Clark County Medical Society

County Line

Newsletter LI April 2004

Contents

The Federal Volunteer Protection Act and the Nevada Health Professional

President’s Message

Membership Applicants

In Memorium

New Members

Malpractice Filings against Health Care Providers, Jan 2001 – Feb 2004

CEO Article

Clark County Health District: Tuberculosis is still a threat!

Referral Tallies

Minutes Synopsis

CME Calendar

Clark County Health District Disease Statistics – February 2004

Classifieds

County Line Advertisers

The Federal Volunteer Protection Act and the Nevada Health Professional

By Weldon (Don) Havins, MD, Esq., Clark County Medical Society, and Kelly Testolin, Esq., Hale Lane Law Firm

On June 18, 1997, President Clinton signed into law the Volunteer Protection Act (VPA). One of the motivations prompting the Act was the increasing liability suffered by Little League coaches and umpires who had the temerity to volunteer to help their communities. A majority in Congress apparently felt these lawsuits, and similar lawsuit abuse outrages, would deter voluntary community activity. Under the "findings and purpose" of the VPA (42 USC 14501) Congress declared that clarifying and limiting the liability risk assumed by volunteers of governmental entities and nonprofit organizations to be an appropriate subject for Federal legislation because of the national scope of the problems created by the legitimate fears of volunteers about "frivolous, arbitrary, or capricious lawsuits." The Congress concluded that "liability reform is an appropriate use of the powers contained in article 1, section 8, clause 3 of the United States Constitution" (the commerce clause), "and the fourteenth amendment to the United States Constitution."

Section 14502 of the VPA provides for preemption of state law inconsistent with the VPA except to the extent that state law provides greater protections to "volunteers in the performance of services for a nonprofit organization or governmental entity." Paragraph (b) of the section provides that a state may enact a statute "citing the authority of this subsection" which declares that the VPA shall not apply to cases against a volunteer in which all parties are citizens of that state. A perusal of Nevada statutes does not reveal any such statute; thus, the VPA applies to Nevada volunteers performing services for nonprofit organizations or governmental entities.

The VPA applies to all volunteers, not just professionals. Professionals must be licensed by the state to perform relevant professional service for the nonprofit organization or governmental entity. Licensed professionals performing services beyond the scope of their license will not receive the protections of the VPA. Otherwise, "no volunteer shall be liable for the harm caused by an act or omission of the volunteer on behalf of the nonprofit organization or governmental entity" not caused by "willful or criminal misconduct, gross negligence, reckless misconduct, or a conscious, flagrant indifference to the rights or safety of the individual harmed by the volunteer." VPA protections will not apply to harm caused an individual by the volunteer operating a motor vehicle, and VPA protections will not apply if the volunteer's conduct results in a conviction for a crime of violence, conviction for a hate crime, conviction of international terrorism, conviction of a sexual offense, conviction for violating an individual's civil rights, or where the volunteer defendant's misconduct occurred under the influence of intoxicating alcohol or drug (42 USC 14503). Should a volunteer be sued for such grievous conduct causing harm, noneconomic damages apply only to the degree of fault (no joint liability for noneconomic damages) and any punitive damages must be proven by clear and convincing evidence.

Conflicting language between the VPA and Nevada law is potentially problematic for Nevada physicians. Under the "liability protection for volunteers" section (14503), the provision states the "no volunteer OF a nonprofit organization or governmental entity shall be liable for a harm caused by an act or omission of the volunteer ON BEHALF of the organization or entity if … the volunteer was acting within the scope of the volunteer's responsibilities IN the nonprofit organization or governmental entity at the time of the act or omission…" (emphasis added)

