Could Cost All Insureds Higher Premiums

 

By Weldon (Don) Havins, M.D., Esq.

C.E.O. and Special Counsel

            Gross malpractice as an exception to the $350,000 "cap" on noneconomic damages creates unnecessary unpredictability in awards, uses the negligence standard of proof when a clear and convincing standard should be applied, and does not punish the doctor for the doctor's egregious conduct.

            The term "gross malpractice"1  is not found in any other statute in Nevada or any statute of any other state.  Gross malpractice, an exception to the $350,000 cap on noneconomic damages under AB 1, is defined as a conscious indifference to the consequences of the conduct constituting gross malpractice, and "disregard for and indifference to the safety … of the patient". 

            The correct terminology for this conduct should be medical gross negligence.  In the common law gross negligence amounts to willful, wanton, or malicious conduct, or reckless conduct in disregard for the consequences of the reckless conduct.  When proven by clear and convincing evidence, punitive damages are available to punish the tortfeasor for his or her egregious conduct which causes injury to another person.   Punitive damages are not payable by an insurer and are not dischargeable in a Chapter 7 liquidation bankruptcy.

            Under Nevada law, punitive damages are available when proven by clear and convincing evidence that the defendant has been guilty of oppression, fraud, or malice2…. The Nevada Supreme Court, in Granite Construction, 107 Nev. 651, sustained the District Court's interpretation of malice (in NRS 41.005) to include “a conscious and deliberate disregard for known safety procedures” and permitted the awarding of punitive damages.  The Federal District Court in Nevada concluded a plaintiff had a viable claim for punitive damages because the plaintiff alleged that the defendants had acted with a conscious disregard for known safety standards and measures. (Coughlin v. Tailhook Ass'n, Inc., 818 F. Supp. 1366, 1370-71 (D.Nev.1993)).   Upon appeal to the Ninth Circuit Court of Appeals, the Appeals Court agreed with the Nevada Supreme Court's interpretation of malice in NRS 42.005, and held that punitive damages were able upon clear and convincing evidence of a conscious disregard for known safety standards and measures.  (Coughlin v. Tailhook Assn., 112 F.3d 1152).

 

Why shouldn't "gross malpractice" (medical gross negligence) be an exception to the negligence noneconomic standard cap of $350,000?

1.  AB 1's inclusion of "gross malpractice" (medical gross negligence) under the negligence standard of proof of "preponderance of the evidence" conflicts with common law and conflicts with the law of all states addressing "gross negligence."  

2.  As an exception to the noneconomic damages in AB 1, the egregious conduct of "gross malpractice" does not punish the doctor.  Rather, the exception provides a windfall to the plaintiff paid by the doctor's insurance company. 

3.  Insurers calculate premiums based on negligence, not upon a doctor's reckless conduct amounting to a conscious indifference to the safety of the doctor's patient.

4.  This exception rewards reckless doctors who injure patients through conscious indifference to accepted safety standards.  The doctor does not pay the money.  The insurer pays the money.  The insurer then must spread the costs of that egregious conduct through the pool of insured doctors, making professional liability insurance premiums more expensive for all.  Unlike punitive damages, negligence liability awards in excess of the doctor's policy are dischargeable in Chapter 7 liquidation bankruptcy.

            Nevada's AB 1 "gross malpractice" does not exist in any other state, does not follow the standard for medical gross negligence, and does not punish the doctor for his or her egregious conduct harming a patient.  This "gross malpractice" does render an additional unpredictable variable which further destabilizes the professional liability insurance market and provides for unnecessarily expensive premiums.

            Punitive damages are available for the egregious conduct constituting medical gross negligence (gross malpractice).   Punitive damages do punish the doctor directly and do not punish all the insureds purchasing premiums from that insurer. Punitive damages are not dischargable in a Chapter 7 bankruptcy.

            As testified recently by the trial lawyers attorneys' lobbyist in Carson City, and sustained by the testimony of medmal defense attorney Kerry Earley, there has never been a case of physician "gross malpractice" found in a medical malpractice case in Nevada.  That being true, why was this "never occurs" exception included in A.B. 1?

