The "Stop Frivolous Lawsuits and Protect Your Legal Rights" constitutional amendment initiative would add a new section (14A) to Article 6 of the Nevada State Constitution if passed in November 2004 and again in November 2006. This Initiative applies to ALL negligence lawsuits, including medical malpractice lawsuits. The first subsection ("1") provides that lawyers who encourage, initiate, or pursue, or defend, frivolous litigation will be personally responsible for the other parties' attorney's fees and costs. Vexatious and frivolous are defined as filing or defending a lawsuit solely to harass or to seek economic gain unrelated to the merits of the lawsuit.

Subsection 2 declares that all persons are entitled to "complete recovery" for all harm and losses caused to them as a result of another's negligent or wrongful conduct. Further, no law shall be enacted which limits a person's rights to this complete recovery. However, this subsection would not change any limitation on damages in effect on January 1, 2004 (such as the $350,000 pain and suffering damage limitations to each plaintiff from each defendant in A.B. 1 of the 2002 Special Session of the Legislature) except the Legislature could increase the dollar limit of the damages or the Legislature could remove all damage limitations.

Subsection 3 provides that "there shall be no interference with a person's right to a fair trial and the judgment that is awarded by a jury".

Subsection 4 provides there shall be no law which limits a (contingency) fee contract between a person and his or her attorney.

Subsection 5 provides that if any part of this amendment is found invalid for any reason, the other provisions shall remain intact. This is known as a severability clause.

The Insurance Rate Reduction and Reform Act

The Insurance Rate Reduction and Reform Act's tort reform provisions apply only to medical malpractice insurance claims and premiums. These tort reform provisions are found in Section 8 of the Act. Subsection 1 of Section 8 provides that ANY statute (law) in effect on December 1, 2006 limiting the amount of recovery for negligence by a doctor, hospital, or other health care provider shall be void unless the Insurance Commissioner, by February 1, 2007, determines that the limitations on an award has reduced (i) the average payout for claims by 10% per year since the limitation became effective, AND (ii) the premiums charged to health care providers have decreased by an average of 10% per year since the limitation became effective.

This amendment to the constitution would not apply to governmental employees or to providers of health care providing services free of charge.

Section 9 contains a severability clause so that if any part of this constitutional addition is held invalid for any reason, the remaining provisions will not be affected.

The other sections of this proposed addition to Nevada's Constitution apply specifically to casualty insurers doing business in Nevada.

Section 1 defines casualty insurance as insurance against any kind of loss, damage or liability, but specifically excepting life, health, workers compensation or disability insurance.

Section 2 would mandate a 20% rollback of casualty insurance premiums in effect between December 1, 2006, and December 1, 2007. This would apply unless an insurer demonstrated to the Insurance Commissioner the reduced rates would fail to provide a fair and reasonable return to the insurer or are otherwise confiscatory.

Section 3 would mandate a 20% "good driver" discount. A good driver is defined in this section.

Insurers would be prohibited from refusing to insure a person who qualified for the discount.

Section 4 mandates that insurers shall be subject to the same laws as all other Nevada businesses.

Section 5 provides the Insurance Commissioner with responsibility for oversight of the insurance industry.

Section 6 provides for the appointment of a person to represent the interests of the public related to insurance. The Insurance Commissioner shall adopt regulations to prohibit unreasonable business practices by insurers.

Section 7 requires that the Insurance Commissioner shall approve each proposed rate to be charged by a casualty insurer as of December 1, 2007. The Insurance Commissioner shall promulgate regulations prohibiting insurers incurring unreasonable expenses and holding unreasonable reserves. Public hearings of all rate increase requests above 7% for personal casualty insurance or greater than 15% for commercial casualty insurance must be held.