Does this mean that a physician volunteering to render medical services to an individual is only protected under the VPA if the patient is physically seen within the governmental entity or nonprofit organization? A look to Nevada statutes does not appear helpful. AB 1 of the 2002 special session appeared to expand Nevada's "Good Samaritan" law by adding the following provision, "[A]ny person licensed to practice medicine under the provisions of chapter 630 or 633 [medical doctors and doctors of osteopathic medicine] of NRS or licensed to practice dentistry under the provisions of chapter 631 of NRS who renders care or assistance to a patient at a health care facility of a governmental entity or a nonprofit organization is not liable for any civil damages as a result of any act or omission by him in rendering that care or assistance if the care or assistance is rendered gratuitously, in good faith and in a manner not amounting to gross negligence or reckless, willful or wanton conduct." (NRS 41.505(5)). Gratuitously means that the person receiving care or assistance is not required or expected to pay any compensation or other remuneration for receiving the care or assistance. (NRS 41.500(11)). The Nevada statute appears to require the patient to be seen AT the health care facility of the governmental entity or nonprofit organization. Because requiring the patient to be seen at the facility arguably provides less protection to the volunteer, it would appear to be preempted by the VPA, which does not require the volunteer to be physically inside the facility when volunteering.

Why is this important to Nevada physicians and dentists? If the VPA applies to professional services rendered while caring for a patient as a volunteer OF a nonprofit organization, the patient could be seen in the physician's or dentist's office where technical equipment and (volunteer) technical staff are available. This would permit greater flexibility for doctors and dentists to volunteer to see patients for a nonprofit organization or governmental entity.

From the provisions of the VPA, the volunteer "performing services FOR a nonprofit organization or governmental entity may not receive compensation other than reasonable reimbursement or allowance for expenses actually incurred or in excess of $500 per year." (Section 14505(6)). Until a court determines otherwise, volunteer Nevada physicians and dentists wishing to be protected from simple negligence under the VPA would be wise to avoid collecting any remuneration from a patient. Any "reasonable reimbursement for expenses actually incurred" should come only from the nonprofit organization or governmental entity.

A search of case law reveals no court to have overturned a provision of the VPA. One reason for this is that the VPA is grounded in the commerce clause of the U.S. Constitution. The government must only establish that the VPA is "rationally related to a legitimate governmental purpose". Laws enacted under this provision of the Constitution are rarely found to be unconstitutional. At least one law journal article contends that the VPA applies to licensed attorneys performing Pro Bono work for nonprofit Pro Bono organizations, including bar associations with Pro Bono programs. (Paul Geogiadis, Esq., Hawaii Bar Journal, April 1988). Pro Bono work is generally performed in the attorney's office rather than within the confines of the bar association building. This would, by analogy, imply that physicians and dentists seeing patients for a nonprofit organization in their office should be covered under the protections of the federal Volunteer Protection Act.

While the protections to volunteers under the VPA are substantial as to negligence lawsuits from third parties, the VPA does not prohibit the governmental entity or nonprofit organization from suing the volunteer. Similarly, a victim of negligence may sue the governmental entity or nonprofit organization.

While the VPA applies to Nevada as well as all states, Nevada's statutes could be amended to remove any ambiguity as to liability protection for health care professional volunteer activities. NRS 41.505(5) could be amended to provide that physicians and dentists who volunteer to see patients OF a governmental entity or nonprofit organization would be immune from ordinary negligence lawsuits. The definition of "gratuitously" should also be clarified, under this subsection, to mean no remuneration would be expected or accepted from the patient to the physician or dentist. This change in Nevada law would not preclude the physician or dentist from receiving reimbursement for costs of materials incurred in caring for the patient of the governmental entity or nonprofit organization when that reimbursement occurs directly from the entity or organization.

With Nevada's uninsured population approaching 20%, these amendments to Nevada law would encourage physicians and dentists to volunteer to help ameliorate the growing crisis in the unavailability of affordable health care.