 

1 AB 1 definition of "gross malpractice" -

Gross malpractice means failure to exercise the required degree of care, skill, or knowledge that amounts to:

            a.  A conscious indifference to the consequences which may result from the gross malpractice; and

            b.  A disregard for and indifference to the safety and welfare of the patient.

 

2  NRS 42.005 Exemplary and punitive damages: In general; limitations on amount of award; determination in subsequent proceeding.

      1.  Except as otherwise provided in NRS 42.007, in an action for the breach of an obligation not arising from contract, where it is proven by clear and convincing evidence that the defendant has been guilty of oppression, fraud or malice, express or implied, the plaintiff, in addition to the compensatory damages, may recover damages for the sake of example and by way of punishing the defendant. Except as otherwise provided in this section or by specific statute, an award of exemplary or punitive damages made pursuant to this section may not exceed:

      (a) Three times the amount of compensatory damages awarded to the plaintiff if the amount of compensatory damages is $100,000 or more; or

      (b) Three hundred thousand dollars if the amount of compensatory damages awarded to the plaintiff is less than $100,000.

 

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Letters to the NSBME Re: Proposed Competency Testing

 

March 28, 2003

 

Dear Dr. Hug-English:

            The Nevada State Board of Medical Examiners is proposing new procedures that are intended to "protect Nevadans from the practice of medicine by licensed physicians who may not be competent to do so."

            For physicians who are Board Certified specialists, maintaining privileges at an accredited hospital is deemed appropriate evidence of being medically "competent" by this proposed plan. Having practiced medicine in Nevada since 1963, I do have some familiarity with local medical practice, and I would question the validity of this concept and this proposal.

            In the first place, for all practical purposes this newly proposed plan would exclude from licensure a significant number of competent physicians who need not and/or choose not to maintain a formal hospital affiliation. On the other hand, the large majority of incompetent malpractice in Nevada is committed, I believe, by physicians who do maintain hospital privileges. The "competency" of a practicing physician is best judged not by a count of the hospitals where privileges are held, not by an arbitrary "test" created to imply a stamp of competency, but rather is evidenced by the end product: the efficiency, reliability, accuracy, and appropriateness of the medical care provided. An ongoing assessment of the successes and failures of this medical care is the only meaningful measure of the competence of the physician, in my view.

            The proposal being discussed currently will, in my judgment, not serve to improve the level of competency of medical practice in this state! I do believe, however, that there are a variety of measures that do have the potential to improve the level of medical practice, and would respectfully suggest that instead of enacting the proposal currently on the table, the Board appoint a "Blue Ribbon Panel" composed of seasoned, competent, well-trained, and respected physicians. Assign them to the task of proposing to the Board possible mechanisms that may have the effect of truly and realistically improving the level of medical practice in the state. I would suggest that the physicians appointed to such a panel should perhaps be limited to individuals who have never had a malpractice verdict against them in a court of law, and/or who have never settled a malpractice action for a "substantial" amount, however you might wish to define a settlement whose amount is clearly more than just a nuisance settlement. Perhaps senior physicians of repute and acknowledged medical competency would be a starting resource for members of such a Panel.

            I do hope that you will reconsider the current proposal. A cosmetic protocol, which does not truly accomplish a real improvement in the level of medical practice in Nevada, will only serve to disillusion the lay public further. A real effort to make meaningful substantive improvements should be carefully pursued.

            Thank you for considering these few thoughts.

 

Respectfully submitted,

Alan E. Feld, M.D.

___________________________

 

April 1, 2003

 

SUBJECT: Physician Competency Testing:

The attached open letter by Dr. Edson Parker (published in the April 2003 County Line) hits the nail squarely on the head. Although well-intentioned, your proposed testing would only inflict more unproductive, time consuming and expense demanding requirements on M.D.'s. What about the D.O. who wants the same rights and privileges as the M.D.? I sat in an "Ethics Presentation" at the Palace Station in which the elected head of the D.O.'s clearly stated that they were not, and would not, concern themselves with "micro-managing" their colleagues. The public sees doctors in one group; will you make it a policy to inform the public of the difference?