The full text of these two proposed constitutional amendments can be found by looking in the Miscellaneous section of the Clark County Medical Society’s website: www.clarkcountymedical.com or www.clarkcountymedical.org

Commentary

By Michael P. Colletti, MD, President, and Weldon (Don) Havins, MD, CEO and Special Counsel

Two constitutional amendment Initiatives have caused some adverse comments in the local newspapers. An article in the Las Vegas Review Journal, dated June 8, 2004, entitled "Duplicity alleged of ballot measures" quoted Larry Matheis, executive director the Nevada State Medical Association, stating the purported auto insurance rollback "is sort of flying under false colors". The article noted that the Insurance Rate Reduction and Reform Act purportedly intends to roll back auto insurance rates 20% with an additional 20% rollback for "good drivers". In fact, the article continued, a Nevada rollback approved by the Legislature in 1989 was found unconstitutional by a federal appeals court. The insurance rollback is simply an invalid pretext hiding the real purpose of the Initiative, which is to void, constitutionally, all laws that in any way limit awards in medical malpractice lawsuits.

The proposed constitutional amendment states that ANY statute in effect on December 1, 2006 which limits the amount of recovery in a medical malpractice action shall be void unless the Insurance Commissioner determines, not later than February 1, 2007, that any such limitation has reduced the annual average amount paid in claims by 10% per year since its enactment AND reduced the amount of premiums by 10% per year since enactment. With at least three of the five professional liability insurance carriers having raised their premium rates by double digits since the passage of A.B. 1 of the 2002 Special Legislative Session, there is essentially no chance of the limitations of A.B. 1 surviving or the limitations of the KODIN Initiative surviving (if passed in November 2004).

This constitutional Initiative amendment would be required to pass in 2004 and then again in 2006 to become effective. The Initiative contains a severability clause stating that if any provision in the Initiative is found invalid for any reason, the remaining provisions remain intact and valid. Thus, if a federal court finds that the mandatory rollback of insurance premiums provision violates the U.S. Constitution, the medical malpractice tort reform obliteration provisions remain valid and intact.

The June 8th article quotes Las Vegas attorney Gerald Gillock as stating Larry Matheis and Scott Craigie, lobbyist for the Nevada State Medical Association, "are just wrong. As far as I know, there is no indication that this is anything more than a sincere effort to get an across-the-board insurance rollback and make insurance companies accountable…." Gillock continued the "he didn't know who was backing the petition drive".

In fact, the group filing the Initiative in April 2004, the "People for a Better Nevada" was, according to the Nevada Secretary of State's website, incorporated in September 2003. The resident agent listed for that organization is the Treasurer for the Nevada Trial Lawyers Association. At the time of filing the petition in April 2004, the person filing, Carmen Cashman, stated that "she had no funding to gather signatures for the two petitions and that she was working out of her home." This misstatement was immediately followed by a article noting that "Southwest Group, a professional signature-gathering group, is collecting signatures for both petitions, said its president, Billy Rogers. Rogers, in an interview last month, said he expects to be successful in qualifying the measures for the ballot." The article concluded that the two petitions filed by Cashman, because they would amend the state constitution, would supercede either medical malpractice reform effort (A.B. 1 and KODIN).

Two days later, June 10th, the Las Vegas Sun noted that "the Nevada Trial Lawyers Association is supporting two statewide initiative petitions…." This comports with a later article in the Review Journal noting that over a month before the petitions were filed a letter written to members of the Nevada Trial Lawyers Association, signed by the NTLA president, stated that the NTLA had "brought together experts in the field and believe that we have a strong constitutional amendment that we plan to pass…." This letter solicited donations from practitioners in the tort arena of from $10,000 to $25,000 each for this cause alone.

The second of the constitutional amendment Initiatives, and the one apparently referred to in the NTLA letter, is entitled the "Stop Frivolous Lawsuits and Protect Your Legal Rights Act". This Initiative would amend Nevada's Constitution to bar any Nevada law from limiting the amount of contingency fees the lawyer could obtain from his or her client. This Initiative applies to all civil actions, not just medical malpractice. Another provision of this Act would void the KODIN Initiative (assuming it passed) and would prohibit the Legislature from passing any law to further limit award of damages more than A.B. 1. The Legislature would specifically not be prohibited from increasing the dollar limits in awards, and would not be prohibited from eliminating all limits on awards. One subsection provides that "there shall be no interference with a person's right to a fair trial and the judgment that is awarded by a jury". Would this mean that arbitration contracts would be void, or that motions to reduce the amount of a jury award (know as a remittitur) would be out of order? It appears only the Nevada Supreme Court could decipher this inscrutable language. Lastly, of course, the Act contains a severability clause stating that if any provision of the Initiative were to be found invalid, the remaining provisions would be unaffected.