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President’s Message

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

I

f you haven’t already heard it by now, the Nevada State Board of Medical Examiners (BME) unanimously voted to indefinitely table its proposal for physician proficiency testing at its last quarterly meeting on March 12. Almost all of the physicians on the BME voiced their opinions as to why they could not support the proposal as it is currently worded. The sentiment expressed by most was that there are currently multiple national-level medical societies that are preparing to make routine testing of their physician members mandatory for determining proficiency and maintaining Board Certification. Therefore, it would be premature, redundant and onerous for Nevada to make additional requirements on its licensees. I believe that the input the BME received from those of us who attended its workshops over the last several months – the unanimous opposition from all physicians who testified at these hearings – actually paid off. The BME actually listened to us and rethought its position on this issue, and then decided to dump the proposal. The system works! Thanks to all of you who took the time and made the effort to voice your opinion on this matter.

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n the February 2004 County Line your Society published a “Position Paper” in response to the Performance Audit by the Federation of Medical Board Examiners last fall of the BME. I had the opportunity to present that information to the State Senate and Assembly members of the Legislative Commission at their February 18th meeting. I believe they received our recommendations regarding the Audit well. At the BME’s most recent quarterly meeting on March 12, your Society’s CEO Don Havins and I had the opportunity to formally present our response to the Audit. Before I spoke, the new BME Deputy Executive Secretary/Special Counsel Tony Clark JD addressed the Audit’s recommendations and how the BME was already implementing a number of them. I am pleased to report that your Society and the BME agreed with many of the recommendations made in the Audit regarding ways that the BME could improve its administrative and disciplinary functions. In a nutshell, most of our recommendations are as follows (and the BME’s responses are included parenthetically).

1. The BME should improve the manner of its evaluation and prioritization of complaints regarding physicians that it receives from patients and other health practitioners. It should improve the way it then communicates its findings and response to that complaint with the complainant (the BME agrees and has already implemented the changes).

2. It should discontinue its current series of Public Service Announcements for educating the public regarding itself (at an annual cost of $60,000), and instead hire a part- or full-time Public Information Officer. By such a change, I believe the BME could then more efficiently reach out to the public and its licensees to better educate them regarding itself and its functions (the BME disagrees with parts of this recommendation. However, it is now making greater efforts to open communication lines with all of the state’s hospitals to facilitate the reporting of disciplinary actions taken against physicians).

3. Allow health practitioners to renew their licenses to practice medicine via the Internet (the BME is still considering such a recommendation).

4. All financial and performance audits of the BME should be presented to the BME publicly, which is not currently being done (the BME is still considering such a recommendation).

5. A “clean-up” bill, AB 5, passed last July during the special session of our Legislature, substantially changed the wording and spirit of an amendment to NRS 630.301 made in SB 250 by the 2003 Legislature, which had provided that “conviction of a felony” constituted grounds for licensure discipline or licensure denial. The “clean-up” bill changed that to read “Conviction of a felony relating to the practice of medicine or the ability to practice medicine”. We recommend the statute be changed back to its original language (the BME agrees).

6. Contrary to the Audit’s recommendation of not allowing for “licensure via endorsement”, we recommended it be continued (the BME appears to agree).

7. The BME should routinely access the National Physician Data Base (NPDB) as another source of information for determining which physicians have been reported for serious disciplinary actions or who have made any payment in a malpractice claim (BME response unknown).

8. We do not agree that every malpractice claim filed against a physician should be investigated by the BME, as is currently being done (and which is not required by law). We consider this a waste of time and resources since approximately 65-70% of such claims are eventually closed without payment to the plaintiff. Current law requires the BME to investigate only those claims resulting in an award, settlement, or adjudication (BME response unknown).

9. “Letters of concern” or “admonishment” should be sent to physicians who have been found guilty of unprofessional behavior that does not rise to the level requiring formal disciplinary action by the BME. We consider such “proactive” measures could help prevent possibly more egregious unprofessional, unethical or illegal activities by doctors thus making future harsher disciplinary actions unnecessary (BME response unknown).

10. The BME should authorize their Investigative Committee to not only receive and investigate complaints against physicians but to adjudicate responses and then write and send these letters (BME response unknown).