As a resident of the State since 1973, and a multiple office holder at UMC (Chief of Staff, Executive Council, etc.), I can recall numerous cases in which the Hospital and/or County and State, DID NOT do due diligence with respect to moral, ethical and behavioral crossing of the line. That extended to other hospitals as well.

In short, I agree with Dr. Parker, DON'T PASS MORE REGULATIONS…. Enforce what's already on the books. Unfortunately, most doctors will NOT take the time to reply. Apathy and indifference seems endemic within our ranks.

 

Sincerely,

Dr. Leonard Kreisler M.D.

___________________________

 

April 12, 2003

 

Dear Sirs:

            As I'm sure you realize, the issue of evaluating physician competency is a very difficult or impossible task. No single test or requirement will provide this information. Many physicians have limited their practices, for various reasons including liability insurance, to very small sub-specialties. There are, for example, physicians in this state who ONLY do hair transplants and do them very well. Requiring such a physician to take the SPEX exam is ludicrous. My own practice is limited to outpatient contraception and abortion care. I am certain that I could produce a dozen questions that pertain only to my practice and could not be answered by any other physician. These proposed regulations would distress many physicians without providing the public with ANY increase in quality of care.

            I do not envy the position you are in. The public demands and deserves competent doctors, but the means to accomplish this job do not exist. Good luck in defining a "Board approved peer review."

 

Very Sincerely,

William D. Ramos, M.D.

President, A-Z Women's Center

___________________________

 

April 17, 2003

 

Dear Board of Medical Examiners,

            While I work with physicians, I am not a medical professional and see the "Competency Testing" issue as an outsider. However as an eight-month pregnant woman, please accept this letter as the viewpoint from a patient with very strong feelings about the need for the best possible medical care available for myself and my family.

            The problem at hand does not seem to be ongoing "competency" for licensed MDs as the Board has exemplary standards for selecting the physicians to license and continuing education requirements to aid in the maintenance of the licensees' awareness of advances in their field. Additionally, the Board has investigative procedures and numerous avenues for aiding or, if needed, removing the licenses of those elderly or otherwise impaired physicians whose competency has begun to slip.

            Rather it seems the crisis demanding a solution by both the legislature and the public is ongoing proficiency and the continuing responsible practice of medicine by physicians licensed by the Board.

            Please consider this example of the difference between testing, competency and proficiency: our privilege to drive a vehicle. Any 16-year-old can request the State grant them the right to drive a 2,000 pound vehicle at speeds in excess of 60 miles per hour, putting thousands of lives at risk every day. The State recognizes that passing a written test is not an accurate measure of competency or proficiency - simply an expression of knowledge of theories and practices. (It is my understanding that any examination of physicians, written or oral, SPEX or Board Certification, is also simply an expression of "book knowledge.")

            The State then must conduct an observation of the individual's ability to drive a vehicle. This examination can indicate the individual's competency to drive the vehicle but can not indicate ongoing proficiency or responsible behavior. It is only though the continued observation of the driver, via maintaining and evaluating an ongoing accurate record of violations by the driver through insurance and police reports, that assessments can be made as to the extending of driving privileges to that driver.

            What's more, a driver takes an examination based specifically on the license he wishes to obtain. The driver of a motorcycle does not take an exam for a passenger vehicle, a limousine or a semi-truck. Likewise, a doctor who does not examine patients seems to have no business being tested on clinical practices.

            There may be few responses to the workshops regarding "competency testing" because the number of physicians directly affected by the most onerous portions of this proposed regulation are few. The majority of physicians will see that they are exempted from the "tests" because they are staffed at hospitals or they are board certified. (Local hospitals may thank the Board for instituting these new regulations as it will most certainly increase their number of physicians on staff.) But please take heed of the few voices you hear as they will represent the minority - those physicians who are most dramatically affected by the regulations, who have the fewest options to respond to them and who are least likely to be the cause of those problems that the public and legislature are demanding be solved.

            Physicians as a whole are disgusted by those among them who are reckless, irresponsible and show no value for the lives with which they are entrusted. There is certainly a need for deeper examination of complaints, particularly those made by colleagues and other health professionals, and analysis of court verdicts and settlement reports from the insurance commissioner. An anonymous medical error reporting system, as used in the airline industry, may also be beneficial. But adding additional bureaucratic hoops for doctors to contend with will only continue to weaken the profession by driving out wonderful physicians and discouraging our brilliant children from pursuing medicine as a career.

