A recent study by the Employment Policy Foundation (a nonprofit, nonpartisan public policy research and educational foundation based in Washington, D.C. focused on workplace trends and policies) revealed that unlimited, uncapped medical malpractice litigation has had the following effects:

- resulted in up to $97.5 billion annually to the cost of hospital and physician services;

- increased the annual cost of employer-provided health insurance by up to 12.7%;

- decreased by 2.7 million the number of workers and their families covered by employer-provided health insurance;

- caused a 6% decline in physicians in the U.S., many of whom work in critical specialty areas;

- eliminated access to critical medical services for up to 14.4 million people;

- generated malpractice underwriting losses of $8.6 billion in 2001; and

- resulted in a low predictive value in identifying whether medical malpractice has occurred.ⁱ

In terms of 2001 health insurance costs, curbing medical malpractice excesses with firm caps in the $250,000 - $350,000 level would reduce total employer-sponsored health insurance plan costs by $17.4 to $30.9 billion.

From 1990 through 2000 general medical costs rose 60%. In the same period medical malpractice tort costs rose 140%. Between 1995 and 2001, median jury awards in medical malpractice cases doubled from $500,000 to $1,000,000; median settlement amounts rose from $350,000 in 1995 to $500,000 in 2001 according to Jury Verdict Research, Inc. The Insurance Information Institute reports payments in closed cases doubled from $63,750 in 1991 to $135,941 in 2001.

The Physicians' Insurers Association states that between 1991 and 2001, the number of medical malpractice claims closed with payments to plaintiffs increased from 27.1% to 33.3%. Bob Byrd, president of the Medical Liability Association of Nevada (MLAN - "the Governor's Plan") testified before the Senate Judiciary Committee this last session that 70% of medical malpractice cases are concluded without payment to the plaintiff, 25% of cases settle, 5% go to trial with the majority of those won by the doctor defendant. A perusal of Clark County District Court medical malpractice trials from 1996 through 2001 revealed a verdict for the defense in 55% of the cases. Medical malpractice trials frequently occurred more than four years after the filing of the case. With our current A.B. 1 law in place, medical malpractice cases filed after October 1, 2003 must get to trial within three years of filing. Medmal cases filed after October 1, 2005 will be required to be brought to trial within two years.

The costs of defending a medical malpractice claim, nationwide, averaged $28,801 per case. The costs of defending medical malpractice cases in Clark County, Nevada are said to be substantially higher than the national average, although Nevada insurers are reluctant to disclose publicly a specific average cost. With the more than doubling of the frequency of medmal cases filed against Clark County physicians in 2002 and 2003 (see attached chart and graphs), the costs of defending these cases alone will tend to drive up professional liability insurers' premium demands.

Nationally, medical malpractice litigation costs are reflected in underwriting losses. Losses doubled from $4.1 billion in 1991 to $8.6 billion in 2001. To compensate for the underwriting losses in 2001, premiums would need to increase by 50% in 2002. Frustrating many observers is the Employment Policy Foundation's conclusion that only 38% of the total dollars that flow though the malpractice litigation system are received by the plaintiffs. With 70% of claims settled without a payment to the plaintiff, but with each of these claims creating substantial costs to the insurer, it is apparent the current litigation system for resolving medical malpractice disputes is inefficient. Additionally, a review of medical malpractice claims by Harvard researchers confirmed the finding that few claims actually represent negligence and demonstrated that the litigation system is no better than a random lottery for identifying and compensating injuries.ⁱⁱ

Between 1976 and 2000, malpractice insurance premiums nationwide increased 505%, a 7.8% compounded rate of growth over the 24 years. In California, malpractice premiums grew 167% over the same period, a 4.2% compounded rate of growth.

In 2001, the ten states that limited noneconomic damages (firm cap) to $350,000 or less reported average medical malpractice premium increases for surgeon, obstetricians, and internists of 12%, compared to average premium increases of 44% in ten states with no limitation on noneconomic damages.ⁱⁱⁱ The states without effective, firm noneconomic damage caps experienced 3.7 times greater increases in premiums than states without caps. While Nevada has a nominal $350,000 cap on noneconomic damages, the cap is not per case, but rather per defendant per plaintiff. Additionally, there are two exceptions to the cap: gross negligence and "special circumstances" which a judge can find after the jury is dismissed. The KODIN Initiative,

to be voted upon in November 2004, eliminates the exceptions to the $350,000 cap, and the cap will be on a per case basis. If successful, the KODIN Initiative will convert Nevada to the "firm cap" state status.