11. The Audit recommended that “statement of charges” against a physician and the BME’s response be made available to the public on its website. We recommend that rather than publicizing the BME’s unproven allegations against a licensee, the Investigative Committee’s “findings of fact and conclusions of law” should be made available along with the Board’s action on the case (BME response unknown).

12. More reliable information regarding the physician workforce in Nevada is needed (BME agrees).

The BME will re-evaluate the Audit in its next quarterly meeting in June before making a final, formal response. It should be recalled that the BME is the primary regulatory agency that determines which doctors can practice in this state, how we are allowed to continue to practice here, what kind and how much continuing medical education is required and how we may be disciplined, including under what circumstances our license to practice medicine in this state may be revoked. Therefore, it behooves all of us to pay close attention to the activities and decisions of our BME since their decisions greatly impact the way you and I practice medicine.

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he “Committee for Affordable and Accessible Health Care” continues to meet on a regular basis, usually every other Tuesday morning at our Society’s office. Dr. Rudy Manthei, who has been very active in the KODIN (Keep Our Doctors in Nevada) committee activities this last year, chairs this committee and Don Havins and I have been actively participating in it. We expect to have literature and information to pass out to every doctor’s office in Clark County available after April 5th. You should each be contacted by either someone from the Society or from the Clark County Alliance during April and May to help start educating our patients about this all-important initiative that will be on the November ballot. The importance of passing this initiative cannot be understated. If approved by our state’s citizens, this will be the country’s first California MICRA-style medical tort reform enacted at the ballot box. Not only should this help alleviate our state’s malpractice insurance crisis and improve Nevadans’ access to medical care, I believe it will also give a shot in the arm to the national movement of federal-level tort reform.

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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

• Peter A Caravella, MD - General Surgery
• Martin J Carignan, MD - General Surgery
• Harry M Condoleon, DO - General Surgery
• Michael E Seiff, MD – Neurosurgery

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. Jerald Malone. Dr. Malone, general practicioner, died March 6, 2004.

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New Members for February 2004

Congratulations and Welcome to the Clark County Medical Society

• Bashab Banerji, MD, Internal Medicine, 10908 Mt Royal Ave, Las Vegas, NV 89144
• Bess L Chang, DO, Neurology, 1399 Galleria Dr #203, Henderson, NV 89014
• Arezo M Fathie, MD, Internal Medicine/Pediatrics, 2649 Wigwam Pkwy #101, Henderson, NV 89074
• Bernadine A Hanna, MD, General Surgery, 1701 W Charleston Blvd #215, Las Vegas, NV 89102
• Katherine A Keeley, MD, Oral/Maxillofacial Surgery, 2649 Wigwam Pkwy #102, Henderson, NV 89074
• Wai Li Ma, MD, Gastroenterology, 3006 S Maryland Pkwy #765, Las Vegas, NV 89102
• Mavis N Matsumoto, MD, Internal Medicine, 870 Seven Hills Dr #102, Henderson, NV 89052
• Neal L Ross, MD, Ob-Gyn, 2128 Bay Tree Dr, Las Vegas, NV 89134
• Yousuf B E Schulz, MD, Radiology, 2020 Palomino Ln #100, Las Vegas, NV 89106

Reinstated Members

• Michael L. Levin, MD, Pediatrics, 220 E Horizon Dr #A, Henderson, NV 89015

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Clark County District Court Medical Malpractice Filings against Health Care Providers

Jan 2001 – Feb 2004

2001 2002 2003 2004

Jan 39 33 109 50

Feb 20 14 88 68

Mar 35 30 148

Apr 37 34 101

May 37 35 108

Jun 27 24 98

Jul 19 100 97

Aug 54 51 63

Sep 20 65 85

Oct 37 83 114

Nov 38 184 50

Dec 9 170 55

Sum 372 823 1116

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CEO Article

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

Florida Tort Reform

Florida and Kentucky appear to be following the approach of Texas to tort reform – an amendment to their state’s constitution. The Kentucky approach is to attempt to pass a bill through their legislature calling for a referendum vote of the people to amend the Kentucky’s constitution to permit caps on noneconomic and punitive damages. The Florida Medical Association is currently circulating a petition to place a constitutional amendment on the November ballot which would limit plaintiff attorney contingency fees to 30% of the first $250,000 (minus costs) and to 10% of awards over $250,000 (minus costs). The petition frames the issue from the patients’ perspective: injured patients will receive 70% of the first $250,000 and 90% of awards over $250,000.