 

Sincerely,

Deborah Barton

___________________________

 

April 18, 2003

 

Gentlemen,

            This letter registers my objection to the proposed amendment to NRS 630.003, 630.130 and 630.253.   The Board has failed to offer any objective evidence that such measures are necessary. Please provide me with documentation supporting the need for this proposed legislation.

            I remind the Board that the requirement for mandatory Continuing Medical Education was intended to maintain physician competency and currency.   If this has proven to be an ineffective mechanism then I suggest the CME requirement be repealed.  The obligatory CME requirement has served to increase physician expense as educational activities that formerly cost less than $100.00 now cost up to $800.00.  Adding transportation and lodging costs to this and considering the time and income loss during course attendance the physician already bears a considerable expense which now, by your action, appears to be unwarranted.  Should the proposed regulations be enacted then this outdated and apparently worthless requirement needs to be repealed.  You cannot arbitrarily continue to increase the financial burden on physicians just because the Board thinks something would be a good idea or would increase the prestige of the Board among its peer group.

            The proposed regulations will effectively prevent a retired physician from being licensed as hospital or surgical center privileges are required.   These privileges mandate the cost of professional liability insurance.   The "Board Approved Peer Review" option is open ended, poorly defined and subject to   an undefined fiscal note for the physician.   You now propose to add these costs to those expended for CME?

            I note, in passing, that your notice of hearing, while meeting legal requirements, is not posted in those places such notice is most likely to come to the attention of the aggrieved parties.

            I shall appear in opposition to the proposed regulations at the workshop on April 30, 2003.     

 

Very truly yours,

S. M. Doubrava, M.D.

 

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Deadline is now for federal HIPAA regulations: Confusing debut for privacy rule

Please follow the link below to read this article from American Medical News:

http://amednews.com/content/pick_03/gvl10414.htm

 

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Dr. Rudy Manthei Responds to Senate Judiciary Amendments to Senate Bill 97

            This is a statement by Dr. Rudy Manthei, Chairman, Keep Our Doctors in Nevada, regarding amendments to Senate Bill 97 approved today by the Nevada State Senate's Judiciary Committee.  Those amendments were approved on a 4 to 3 vote, sending the amended version of the bill out of Committee for consideration by the State Senate.

            Senate Bill 97 was written and proposed by Keep Our Doctors in Nevada.  The original bill contained all the changes to Nevada state law that are also contained in the Initiative Petition signed by 95,000 registered Nevada voters.  That Initiative Petition has been approved by the Nevada Secretary of State and will appear on the General Election Ballot in the fall of 2004.  

Statement by Rudy Manthei:

            “Unfortunately, the Senate Judiciary Committee's version of SB 97 is not what nearly 100,000 Nevadans who signed the initiative petition wanted in a bill to solve the medical malpractice insurance crisis.

            “Nothing that the committee passed today will stop the exodus of doctors from our state.  Nothing that is in this bill will result in insurers lowering premium rates for doctors.  Nothing in this bill will encourage insurers to enter the Nevada malpractice insurance marketplace.  Nothing in this bill fosters a competitive insurance market in Nevada.

            “We intend to pursue this bill through the Senate and the Assembly to see if we can get some positive changes so that this bill can solve the problems it is intended to address.  There are still 45 days left in this legislative session, so we have not given up hope for gaining a bill that will work for Nevadans.  That is what Nevadans have shown that they want, through actions such as signing the initiative petition and through their answers in numerous polls, and that is what we will work to give them.”