The federal government estimates that between 7.2% and 12.7% of the $764.8 billion spent on hospital and physician services could be saved by California-type curbs on noneconomic damages nationwide. This savings would lower employers' costs for health insurance between $198 and $353 per covered employee annually. The employee's share of annual plan costs would be reduced by $59 to $109.^iv Empirical studies have found that a 3% rise in health insurance costs results in a 1% fall in the number of employees covered by employer-sponsored plans.^v These findings mean that the excess costs of uncurbed medical malpractice litigation result in loss of health care coverage for 1.5 to 2.7 million employees and their families. It has been estimated that implementation of effective curbs on noneconomic damages, along with effective continuous quality improvement systems in hospitals could improve patient outcomes while reducing health care costs by up to 30%.^vi

The first step toward reaching these goals is the passage of the KODIN Initiative in 2004. In the coming months physicians will be asked to support the Initiative in word as well as deed. All Nevadans will benefit from a successful effort.

ⁱ Employment Policy Foundation, Issue Backgrounder, Contemporary Issues in Employment and Workplace Policy, June 19, 2003.

ⁱⁱ A.R. Localio and A.G. Lawthers, "Relation Between Malpractice Claims and Adverse Events Due to Negligence: results of the Harvard Medical Practice Study III," New England Journal of Medicine, 325: 245 - 251, July 25, 1991.

ⁱⁱⁱ U.S. Department of Health and Human Services, "Confronting the New Health Care Crisis," July 2002, p. 10.

^iv U.S. Department of Health and Human Services, National health Expenditures Account, 2001.

^v J. Gruber and M. Lettau, "How Elastic is the Firms's Demand for Health Insurance?", National Bureau of Economic Research Working Paper No. 8021, July 2000.

^vi Donald M. Berwick, "As Good As It Should Get: Making Healthcare Better in the New Millennium," National Coalition for Healthcare, 1998, cited in U.S. Department of Health and Human Services, "Addressing the New Healthcare Crisis,", March 3, 2003.

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CMS: File Medicare claims electronically or don't get paid

The Centers for Medicare and Medicaid Services will not pay Medicare claims submitted on paper once the HIPAA transaction rules take effect Oct. 16, 2003, except in limited instances, according to an interim final rule published Friday, August 15, 2003.

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President’s Message

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

Summer is officially winding down now, but it would be hard to tell by the temperatures here in Las Vegas, unlike everywhere else in the country where the first hint of fall is in the air. School's back in session and everyone's home from vacation, so I guess it's time to get back to work. That includes our Society's various committees many of which should start meeting this month. The biggest challenge we face as a Society is our flagging membership enrollment, which has been dropping each year for the last two years. What are the benefits to physicians by joining the Society? Foremost is that we can address the many problems we face with a unified voice - there is definitely strength in numbers, especially when those numbers are organized. We can directly influence the local and statewide legislative process by our financial contributions to those candidates that are most sympathetic to our causes, as well as through our yearly mini-internship program ably run by Dr. Bernstein. There are numerous educational seminars sponsored by the Society year-round, offered free to members. We have a wonderful medical-legal resource in our executive secretary, Dr. Don Havins, who as both physician and attorney is a wealth of information and advice for our members. We are also investigating the possibility of being able to offer the option of low cost health insurance for our members, their families and their office employees.

As most everyone probably knows by now, yet another malpractice insurance carrier is leaving the state: Medical Insurance Exchange of California (MIEC), which insures about 100 physicians who must now scramble to look for malpractice coverage elsewhere. Of course, these same physicians must now pay for a "tail" on their old MIEC policy, and if they've had the misfortune of experiencing any "incidents" while with MIEC, they may have a difficult time finding another carrier willing to insure them. I would like to share my own personal experience with our carrier, PIC of Wisconsin, which was ready to dump my partners and me earlier this year, initially with only a two-week notice. We pleaded with them to extend the termination date, which they did by a few months, and then we invited them out to our offices for a visit, which they also did. And did that make a difference! After personally visiting our different office sites and meeting with our CEO and other office and clinical employees, they completely changed their minds about dumping us and have contracted with us for another year. I guess they decided that we Las Vegas physicians, once they had actually met us face-to-face, weren't all that bad. Therefore, I strongly urge any physicians whose liability insurance companies are thinking of dropping them or of increasing their premiums to invite the company's executives out to visit with them and their offices so they can see for themselves how most of us are, in fact, competent physicians who are truly committed to good patient care.