The Florida trial lawyers have retaliated with circulating three constitutional amendment petitions. One would require the state to suspend the medical license of any physician found to be at fault in three medical malpractice actions. The second is intended to open peer review actions to the public. The third would limit physicians’ fees to an amount previously charged (making raising fees nearly impossible).

Is this where we are headed if the KODIN tort reform Initiative does not pass?

Scope of Practice Expansion for CRNAs

Montana and Oregon have joined other states in permitting non-supervised, independent practice of nurse anesthesia for certified nurse anesthetists. Alaska, Idaho, Iowa, Kansas, Minnesota, Nebraska, New Hampshire, New Mexico, North Dakota, and Washington currently permit non-supervised, independent practice by CRNAs. Under federal Medicare regulations, states are permitted to “opt out” of the normal Medicare requirement that CRNAs must be supervised in hospitals and surgicenters. A state must determine that requiring supervised CRNA care would “impede patients’ access to care” to implement the “opt out” provision.

On-Call Trends

An organization known as the “Governance Institute” in San Diego conducted a fax poll of 125 hospitals across the U.S. in February 2004. Results of the survey were compared to a survey conducted two years earlier. This year, 42% of hospitals provide or plan to provide compensation to on-call physicians, up from 39% in 2002. A daily stipend is the most common method of payment for on-call coverage with a range of $407 to $878 in 2004, which is down from the 2002 range of $392 to $1,120. More hospitals are reporting specialties refusing to provide on-call coverage. In 2001, 90% of surveyed hospitals reports neurosurgery coverage. In 2002, just over 50% reported neurosurgery coverage. Coverage for oral surgery and nephrology also dropped. On-call coverage for obstetrics and for family medicine increased.

CCMS is informed that in southern Nevada, UMC provides compensation to the great majority of on-call specialists. Other major hospitals remunerate on-call OBGYNs, with a few also providing compensation to on-call general surgeons, orthopedists, and/or neurosurgeons.

Manpower Shortages

U.S. immigration policy is not helping with the doctor and nurse shortages. Foreign-born U.S. physicians constitute about 25% of the U.S. physician population. 11.5% of registered nurses are foreign-born. In February 2002, the U.S. Department of Agriculture withdrew as sponsor of foreign-born physicians who were allowed to remain in the U.S. after taking their residency (under the J-1 visa program). Foreign-born physicians training under J-1 visas were required to return to their country for a minimum of two years before they could apply for a work permit (“green card”) or be granted permanent residence status in the U.S. They could remain if they obtained a waiver (H-1B visa) from a sponsoring agency and worked in a medically underserved area. A full 18 months after UDSA’s withdrawal from granting H-1B visas, HHS implemented a similar program but with more strict rules.

Under current HHS rules, H-1B visas are only issued to the most underserved areas and only for work in community health centers and rural clinics. These new restrictions eliminate about 86% of previously qualifying areas.

In 1994, Senator Kent Conrad (D – N.D.) sponsored a bill which now permits 30 waivers per state for foreign born physicians to work in medically underserved areas. Nevada gets exactly 30 and California, with over twenty times the population of Nevada, also gets only 30. This does not meaningfully ameliorate the physician shortage.

Dr. Richard Cooper, director of the Health Policy Institute at the Medical College of Wisconsin in Milwaukee, predicts the U.S. will lack 150,000 physicians by 2020. This would require at least 25 new medical schools to fill that need. Dr. Cooper doubts that current medical schools and schools of osteopathy can expand to meet the need.