 

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Calendar of Events

 

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Clark County District Court Medical Malpractice Filings Against Health Care Providers

Jan 2001 - Mar 2003

                       2001     2002    2003

Jan                   39        33       80

Feb                  20        14       72

Mar                  35        30       75

Apr                  37        34

May                 37        35

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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Alliance Message

By Karen Schroeder, 2002-2003 CCMS Alliance President

            The Clark County Medical Society Alliance (CCMSA) held an extremely successful Fashion Show Luncheon benefit in March.  In only our third year we increased our profit over 160 percent.  This endeavor was made possible through generous donations from Tenet Health Care, Giorgio Armani who presented the fashions and a $1,000 gift certificate, and a host of area businesses that donated to our silent auction and raffle prizes.  This annual event was held at the Bellagio and chaired by Karen Zamboni.  Many thanks go out to all who helped make this possible.  Recipients of the benefit were Families for Effective Autism Treatment (F.E.A.T.) and New Horizons Academy as scholarships for their core program.

            Donations of new and used preschool to grade four books have been collected all year.  These books have been given to a non-profit organization Spread the Word Kids to Kids and recently I was excited to learn that they are adopting another local elementary school into the program.  That makes two elementary schools in the past seven months!  Now folks, if you have not yet participated we are still collecting books and would love to exceed our goal of 500 books donated.  Help us help local at risk children learn to read.

             During the April general membership meeting the Alliance will give out three nursing scholarships.  Two recipients are from UNLV's nursing program and one recipient from the Community College of Southern Nevada nursing program.  As nurses are in high demand and the numbers practicing have diminished, the Alliance members are proud to do a small part in helping educate nurses.  This practice of giving nursing scholarships has been a part of the CCMSA for more than a decade.

            I am still recruiting members, their adult friends and family to participate in the Susan G. Komen Breast Cancer Foundation Race for the Cure.  During the morning of Saturday, May 3, 2003 runners and walkers will participate and the CCMSA will do its part by manning the food court.  We will replenish the food (water and fruit) as participants take them and cut oranges as needed.  Come join us, celebrate a survivor of breast cancer or honor someone who has not survived.  Call me, Karen Schroeder, at 898-2595 for more details about the event.

            The month of May brings the beginning of our membership drive and installation of officers for the year 2003-2004.  I ask that all that read this please share information with your spouses and spouses of your colleagues.  As a quote that I like to use from an unknown source says "Greater the numbers, the stronger the voice, stronger the voice, more powerful the message."  I hope over this past few months that I have given you concrete ways the Alliance is active in our community.  Thank you for listening.

 

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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, March 18, 2003; 6:00 P.M.

Action Items

Committee Reports

Alliance Report

President's Report

Old Business

New Business

 

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CEO Editorial

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

HIPAA Information

            Realizing that many CCMS members may have not yet fully complied with the HIPAA Privacy Regulations which became mandatory on April 14, 2003, the following sample Policies and Procedures is provided for your consideration.  Of course, no assurance of the even minimal adequacy of the following is made and all liability of the Clark County Medical Society and its employees is hereby disclaimed.  Therefore, use only at your own risk.  

            Attendance of at least one HIPAA Privacy Regulations seminar is strongly recommended.

            For these healthcare providers who react to the HIPAA Privacy Standards mandate with a “Bronx cheer,” the interim rule for "Civil Money Penalties; Procedures for Investigations, Impositions of Penalties, and Hearings" can be read at the following web site: 

http://a257.g.akamaitech.net/7/257/2422/14mar20010800/edocket.access.gpo.gov/2003/03-9497.htm

 

[Name of Medical Practice]

HIPAA PRIVACY REGULATIONS

POLICY AND PROCEDURES

 

ADMINISTRATIVE REQUIREMENTS

(45 CFR 164.530)

Personnel Designation

            [Name of Medical Practice] has designated [Name of Privacy Official] as the Privacy Official of our practice.  [Name of Privacy Official] will develop and implement policies and procedures in compliance with the HIPAA Privacy Regulations (45 CFR 160 - 164).

            The privacy official of [Name of Medical Practice] is the contact person to receive complaints and provide further information about matters covered in the Privacy Regulations.

 

Training

            The privacy official of [Name of Medical Practice] is responsible for training of all existing employees regarding the Privacy Regulations and our policies and procedures.  All new employees will be trained in these policies and procedures within 30 days of their date of employment.  Employees of [Name of Medical Practice] shall receive retraining in policies and procedures regarding the HIPAA Privacy Regulations every three years.

            All training of all employees shall be documented by [Name of Privacy Official].