On the national level, the Senate Republicans were unable to defeat a filibuster against malpractice litigation limits, so the bill is still in gridlock. I think that the entire medical-legal tort system should be overhauled at a national level, beginning with the establishment of state-by-state medical-legal screening panels (which we unfortunately traded away for AB1 last year) to review every malpractice case filed, which would have sufficient teeth to either reject the case outright or allow it to proceed to be heard before a panel of specially-trained judges. The plaintiff, if he/she loses, pays for all court expenses. Of course, there would be a significant limit on non-economic damages. This system would undoubtedly reduce the number of malpractice cases currently being filed thus reducing the cost of our malpractice insurance premiums.

As most everyone also probably knows, Congress is back in session after its summer recess. Legislators from both the House and the Senate are meeting in a Conference Committee to try reconciling the Medicare Prescription bills that each chamber passed earlier this year. This will be the single largest revision of Medicare in its nearly 40-year history, if the committee is successful, since President Bush has already expressed his intention to sign such a bill. Like most bills that come from Congress, this 1000-page legislation is also much more than just a "prescription medication" bill - it also contains provisions regarding rural health care, emergency room care, nursing care and even new regulations for chiropractors. There is also a provision that severely reduces chemotherapy reimbursement, which could drastically alter the way Medicare cancer patients receive their treatments in the future. If Congress does not balance this fund reduction with an increase in the cost of chemotherapy administration ("balanced reform"), which has always been woefully under-funded, then many cancer clinics could close their doors to Medicare cancer patients who would then need to receive their treatment elsewhere, perhaps in hospitals. Hopefully, it won't come to that since the oncology community has been very busy educating our politicians about the potentially devastating effect this legislation, if not corrected, could have on cancer care in this country. If this reform passes, it will provide two private-sector alternatives for the nation's 40 million Medicare beneficiaries: they will either be able to purchase additional policies solely for prescription drugs or join preferred-provider networks. Hold on to your seats: this drug benefit plan will cost $400 billion, at least, over the next 10 years. And we all know who's going to be paying for that!

I note with sadness the recent passing of several prominent local physicians, including Dr. Don Christensen, a retired general surgeon, and Dr. George Wirges who was still practicing family medicine. Both of these men were widely admired by their patients and colleagues alike and will be greatly missed.

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Clark County District Court Medical Malpractice Filings Against Health Care Providers

Jan 2001 - Jul 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 58

Jul 19 100 63

Aug 54 51

Sep 20 65

Oct 37 83

Nov 38 184

Dec 9 170

*Note: The doubling of the frequency of

Medmal Filings against health care providers

in Clark County persists when compared to

the 2001 base year.

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Mutual Binding Arbitration Contracts in Medical Services

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

From 1996 through 2000, medical malpractice jury verdicts in Clark County totaled slightly over $21 million. Medical malpractice jury verdicts in Clark County for 2001 alone totaled over $22 million. Whereas a $1 million medical malpractice award before 1995 was a rarity, 75% of medical malpractice jury verdicts in 2001 were over $1 million (including verdicts for $6 million, $5.4 million, and $4.6 million). Many physicians believe that jury verdicts are out of control in Clark County.

Medical malpractice disputes resolved in binding arbitration are concluded with the decision of arbitrators, not juries. Binding arbitration decisions are very rarely disturbed by the courts. In the rare instance when an arbitrator's decision is reversed, the reason for the reversal usually involves an egregious violation of propriety, such as when an arbitrator had an undisclosed financial interest in the outcome of the arbitration, or when the arbitrator harbored an undisclosed bias toward one of the parties.