A medical recruiter in Texas (Herritt, Hawkins Associates) reports difficulties filling positions in radiology, orthopedics, anesthesiology, cardiology, rheumatology, dermatology and urology. Rural areas are the most difficult to fill. It does not appear that current U.S. immigration laws will help ameliorate the coming access problem.

The critical nursing shortage has been exacerbated by our new immigration laws. Implementation of the Immigration Act of 1990 required nurses granted H-1B visas to be graduates of four year colleges, although only one state requires nurses to have a college degree for licensure. A new visa classification for nurses, the H-1C program implemented in 1999, permits a total of 500 visas a year for hospitals in medical shortage areas, and then there are caps on individual states. Dr. Cooper states that even doubling the current admission rates of U.S. nursing schools beyond the current 7,000 per year would have little impact on the 126,000 nurse shortfall. (The 2002 Nevada Legislature mandated Nevada nursing schools to double their enrollment by 2005). Dr. Cooper concludes that the only reasonable means of addressing this problem is by revising immigration policy for nurses.

Relationship Between Medical Malpractice Suits and Actual Medical Negligence

The Harvard Medical Practice Study evaluated over 31,000 hospitalizations in New York in 1984. Physician reviewers identified instances of apparent medical error (medical negligence) and reviewed all malpractice claims against the involved doctors and hospitals during the relevant period. Only 1.5% of medical error events were accompanied by a malpractice claim. Twenty-six percent of medical malpractice claims occurred involving patients with no history of medical error.

Another study by Troyen Brennan, MD, JD, MPH of the Health Policy and Management school at Harvard University School of Public Health examined 51 cases of malpractice closed as of December 31, 1995. Twenty four cases were determined to have no adverse event – 10 of the 24 were settled in favor of the plaintiffs (mean payment = $28,760). Thirteen cases had been classified as involving adverse events but no negligence – 6 of the 13 settled in favor of the plaintiffs (mean payment = $98,192). Of nine cases of adverse events associated with negligence, five settled for the plaintiffs (mean payment = $66,944). Seven of eight claims involving permanent disability were settled for the plaintiffs (mean payment = $201,250). In a multivariate statistical analysis, disability (permanent vs. temporary or none) was the only significant predictor of payment (P=.03). There was no correlation between the occurrence of an adverse event due to negligence and a payment to the plaintiff, and no correlation between an adverse event without negligence and payment to the plaintiff.

Thus, the severity of the patients’ permanent disability, and not the occurrence of negligence, determined the probability of a payment to the plaintiff.

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Clark County Health District: Tuberculosis is still a threat!

By Donald Kwalick, MD, MPH. Clark County Health Officer

World TB Day, held on March 24 of each year, is an occasion designed to raise awareness of an international health threat that continues to have a major impact on public health.

From a global perspective the statistics are sobering - every 15 seconds someone dies of TB; eight million people develop active TB every year; more than 900 million women are infected with TB; the disease accounts for one third of AIDS deaths; and one person can infect between 10 and 15 people in one year.

At the local level, we documented 74 active cases of the disease in 2003, an increase from 62 cases reported during the previous year. Of these cases, 74 percent were foreign born; 10 percent were homeless; 10 percent were infected with HIV; and 13 percent were type II diabetes, in poor control.

Our staff at the Clark County Health District Tuberculosis Treatment and Control Clinic have been proactive when responding to cases of active tuberculosis.

In 2003, a case of infectious tuberculosis was identified in an inmate with AIDS who was incarcerated in a local correctional facility. Additionally, our case investigation revealed the inmate had been in a municipal court several times over a period of six months. This person refused treatment and therefore never received a skin test or chest x-ray. As a result, staff tested 550 correctional and medical staff and 209 contacts from Clark County District Court. Contacts identified during this investigation who were found to have positive TB skin tests were offered INH treatment.