Either of these Initiatives would destroy medical liability tort reform and make it constitutionally impossible for the Legislature to pass laws to ameliorate the chaos in medical liability insurance availability and affordability that would very likely follow passage of these constitutional Initiatives.

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President’s Message

By Michael P Colletti, M.D., 2004-2005 CCMS President

This is going to be an exciting and challenging summer. The CCMS Executive Committee will meet monthly and the full Board will meet in September. There are several important topics and issues facing the doctors and patients of Clark County, the outcome of which will affect the quality, availability and affordability of medical care for the next several years.

We are in the process of educating our patient/voters about Question #3, KODIN - Keep Our Doctors in Nevada, which will be on the November ballot. In addition to physicians and other health care providers being well versed about KODIN, we also need our office staffs informed about KODIN. The CCMS auxiliary has been hard at work delivering KODIN kits to physician offices for distribution to our patients. Please take the time to meet with your staffs and stress the importance of patient/voter education.

Under the leadership of Dr. Jerry Jones and past president of the CCMS Alliance Annette Mohs, CCMS has established voter registration in many physician offices. It is easy to do and I encourage all physicians to become involved. You can receive further information by calling the CCMS office at 739-9989. Early voting will be one of the most important means of ensuring the passage of Question #3 and we will continue to keep you informed about early voting.

The Trial Attorneys are attempting to amend the Nevada constitution with the ultimate effect of eventually nullifying KODIN's key provision which is a cap on non-economic damages. They are gathering signatures of citizens to have their two initiatives on the November ballot. To become part of the Nevada constitution, the two initiatives would also have to pass on the 2006 ballot. The first is called "Stop frivolous lawsuits and protect your legal rights act" and the second, "The insurance rate reduction and reform act." While these sound like good ideas, (like "Motherhood and Apple Pie") the fine print is really intended to allow trial attorneys to protect their huge personal financial interests. The details of these two petitions will be discussed by our CEO, Don Havins, MD, JD, in this issue of the County Line.

CCMS MedPac, headed by Dr. David Steinberg, will be interviewing candidates for the Nevada Assembly and Senate. We will strongly support candidates who are in favor of KODIN and strengthening our health care system. We also intend to oppose those not supportive. Many candidates seek endorsement from the CCMS and our financial support. If you have not made a contribution to MedPac, please consider doing so. It is money that will be carefully and well spent.

CCMS continues to be involved with the Southern Nevada Medical Industry Coalition (SNMIC). Our main focus is with the legislative and nursing education committees. Physicians and patients should know that there is widespread support for physicians, KODIN and healthcare among many of our business and local government leaders. They know the importance of assuring quality health care in Las Vegas, Henderson, and all of Southern Nevada. We, and they, want to be proud of the medical care our communities have to offer. Healthcare is one of the most important parts of the infrastructure of any society and makes the environment more livable. Your continued support in all of these endeavors is greatly appreciated.

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New Members - June 2004

Congratulations and Welcome to the Clark County Medical Society

Gorden Chu, MD., Diagnostic Radiology, 2950 S Maryland Pkwy, Las Vegas, NV 89109
Wen Liang, MD, Internal Medicine, 10120 S Eastern Ave #150, Henderson, NV 89052

Reinstated Members

David G Browne, MD, Radiology, 2950 S Maryland Pkwy, Las Vegas, NV 89109
Lisa D Gamino, MD, Radiology, 2950 S Maryland Pkwy, Las Vegas, NV 89109
Robert C Gutierrez, MD, Orthopaedics, 10001 S Eastern Ave #102, Henderson, NV 89052
Francis W Teng, MD, General Surgery, 3150 N Tenaya Wy #680, Las Vegas, NV 89128
Mark L Winkler, MD, Diagnostic Radiology, 2950 S Maryland Pkwy, Las Vegas, NV 89109

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Resolutions from the 2004 NSMA Annual Meeting

The Nevada State Medical Association held its annual meeting West, at the Wigwam Resort, Litchfield Park, Arizona, April 17, 2004. Following are the Resolutions discussed at that meeting and their results.