In 1975, California's MICRA law, now codified in California Code of Civil Procedure, section 1295, provided a specific contract for arbitration of medical malpractice disputes. This voluntary, mutually binding contract has remained unchanged since 1975. Nevada law more generally addresses the validity of binding arbitration agreements. NRS 38.035 provides that "a written agreement to submit any existing controversy to arbitration or a provision in a written contract to submit to arbitration any controversy thereafter arising between the parties is valid, enforceable and irrevocable, save upon such grounds as exist at law or in equity for the revocation of any contract." On October 1, 2003, Nevada will formally implement the provisions of the Uniform Arbitration Act of 2000 (adopted in the 2001 Legislative session and effective on October 1, 2003). The "new" Nevada Revised Statutes contain similar provisions:

NRS 38.219 Validity of agreement to arbitrate.

1. An agreement contained in a record to submit to arbitration any existing or subsequent controversy arising between the parties to the agreement is valid, enforceable and irrevocable except upon a ground that exists at law or in equity for the revocation of a contract.

2. The court shall decide whether an agreement to arbitrate exists or a controversy is subject to an agreement to arbitrate.

3. An arbitrator shall decide whether a condition precedent to arbitrability has been fulfilled and whether a contract containing a valid agreement to arbitrate is enforceable.

4. If a party to a judicial proceeding challenges the existence of, or claims that a controversy is not subject to, an agreement to arbitrate, the arbitral proceeding may continue pending final resolution of the issue by the court, unless the court otherwise orders.

Arbitration agreements must fulfill the requirements of contract law. Conduct or provisions which would violate standard contracts will invalidate arbitration agreements. If the signature of the contracting party is obtained under duress or if the signature is coerced, the arbitration contract cannot be enforced against that signatory. Thus, in the medical services context, medical treatment cannot be conditioned upon the patient signing the contract. The California arbitration agreement provides the patient may rescind the contract, in writing, up to 30 days after signing. After that time, the contract cannot be unilaterally rescinded except upon a court finding fraud in the inducement or "unconscionability". The sample arbitration agreement appended similarly provides 30 days in which a patient may rescind the agreement.

The appointment of arbitrator(s) is governed by NRS 38.055 until September 30, 2003.

NRS 38.055 Appointment of arbitrators by court. [Effective through September 30, 2003.] If the arbitration agreement provides a method of appointment of arbitrators, such method shall be followed. In the absence thereof, or if the agreed method fails or for any reason cannot be followed, or when an arbitrator appointed fails or is unable to act and his successor has not been duly appointed, the court on application of a party shall appoint one or more arbitrators. An arbitrator so appointed has all the powers of one specifically named in the agreement.

On October 1, 2003 and thereafter NRS 38.266 applies.

NRS 38.226 Appointment of arbitrator; service as neutral arbitrator.

1. If the parties to an agreement to arbitrate agree on a method for appointing an arbitrator, that method must be followed, unless the method fails. If the parties have not agreed on a method, the agreed method fails, or an arbitrator appointed fails or is unable to act and a successor has not been appointed, the court, on motion of a party to the arbitral proceeding, shall appoint the arbitrator. An arbitrator so appointed has all the powers of an arbitrator designated in the agreement to arbitrate or appointed pursuant to the agreed method.

2. An individual who has a known, direct and material interest in the outcome of the arbitral proceeding or a known, existing and substantial relationship with a party may not serve as an arbitrator required by an agreement to be neutral.

Arbitration agreements that have been illicitly obtained through fraud, under duress, or as a result of coercion are invalid. For example, the Nevada Supreme Court, in its 2002 decision in Burch v. District Court (118 Nev. Adv. Op. No. 46, 49 P.3d 647), invalidated a binding arbitration contract involving a homeowner's warranty. The Court stated the warranty was presented to the new homeowners for signature four months after the home purchase. The warranty, unbeknownst to the new homeowners, contained the mandatory binding arbitration provision (arguably fraud in the inducement). The binding arbitration agreement provided less rights than the homeowners would have in court, provided that the insurance company issuing the warranty had the sole right to choose the arbitrator and decide the rules of the arbitration. The Court found these provisions to be "unconscionable". For these reasons the court voided the arbitration contract, which had been held valid by the District Court, and sent the case back to District Court for trial. The Supreme Court also opined that charging a filing fee to the consumer, shortening the time to bring an action, and depriving the prevailing claimant of the ability to seek to recover costs and attorney's fees are all unconscionable provisions which would likely result in a court finding the arbitration contract invalid.