 

Safeguards

            [Name of Medical Practice] has created and implemented appropriate administrative, technical, and physical safeguards to protect the privacy of protected health information (PHI) from intentional or unintentional use or disclose in violation of the HIPAA Privacy Regulations.

            This includes incidental uses or disclosures of PHI.

             

Complaints to [Name of Medical Practice]

            The Notice of Privacy Practices (NPP) provided to each new patient of the [Name of Medical Practice] details the manner in which individuals may make complaints concerning unauthorized use or disclosure of their PHI.   The NPP is provided to each new patient of [Name of Medical Practice] to obtain the individuals signature indicating acknowledgement of receipt of the NPP.  Patients may sign an acknowledgement of receipt of the NPP or may refuse to sign.  Reason for refusal to sign will be documented and witnessed.  No patient will be refused medical services for refusing to sign the NPP. 

            Complaints received will be documented, processed in the manner to be described, and saved for a minimum of 6 years.  This includes disposition of each and every complaint. 

 

Sanctions

            [Name of Medical Practice] will sanction employees failing to comply with the HIPAA Privacy Regulations and the [Name of Medical Practice]'s policies and procedures.  Sanctions will include:

            First event - a verbal warning.

            Second event - a written warning in the form of a letter of reprimand.

            Third event - A $100 fine and/or a suspension without pay for no more than 1 week.

            Fourth event - termination.

The Privacy Official shall document all sanctions and keep these records for at least 6 years.

 

Mitigation

            [Name of Medical Practice] will mitigate, up to $500, damages caused by the unauthorized use or disclosure of an individual's PHI when those damages occur from other than incidental conduct by [Name of Medical Practice] or an employee or volunteer of [Name of Medical Practice].

 

Refraining from Intimidating or Retaliatory Acts

            [Name of Medical Practice] will not intimidate, threaten, coerce, discriminate against, or take other retaliatory actions against an individual who files a complaint with [Name of Medical Practice], files a complaint with the Secretary of Health and Human Services, testifies, assists, or participates in an investigation or compliance proceeding, or opposes any act or practice made unlawful by the regulations, providing that the act is in good faith belief of unlawfulness, and the opposition is reasonable and does not involve the disclosure of PHI.

 

Waiver of Rights

            [Name of Medical Practice] will not require a waiver of rights as a condition of treatment or to bill for or accept payment for services.

 

Reservation of Right to Modify Policies and Procedures

            [Name of Medical Practice] reserves the right to modify, amend, or otherwise change the practice's Policies and Procedures, at any time, when not inconsistent with applicable Federal and State law and/or regulations.  Any such modifications, amendments, or changes shall apply only to PHI created or received after the date of such modifications, amendments, or changes.

 

[specific policies and procedures, as they exist or are developed, should be described from this point onward]

example:

AUTHORIZATIONS

(45 CFR 164.508)

            [Name of Medical Practice] will obtain authorization from an individual prior to use and disclosure of that individual's PHI except as provided by HIPAA Privacy Regulations or other applicable law. 

            Except for psychotherapy notes, [Name of Medical Practice] will not obtain an individual's authorization to use or disclose PHI for treatment, payment, or healthcare operations purposes.  Unrestricted use or disclosure of PHI will apply in treatment situations.  [Name of Medical Practice] will utilize minimum necessary use and disclosure rules for payment and healthcare operations.

            [Name of Medical Practice] will not obtain authorization for use or disclosure of PHI when use or disclosure of PHI is required by law, including disclosures to the HHS Secretary (or the Secretary's authorized representative) for enforcement of the HIPAA Privacy Regulations.

            [Name of Medical Practice] will obtain the individual's authorization to use or disclose PHI for the following purposes:

1.         Marketing

2.         Pre-Enrollment Underwriting

3.         Employment Determinations

4.         Fundraising

5.         Psychotherapy Notes

 

Revocation of Authorization

            [Name of Medical Practice] will honor an individual's revocation of their authorization at any time, except to the extent that [Name of Medical Practice] has taken action in reliance on the authorization.  If the individual elects to revoke the authorization, he or she must revoke the authorization in writing. Individuals do not have the right to revoke an authorization if the authorization was obtained as a condition of obtaining insurance coverage and the insurer obtained the authorization with the right to contest a claim under the policy.