A positive result of this investigation was the implementation of protective measures and a training program by the Las Vegas Metropolitan Police Department. Current staff and new recruits receive information on the disease and all correctional officers now receive an annual mandatory PPD test along with their yearly physical.

Another high profile case occurred in September 2003. This involved a health care worker at a medical facility. During this investigation 378 contacts were tested. Of these contacts, 24 have converted on skin test and INH treatment was offered to these individuals.

While these investigations are costly to the health district, this is money well spent. With a communicable disease such as TB we are faced with a "pay now or pay more later" situation. To not pursue contacts of persons with infectious tuberculosis aggressively could lead to an outbreak - and tuberculosis treatment can be prolonged and expensive. If a person develops tuberculosis that is resistant to treatment, the cure can cost upwards of $200,000.

Past experience with tuberculosis has demonstrated we cannot afford to become complacent. The disease was once the leading cause of death in the United States. Improved medical treatment and new therapies led to the steady decline of the illness making the elimination of tuberculosis in our country an attainable goal. In the mid-1970s, when tuberculosis seemed well under control, funds, once designated to the prevention and control of the disease, were directed towards other areas. The upshot of this loss of funding and attention led to reversal of the trend towards elimination and case increases of 20 percent between 1985 and 1992.

Currently, we have more than 60 clients on directly observed therapy (DOT) and 12 children on directly observed prophylactic therapy (DOPT). More than 700 of our clients are on INH treatment and over 400 of these are under 35 years of age. Our practice of DOT and intensive case management services continue to increase rates of completion of therapy. We will continue to actively investigate and treat new cases in order to prevent further spread of the disease.

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Referral Tallies

The following referrals were provided to CCMS members in the first quarter of 2004 (through March 19)

Specialty Referrals

Addiction Medicine 0

Allergy 2

Anesthesiology 1

Cardiology 6

Cardiovascular Surgery 1

Colon & Rectal Surgery 1

Dermatology 9

Diagnostic Radiology 0

Endocrinology 6

Family Practice 18

Gastroenterology 5

General Surgery 2

Geriatrics 1

Gynecologic Oncology 0

Hematology 2

Infectious Medicine 1

Internal Medicine 23

Nephrology 2

Neurology 7

Neurosurgery 1

Ob-Gyn 11

Occupational Med 1

Oncology 9

Ophthalmology 10

Oral/Maxillofacial Surg. 2

Orthopaedic Surgery 8

Otolaryngology 7

Pain Management 2

Pathology 0

Pediatrics 0

Ped. Surgery 0

Physical Med/Rehab 0

Plastic Surgery 3

Preventative Medicine 0

Psychiatry 9

Pulmonology 6

Radiology 0

Rheumatology 2

Thoracic Surgery 1

Urology 8

Vascular Surgery 0

Totals 167

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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, February 17, 2004; 6:00 P.M.

Action Items

The minutes from the January 20th meeting were approved.

Financial Report

Dr. Steinberg reported the revenue thus far in the fiscal year is less than it was last year at this time. Expenses are about the same as last year at this time.

Committee Reports

Community Relations/ Community Health

Dr. Bernstein reported the Mini-Internship program and dinner was a success. Dr. Bernstein announced the Legislative Dinner date has been changed to April 29 at 6:00pm at the Green Valley Ranch Resort, with AMA President-Elect Dr. John C. Nelson and Scott Craigie as the guest speakers. CME Committee is processing the request for 1 hour of CME credit for the event. Also, Dr. Bernstein stated his Committee has determined they will focus on community efforts by setting up a speaker's bureau to speak to various community groups.

Med PAC

Dr. Havins reported NSMA's NEMPAC formally endorsed Senator Ann O'Connell. MEDPAC members and directors present at the BOT meeting, constituting a quorum, voted to formally endorse Senator O'Connell.