California's Mutual Binding Arbitration Agreement contains none of these unconscionable provisions. The provisions of this statutorily provided agreement have never been held invalid. A voluntary, mandatory binding arbitration agreement patterned directly after the California agreement is provided below. Many plaintiff attorneys are opposed to these agreements because they do not permit jury trials. Some defense attorneys are opposed to these agreements under the theory that the arbitrator will likely require physicians to pay something, even in a frivolous case, because arbitrators are prone to "split the baby" (an apparent reference to the Biblical King Solomon). A perusal of California legal sources does not sustain that concern. Both in California and Nevada, arbitrators are provided the full authority to make findings and awards equal to that which may be made by judges and juries. Arbitrators can (and in California have) find gross negligence and award punitive damages in medical malpractice disputes.

The fundamental difference between standard litigation in medical malpractice cases and the use of arbitration to resolve medmal disputes is the absence of a jury in arbitration. Most observers have concluded that arbitrators are more objective and less subjective to the emotional appeals of skilled plaintiff attorneys with awards being "more fair". Patients with medical services disputes are advantaged under the arbitration agreement because the dispute is routinely resolved much faster than proceeding through the horrendously congested civil court litigation system.

For physicians practicing in specialties perceived at high risk for emotionally driven, unreasonably high jury awards, it may be worthwhile considering contracting with patients in voluntary, mutual binding arbitration agreements and forgo juries in favor of adjudication by a neutral arbitrator. Three OBGYN physicians have been recently obtaining arbitration contracts with patients. These physicians report that very few patients have refused to sign the contracts, and no patients have rescinded the contracts within the 30 day period after signing. (Please see a sample on the next page.)

MUTUAL BINDING ARBITRATION AGREEMENT

Patient's Name: _________________________________

This mutual binding arbitration agreement constitutes an integral part of a contract for medical

services by and between __________________________________________ (name of patient)

and ______________________________________________ (name of physician) who agree to

be bound as described hereunder:

1. It is under stood that any dispute as to medical malpractice, that is, as to whether any medical services rendered under this Contract were unnecessary or unauthorized or were improperly, negligently or incompetently rendered, will be determined by submission to arbitration as provided in Nevada law, and not by lawsuit or resort to court process except as Nevada law provides for judicial review of arbitration proceedings. Both parties to this Contract, by entering into it, are giving up their constitutional right to have any such dispute decided in a court of law before a jury, and instead are accepting the use of arbitration.

2. Such arbitration shall be in accordance with the Nevada Revised Statutes governing arbitration. This Mutual Binding Arbitration Agreement shall apply to any legal claim or civil action in connection with any and all medical care or medical services rendered, whether inpatient or outpatient, against Dr. ___________________ or any of Dr. ___________________ 's employees or contracted staff.

3. The execution of this Mutual Binding Arbitration Agreement shall not be a precondition of the furnishing of medical services by

Dr. ___________________. This Mutual Binding Arbitration Agreement may be rescinded by written notice from the Patient or Patient's legal representative within 30 days of signature.

4. The Mutual Binding Arbitration Agreement shall bind the parties hereto, including newborns, and the heirs, representatives, executors, administrators, successors, and assigns of such parties and newborns.

NOTICE: BY SIGNING THIS CONTRACT YOU ARE AGREEING TO HAVE ANY ISSUE OF MEDICAL MALPRACTICE DECIDED BY NEUTRAL ARBITRATION AND YOU ARE GIVING UP YOUR RIGHT TO A JURY OR COURT TRIAL. SEE ARTICLE 1 OF THIS CONTRACT.

Date: ___________________________ Time: ____________________ A.M./P.M.

Signature: ___________________________ (patient/parent/legal guardian/legal representative)

If signed by other than patient, indicate relationship: ______________________________

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In Memorium

The Clark County Medical Society is saddened to announce the passing of Dr. George Wirges, family practice, on July 15, 2003. Dr. Wirges was a member of the Clark County Medical Society since 1995.

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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

Mark I Degen, MD, Oral/Maxillofacial Surgery
Lyn A Knoblock, MD, General Surgery/ Laparoscopic Surgery
Linda P Veneman, MD, Pathology
Ty S Weller, MD, Anesthesiology/ Pain Management

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

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Alliance Message

By Annette Mohs, 2003-2004 CCMS Alliance President, admohs@earthlink.net

"Unity - when all is said and done - is really very simple,…It means building coalitions with other community groups, so our message rings out louder, clearer, stronger. It means urging our spouses to show their support for us, by signing up to join (the Alliance).