#2004-01, "MEMORIAL RESOLUTION", was PASSED.

RESOLVED: THAT THE NEVADA STATE MEDICAL ASSOCIATION HOUSE OF DELEGATES EXPRESS ITS SORROW AT THE PASSING OF THE FOLLOWING:

Steven Agata, M.D., CCMS, 06/07/2003

Robert Balin, M.D., CCMS, 07/01/2003

Robert L. Brown, M.D., CDCMS, 07/25/2003

Gerald L. Dales, M.D., WCMS, 02/25/2004

Joseph C. Elia, M.D., WCMS, 11/21/2003

Charles E. Fleming, M.D., WCMS, 01/28/2004

J. Christopher Hastings, M.D., WCMS, 06/26/2003

Thomas F. Keyes, MD, CCMS, 04/03/2004

Jerome J. Mahoney, M.D., WCMS, 02/25/2004

Jerald Malone, M.D., CCMS, 03/06/2004

Josue Rojas, M.D., CCMS, 07/2003

Richard C. Sheretz, M.D., WCMS, 08/25/2003

E. Kenneth Smith, M.D., WCMS, 10/09/2003

W. Ross Tappan, M.D., WCMS, 07/15/2003

Newton L. Thompson, M.D., WCMS, 06/20/2003

Hans (George) Wirges, CCMS, 07/15/2003

And, be it further

RESOLVED: THAT UPON PASSAGE OF THIS RESOLUTION, THE HOUSE OF DELEGATES RISE IN SILENT TRIBUTE.

#2004-02, "PRORATED DUES", was discussed and DID NOT PASS.

#2004-03, " HEALTH INSURANCE AVAILABILITY", was divided into 2004-03 and 2004-03a

#2004-03 "HEALTH INSURANCE AVAILABILITY" was REFERRED TO THE INTERNAL AFFAIRS COMMISSION.

RESOLVED: THAT NSMA STAFF ATTEMPT TO ARRANGE GROUP HEALTH INSURANCE AVAILABILITY FOR PHYSICIAN MEMBERS AND THEIR OFFICE STAFF.

#2004-03a "HEALTH INSURANCE AVAILABILITY" was PASSED.

RESOLVED: THAT NSMA REQUEST THAT THE AMA ARRANGE AND OFFER TO ITS MEMBERS GROUP HEALTH INSURANCE AS A MEMBER BENEFIT.

#2004-04 "PEER REVIEW", was discussed and DID NOT PASS.

#2004-05, "NSBME REVIEW OF LEGALLY CONTESTED HOSPITAL MEDICAL STAFF DISCIPLINARY ACTION", was discussed and PASSED AS AMENDED.

RESOLVED: THAT THE NSMA WILL WORK TO ACHIEVE STATE LEGISLATION THAT MANDATES THE NEVADA STATE BOARD OF MEDICAL EXAMINERS WILL AUTOMATICALLY AND THOROUGHLY REVIEW THE CHARGES AND RESULTING DISCIPLINARY ACTION RECOMMENDED BY THE HOSPITAL MEDICAL STAFF IN ANY AND ALL SITUATIONS .

#2004-06, "MANAGED CARE ABUSIVE PRACTICES ", was discussed and PASSED AS AMENDED.

RESOLVED: THAT NSMA CONVENE A TASK FORCE TO EVALUATE MANAGED CARE ABUSES.

#2004-07, "CRIMINAL BACKGROUND CHECKS", PASSED AS AMENDED.