Credentials

The following applicants were approved for membership: Bashab Banerji, MD, Internal Medicine; Bess Chang, DO, Neurology; Arezo Fathie, MD, Internal Medicine/Pediatrics; Bernadine Hanna, MD, General Surgery; Katherine Keeley, MD, Oral/Maxillofacial Surgery; Wai Li Ma, MD, Gastroenterology; Mavis Matsumoto, MD, Internal Medicine; Neal Ross, MD, Ob-Gyn; and Yousuf Schulz, MD, Radiology.

Membership

Marlaina Burns presented information regarding the different categories of the membership, both dues paid and unpaid. This report will be submitted on a monthly basis.

Bylaws

Dr. Evins presented a proposed revision to the Bylaws, involving amendment of provisions involving Nominating Committee members, Article V Section A1. The Board approved the recommended revisions. These will be sent to the membership for referendum voting in April.

Nominating

The slate of Officers and Trustees for 2004 chosen by the Nominating Committee was presented to the Board members.

Voter Registration

Dr. Jones demonstrated packets he is making available to anyone interested in registering patients to vote in their offices. Dr. Jones or an Alliance representative will travel to those interested offices and train the staff on how to set up for registering voters.

County Health Officer Report

Dr. Kwalick was unable to attend the meeting but sent a two-page report updating Board members on the compelling issues at the Clark County Health District. Dr. Havins reported he was aware of doctors being prosecuted for not reporting communicable diseases to the Health District. Dr. Havins was asked to clarify if the physician must report even if the lab reports.

[follow-up: NAC 441A requires each and every healthcare provider to report any of 66 communicable diseases to the CCHD, notwithstanding reports sent to the CCHD by other healthcare providers.]

NSMA Update

Dr. Evins gave an update on the Medicaid reimbursement issue. Telephone conferences are being held weekly with Mr. Duarte, representatives of First Health, NSMA's Larry Matheis, NSMA's lobbyist Scott Craigie, and CCMS's Don Havins. Reimbursement problems and status are discussed and resolved.

President's Report

Dr. Kingsley reported the KODIN task force is meeting every other week. Dr. Fischer met with Dean Heller and reported Dean Heller will assign a number to the Initiative soon. [update: Question #3] Sig Rogich attended the KODIN meeting last week. The task force would like to have a group of physicians be on an advisory committee with each person in charge responsible for raising $5,000.

Dr. Kingsley reported on the NBME workshop regarding the proposed "proficiency" regulations.

Administrative Report

Dr. Havins informed the Board of the story in the Reno Gazette Journal regarding the NBME and presented copies of the articles to the Board members.

Dr. Havins announced a fundraiser Sandra Tiffany is having on Monday, March 15. She is requesting physician attendance and support.

Dr. Havins reported the request of Dr. Brad Thompson, Interim Director of the Nevada Health Professional Assistance Foundation for using the CCMS conference room. It was decided the Foundation could use the conference room, when not in use, during working hours only.

Inactive Membership Status

The Board approved the "Inactive" status requested by Dr. Barry Markman and Dr. Henry Soloway.

UNSOM Graduation Ad Request

The board approved running a CCMS half page ad (for $500) in the Nevada School of Medicine's graduation yearbook.

The next Board of Trustees meeting will be Tuesday, March 16, 2004 at 6 pm.

There being no further business, the meeting was adjourned by Dr. Kingsley at 7:30 pm.

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CME Calendar

Cardiovascular Consultants 691-9154

Clark County Medical Society 739-9989

• 4/21 - “OSHA for Physicians,” 5:45 p.m., 2 CME hours
• 4/24 - “Religion and Medicine: Implications for Clinical Care,” 9 a.m., 2 CME hours
• 4/28 - “EMTALA and Emergency Care,” 6 p.m., 2 CME hours
• 4/29 - “Update on Legislative Changes Affecting the Practice of Medicine,” 6 p.m., 1 CME hour
• 5/26 - “Clinical Trends in Ophthalmology for the Non-Ophthalmologist,” 6 p.m., 2 CME hours

HealthInsight (801) 892-0155

• 5/13 & 14 - “Incident Investigation and R