Most of all, it means becoming a tipping point for the future of medicine- because if we all unite as a single Alliance- our legislative voice will be louder; our hands reaching out to children in our communities will be more numerous; our leadership base will multiply...and truly, we will become tipping points to heal a hurting world."

Gay Bowman, President, American Medical Association Alliance

These inspirational words from our National Alliance president were spoken at her inauguration speech and they are not only relevant to the National Alliances but they reflect my feelings about the Clark County Medical Society Alliance and the Alliance's relationship with the Clark County Medical Society. The Alliance and Society need to build a coalition and then reach from our strong foundation to other community groups "so our message rings louder, clearer, stronger" Please encourage your spouse to join the Alliance so we can "become tipping points to heal a hurting world."

For more information about the Alliance or to receive an application please contact Christina Duke at 837-6553 or Heather Gerson at 897-2081.

Now for an update: the Alliance board has been very busy this summer planning our coming year. Our first meeting will be at Cili's restaurant at the Bali Hai Golf Course, September 16, 2003 at 11:30 am. Any person wishing to join us can contact Shanila Choudhury at 355-2019 or Randi Lampert, M.D., at 838-6101.

On September 9, a New Members Coffee is scheduled. This is a fantastic opportunity to meet our wonderful board and find out about the many different opportunities in the Alliance. If your spouse is a new member, or is interested in joining the Alliance please contact Heather Gerson at 897-1082.

Thank you, I look forward to working with you all. And please feel free to contact me with any suggestions, concerns or questions at admohs@earthlink.net or 248-9624.

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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, July 15, 2003; 6:00 P.M.

Action Items

The minutes from the June 17th Board meeting were approved.
In the end of the fiscal year financial report, revenue received for the entire fiscal year exceeded the budgeted revenue amount. The expense to change the landscaping to the water conservation xeriscape was recorded in this fiscal year but the rebate check from the Water District was not received in time to apply it to the revenue for this fiscal year.
The proposed budget for Fiscal Year 2003-2004 passed unanimously.

Committee Reports

Dr. Kingsley's list of committee chairs and committee members was distributed. Dr. Kingsley stated he allowed all interested members to be on the committees which they had requested to be on and stated his desire to focus on increasing CCMS membership.
The following members were granted the status they had requested:

Charles Walton, MD, Retired Member; Saul Sobol, MD, Retired Member; J Randall Edwards, MD, Retired Member; Richard Hodnett, MD, Inactive Member (one year Leave of Absence)

Dr. Kingsley announced the passing of member Robert Balin.

Old Business

Dr. Colletti attended two meetings, one dealt with the education of nurses and the other dealt with legislation relating to nursing.

New Business

Dr. Kingsley asked the board members to contact him with any suggestions they may have regarding setting goals for the Board of Trustees. He will write a list of proposed goals to be voted on at the next Executive Council meeting.
Dr. Kingsley distributed KODIN information which summarizes the malpractice problem and lists the solutions to fix it. He stated this information should be used for doctors to educate their patients, which should start now. It was suggested CCMS coordinate efforts with the KODIN task force.
CCMS assigned Dr. Mitch Keamy to be a CCMS representative to Nevada Medical Credentialing.
A survey will be sent to all CCMS members inquiring as to the extent of their difficulties they have had with downcoding, denials and delayed payments from the major insurance companies.
Dr. Horne reported information from the recent AMA meeting he attended. The next meeting will be in December and resolutions can be submitted at that time.
Dr. Kingsley read the letter to the Washoe County Medical Society from Alice Molasky-Arman, Insurance Commissioner, which allows the members of that Society and their staffs to seek group health insurance. NSMA sent out a consensus to their members after the two insurance companies who responded requested it. They are compiling this information.

The next Executive Council meeting is scheduled for Tuesday, August 19, 2003 at 6:00pm.

There being no further business, the meeting was adjourned at 7:40pm

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AMA Delegate’s Report: What have they done and why should I be a member?

By Robert Lynn Horne, MD, CCMS AMA Delegate

CCMS was represented at the AMA House of Delegates from June 14-June 19, 2003 by Delegate Robert Lynn Horne, MD and Alternate Delegate Marietta Nelson, MD

Often I am asked, "What has the AMA done for me and why should I join it?" President Yank Cobel, Jr., MD reported on what the AMA has done for you in the past year.