RESOLVED: THAT THE NEVADA STATE MEDICAL ASSOCIATION REQUEST THAT THE NEVADA STATE BOARD OF MEDICAL EXAMINERS AND THE NEVADA STATE BOARD OF OSTEOPATHIC MEDICINE PERFORM CRIMINAL BACKGROUND CHECKS ON ALL PHYSICIANS WHO ARE APPLYING FOR LICENSURE TO PRACTICE MEDICINE IN THE STATE OF NEVADA; and be it further

RESOLVED: THAT IF THE NSBME AND THE NEVADA STATE BOARD OF OSTEOPATHIC MEDICINE REFUSE, THAT NSMA WILL WORK WITH THE NEVADA STATE LEGISLATURE TO MANDATE THAT THE NEVADA STATE BOARD OF MEDICAL EXAMINERS AND THE NEVADA STATE BOARD OF OSTEOPATHIC MEDICINE PERFORM CRIMINAL BACKGROUND CHECKS ON ALL PHYSICIANS WHO ARE APPLYING FOR LICENSURE TO PRACTICE MEDICINE IN THE STATE OF NEVADA.

#2004-08, "PATIENT CONFIDENTIALITY", was REFERRED TO COUNCIL.

#2004-9, "NEVADA STATE BOARD OF MEDICAL EXAMINERS SPECIAL BME CME REQUIREMENTS", was discussed and DID NOT PASS.

#2004-10, "REESTABLISHMENT OF AN IMPROVED MEDICAL DENTAL SCREENING PANEL", was discussed and PASSED AS AMENDED.

RESOLVED: THAT THE NEVADA STATE MEDICAL ASSOCIATION PROPOSE A BILL DRAFT REQUEST TO AMEND NEVADA LAW TO PROVIDE FOR A MEDICAL DENTAL SCREENING PANEL AS PROPOSED IN AB 300 AT THE 2003 LEGISLATIVE SESSION.

#2004-11, "OPEN ADMINISTRATIVE HEARINGS BY THE NSBME", was PASSED AS AMENDED.

RESOLVED: THAT THE NEVADA STATE MEDICAL ASSOCIATION PROPOSE A BILL DRAFT REQUEST TO AMEND NEVADA LAW TO PROVIDE THAT ADMINISTRATIVE HEARINGS OF THE NSBME BE OPEN TO THE PUBLIC UNLESS THE DEFENDANT REQUESTS IN WRITING THAT THE HEARING BE CLOSED; and be it further

RESOLVED: THAT ADMINISTRATIVE HEARINGS OF THE NSBME INVOLVING DEFENDANTS FROM CLARK, NYE OR LINCOLN COUNTIES BE HELD IN LAS VEGAS, NEVADA.

#2004-12, "ELIMINATION OF PROFICIENCY REGULATIONS ", was discussed and PASSED AS AMENDED.

RESOLVED: THAT THE NEVADA STATE MEDICAL ASSOCIATION PROPOSE A BILL DRAFT REQUEST AMENDING NEVADA'S MEDICAL PRACTICE ACT, NRS 630, TO ASSURE THAT ANY NEVADA STATE BOARD OF MEDICAL EXAMINERS PROFICIENCY REGULATIONS ARE CONSISTENT WITH FUTURE PROPOSED UNIFORM STATE LAW, ENDORSED BY THE AMERICAN MEDICAL ASSOCIATION, ADDRESSING RELICENSURE ON A RATIONAL BASIS EVALUATING COMPETENCY AND/OR PROFICIENCY.

#2004-13, "LETTERS OF CONCERN AND NON-PUNITIVE LETTERS OF ADMONITION BY THE NSBME", was withdrawn by the author.

#2004-14, "PUBLIC COMMENT BEFORE AGENCY VOTING", was PASSED AS AMENDED.

RESOLVED: THAT THE NEVADA STATE MEDICAL ASSOCIATION INITIATE A BILL DRAFT REQUEST AMENDING NEVADA'S OPEN MEETING ACT AS

FOLLOWS:

Chapter 241 of NRS is hereby amended by adding thereto a new section to read as follows:

1. Except as otherwise provided in subsection 3, a licensing board may not take action by vote on an item on the agenda of a meeting on which action may otherwise be taken until public comment on the item has been allowed. Such public comment may be allowed immediately preceding action on the specific item, during a single period preceding action on any item on the agenda, or any combination thereof.