 

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CME Calendar

Cardiovascular Consultants     691-9154

Clark County Medical Society     739-9989

Future Programs Planned

June - “End of Life”

July - “Medical Legislative Update,”  “Expert Witness”

August - “Patient Consent and Rights”

Desert Radiologists     598-1006

St. Rose Hospital     616-5832

Southern Nevada AHEC     318-8452

Southwest Medical Associates   242-7347

Sunrise Hospital     731-8210

UMC     383-2604

Valley Hospital     388-4847

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

To have your CME courses listed on our calendar, please contact Deborah Barton at 739-9989 prior to the deadline of the 12th each month.

 

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CLARK COUNTY HEALTH DISTRICT DISEASE STATISTICS* - MARCH 2003

 

DISEASE                                         CASES REPORTED           YEAR TO DATE

                                                    Mar. 2002   Mar. 2003         2002        2003

VACCINE PREVENTABLE DISEASES

DIPTHERIA                               0          0          0          0

HAEMOPHILUS INFLUENZA      2          0          3          2

          (invasive)                        

HEPATITIS A                             4          1          10         4

HEPATITIS B                             4          7          7          17

INFLUENZA                               27         16         51         28

MEASLES                                0          0          0          0

MUMPS                                    0          0          0          0

PERTUSSIS                              0          0          0          1

RUBELLA                                 0          0          0          0

TETANUS                                 0          0          0          0

 

SEXUALLY TRANSMITTED DISEASES

AIDS                                        20         22         54         55

CHLAMYDIA                            378       389       1110     1147

GONORRHEA                          134       129       391       412

HIV                                          7          26         29         59

SYPHILIS                                  1          0          1          1

          (Primary & Secondary)    

SYPHILIS (Early Latent)             3          6          4          10

 

ENTERICS

AMEBIASIS                              3          4          6          7

BOTULISM-INTESTINAL             0          0          0          0

CAMPYLOBACTERIOSIS           4          7          20         21

CHOLERA                                 0          0          0          0

CRYPTOSPORIDIOSIS              1          2          2          2

E. COLI O157:H7                       0          0          1          0

GIARDIASIS                              6          7          26         21

ROTAVIRUS                              63         61         190       245

SALMONELLOSIS                     10         5          40         16

SHIGELLOSIS                           0          5          0          6

TYPHOID FEVER                      0          0          0          0

YERSINIOSIS                            0          0          0          0

 

OTHER

ANTHRAX                                 0          0          0          0

BOTULISM INTOXIFICATION       0          1          0          1

BRUCELLOSIS                          0          0          0          0

COCCIDIOIDOMYCOSIS            3          2          6          9

ENCEPHALITIS                         1          0          1          0

HANTAVIRUS                            0          0          0          0

HEMOLYTIC UREMIC                0          0          0          0

            SYNDROME (HUS)

HEPATITIS C                             0          0          0          0

HEPATITIS D                             1          0          1          0

LEGIONELLOSIS                       0          1          0          1

LEPROSY (HANSEN'S DISEASE)      0          0          0          0

LEPTOSPIROSIS                      0          0          0          0

LISTERIOSIS                             0          0          0          0

LYME DISEASE                        0          0          0          1

MALARIA                                  0          0          1          0

MENINGITIS,                             9          7          18         13

            ASEPTIC/VIRAL

MENINGITIS, BACTERIAL          4          6          9          10

MENINGOCOCCAL DISEASE    3          0          8          2

PLAGUE                                   0          0          0          0

RABIES (HUMAN)                     0          0          0          0

RELAPSING FEVER                  0          0          0          0

RSV (RESPIRATORY                562       343       1453     1127

          SYNCYTIAL VIRUS)        

ROCKY MOUNTAIN                   0          0          0          0

            SPOTTED FEVER

TOXIC SHOCK SYNDROME       0          0          0          0

TUBERCULOSIS                       0          8          8          21

TULAREMIA                              0          0          0          0

                         *Numbers include confirmed and probable cases

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Classifieds