1. In February, the AMA prevented a 4.4% Medicare fee payment cut and won a 1/6% increase instead. This restored $54 billion in Medicare spending on physician fees during the next 10 years.

2. The AMA worked to pass HR 5, the HEALTH Act in March. This bill calls for MICRA reforms on a national level, including capping non-economic damages at $250,000 and limiting lawyers' contingency fees, so injured patients get a larger share of their awards. Cobel described it as "legislation that's fairer to our patients and fairer to us." Our Congressmen Jon Porter and Jim Gibbons voted for the bill, Congresswoman Shelly Berkley voted against it. The companion bill is stalled in the Senate. Senator John Ensign is a co-sponsor. Senator Harry Reid is opposing the bill because, he says, the Nevada Legislature fixed Nevada physicians' malpractice insurance problems last July and federal legislation is not needed by Nevada physicians or patients. IF YOU DISAGREE, please CALL Senator REID in Washington through the AMA hotline, 800-833-6354. By following the voice prompts you will be connected to Senator REID's office so you can ask him to SUPPORT S-11 because Nevada's MALPRACTICE problems are NOT FIXED.

3. This year the House of Representatives passed important patient safety legislation, called HR 663. The AMA helped shape companion legislation in the Senate. If made into law, this legislation will bring down barriers to voluntary, confidential error-reporting systems, systems that can help us prevent error, put an end to shame and blame and enable us to turn with renewed energy to other quality issues.

4. The AMA is also working to reduce paper work and get health insurance coverage for over 40 million uninsured Americans.

Dr. Cobel shared a story that we all can use. He was debating a trial lawyer at Columbia University who railed against physicians, saying we thought we were different from everybody else. We felt entitled to keep patients waiting for hours. Much to his surprise, Dr. Cobel said he was right. "I was guilty of keeping patients waiting. And I was guilty of thinking medicine is different from other professions. Sometimes it takes me a long time to talk to patients about the best way to monitor their diabetes. Or lose weight. Sometimes the extra time I take means other folks sit a little longer in the waiting room than I like. Still, I do it. Because I am obligated to give the best care possible. My patients understand."

AMA will remain an organization with individual membership. Advocacy for patients and American physicians will remain the highest priority for the organization. Specifically the top 4 priorities will be:

1) Work to change federal legislation and regulatory environment to improve the practice environment for physicians and their patients;

2) Develop medicine's consensus recommendation on payment policies to the Centers for Medicare and Medicaid Services;

3) Develop policies on legislative issues;

4) Administer a Political Action Committee in support of federal advocacy campaigns.

Nevada is part of the Rocky Mountain Caucus of the AMA. We were successful in electing John Nelson, an OB-GYN from Salt Lake City as President-Elect of the AMA and Jeremy Lazarus, a psychiatrist from Colorado, as Speaker-Elect of the House of Delegates. Dr. Nelson attended the Nevada State Medical Association meeting in Reno in May 2003 and impressed many of our members.

Please consider joining your AMA. The dues are $420 per year, and include many benefits including journal subscriptions and opportunities for all the CME credits required by the NSBME. The average physician saved much more than that amount from the efforts of the AMA regarding Medicare reimbursement and stands to gain much more in the future as AMA leads the fight for Malpractice Reforms on a national level. To join please call 800-AMA-3211.

The next meeting of the AMA House of Delegates is in December 2003, and it will focus on advocacy and legislative issues. If you have ideas for a resolution that you would like submitted to become part of AMA policy or an action item, please call Dr. Horne at 822-1188 asap or send him an email to LVISMPresident@aol.com

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CME Calendar

American Back Society 510-536-9929

11/13-11/15 - “Advanced Diagnosis & Treatment for Neck & Back Pain,” Riviera Hotel, up to 24 CME hours (40% discount for CCMS members)

American Association of Professional Ringside Physicians www.aaprp.org

9/11-9/14 - “3rd Annual Medical Seminar,” Aladdin Hotel & Casino

Cardiovascular Consultants 691-9154

Clark County Medical Society 739-9989

9/6 - “Health Care Fraud and Abuse,” 8:45 - 11 a.m., 2 CME hours

St. Rose Hospital 616-5832

Southwest Medical Associates 242-7347

9/11 - “Chiropractic Myths and Truths”

Summerlin Hospital 233-7572

9/27 - “Bioterrorism and Weapons of Mass Destruction Training,” 8 a.m., 7.5 CME hours

Sunrise Hospital 731-8210

UMC 383-2604

9/11 - “Carcinoma of the Lung - Pathological Staging,” 12:15 p.m.
9/12 - “(Childhood Obesity) Weapons of Mass Destruction: the Traditional Food Pyramid and the Couch,” 7:30 a.m.
9/18 - “Carcinoma of the Lung - Chemotherapy,” 12:15 p.m.
9/19 - “Practicing Medicine Today - Perils & Pitfalls,” 7:30 a.m.
9/25 - “Carcinoma of the Lung - Radiation Therapy,” 12:15 p.m.
9/26 - “HIV Update,” 7:30 a.m.

Valley Hospital 388-4847

9/9 - “Nosocomial Infections in the NICU,” noon
9/23 - “Weight Loss - Practical Approaches,” noon

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

To have your CME courses listed on our calendar, please contact Deborah Barton at 739-9989 prior to the deadline

of the 12th each month.

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CLARK COUNTY HEALTH DISTRICT DISEASE STATISTICS* - July 2003

DISEASE CASES REPORTED YEAR TO DATE

Jul. 2002 Jul. 2003 2002 2003

VACCINE PREVENTABLE DISEASES

DIPTHERIA 0 0 0 0

HAEMOPHILUS INFLUENZA 0 0 4 4

(invasive)

HEPATITIS A 3 0 13 9

HEPATITIS B 5 3 26 38

INFLUENZA 0 0 59 47

MEASLES 1 0 1 0

MUMPS 0 0 2 1

PERTUSSIS 3 2 13 9

RUBELLA 0 0 0 0

TETANUS 0 0 0 0

SEXUALLY TRANSMITTED DISEASES

AIDS 12 13 138 135

CHLAMYDIA 354 380 2604 2673

GONORRHEA 145 149 997 1043

HIV 14 15 102 132

SYPHILIS (Primary & Secondary) 1 2 6 6

SYPHILIS (Early Latent) 0 1 4 16

ENTERICS

AMEBIASIS 0 2 11 11

BOTULISM-INTESTINAL 0 0 0 1

CAMPYLOBACTERIOSIS 15 5 70 47

CHOLERA 0 0 0 0

CRYPTOSPORIDIOSIS 0 2 2 5

E. COLI O157:H7 3 1 9 5

GIARDIASIS 7 7 54 48

ROTAVIRUS 9 23 332 456

SALMONELLOSIS 14 8 105 56

SHIGELLOSIS 3 2 8 21

TYPHOID FEVER 0 0 0 0

YERSINIOSIS 0 0 0 0

OTHER

ANTHRAX 0 0 0 0

BOTULISM INTOXIFICATION 0 0 0 0

BRUCELLOSIS 0 0 0 0

COCCIDIOIDOMYCOSIS 0 0 15 18

ENCEPHALITIS 1 0 2 2

HANTAVIRUS 0 0 0 0

HEMOLYTIC UREMIC 0 0 0 0

SYNDROME (HUS)

HEPATITIS C 1 0 3 3

HEPATITIS D 0 0 1 0

LEGIONELLOSIS 0 1 1 3

LEPROSY (HANSEN'S DISEASE) 0 0 0 0

LEPTOSPIROSIS 0 0 0 0

LISTERIOSIS 1 0 1 1

LYME DISEASE 0 2 0 3

MALARIA 0 1 3 1

MENINGITIS, ASEPTIC/VIRAL 8 11 43 57

MENINGITIS, BACTERIAL 1 1 14 17

MENINGOCOCCAL DISEASE 2 0 13 3

PLAGUE 0 0 0 0

RABIES (HUMAN) 0 0 0 0

RELAPSING FEVER 0 0 0 0

RSV (RESPIRATORY 34 6 1754 1342

SYNCYTIAL VIRUS)

ROCKY MOUNTAIN 1 0 2 0

SPOTTED FEVER

TOXIC SHOCK SYNDROME 0 0 1 1

TUBERCULOSIS 3 1 31 37

TULAREMIA 0 0 0 0</

Contents

The Cost of Our Unrestrained Medical Liability Tort System