2. Each licensing board shall adopt a rule of procedure regarding the public comment required pursuant to subsection 1.

3. The provisions of this section do not apply to a contested case, as that term is defined in NRS 233B.032.

#2004-15, "MEDICAL LIABILITY REFORM STATUTES", was PASSED AS AMENDED IN THE EVENT OF THE FAILURE OF QUESTION 3.

RESOLVED: THAT THE NEVADA STATE MEDICAL ASSOCIATION PROPOSE BILL DRAFT REQUESTS TO AMEND NEVADA REVISED STATUTES TO PROVIDE FOR A $250,000 FIRM CAP ON NON-ECONOMIC DAMAGES IN MEDICAL MALPRACTICE ACTIONS, PROVIDE FOR THE ADMISSIBILITY BY THE DEFENDANT OF COLLATERAL SOURCES OF PAYMENTS TO THE PLAINTIFF IN MEDICAL MALPRACTICE ACTIONS, AND PROVIDE FOR CONTINGENCY FEE LIMITATIONS OF PLAINTIFF ATTORNEY FEES IN MEDICAL MALPRACTICE ACTIONS.

#2004-16, "MODIFY NEVADA'S GOOD SAMARITAN LAWS", was PASSED AS AMENDED.

RESOLVED: THAT THE NEVADA STATE MEDICAL ASSOCIATION PROPOSE A BILL DRAFT REQUEST TO AMEND NRS 41.505(5) TO UNAMBIGUOUSLY PROVIDE THAT GRATUITOUS MEDICAL AND DENTAL SERVICES PROVIDED BY AN APPROPRIATELY STATE LICENSED VOLUNTEER OF A NONPROFIT ORGANIZATION OR GOVERNMENTAL ENTITY SHALL NOT BE LIABLE FOR CIVIL DAMAGES FOR PROFESSIONAL CARE OR ASSISTANCE RENDERED EXCEPT AS PROVIDED IN NRS 41.505(5); and be it further

RESOLVED: THAT THE BILL DRAFT REQUEST PROVIDE FOR THE SAME PROTECTIONS FOR LICENSED ATTORNEYS PROVIDING GRATUITOUS LEGAL SERVICES FOR INDIVIDUALS OF A NONPROFIT ENTITY ORGANIZED TO PROVIDE AND COORDINATE PRO BONO LEGAL SERVICES.

#2004-17, "NSMA AND BIOTERRORISM AND DISASTER PREPAREDNESS" was discussed and PASSED.

RESOLVED: THAT NSMA:

(A) WILL PARTICIPATE IN THE STATE PROCESS TO ASSURE THAT AVAILABLE FEDERAL FUNDS AWARDED ARE USED TO ENABLE NEVADA TO: (1) ENHANCE ITS PUBLIC HEALTH INFRASTRUCTURE, INCLUDING DISEASE SURVEILLANCE AND REPORTING ACTIVITIES, TO ASSURE THAT NEVADA CAN RESPOND APPROPRIATELY TO ANY BIO-TERROR INCIDENT OR DISASTER SITUATION; (2) TRAIN PHYSICIANS AND OTHER MEDICAL PERSONNEL FOR THE EARLY RECOGNITION AND TREATMENT OF DISEASES CAUSED BY THE RELEASE OF BIOLOGICAL AGENTS; (3) IMPLEMENT MECHANISMS FOR TIMELY AND EFFICIENT DISSEMINATION OF INFORMATION TO THE MEDICAL COMMUNITY AND THE PUBLIC AT LARGE; AND (4) ACQUIRE THE NECESSARY EQUIPMENT TO RESPOND TO SUCH AN ATTACK.

(B) WILL IDENTIFY THE TRAINING AND EDUCATIONAL NEEDS OF NEVADA PHYSICIANS REGARDING BIO-TERRORISM AND RELATED THREATS AND WILL DEVELOP OR ASSIST IN THE AVAILABILITY OF NEEDED EDUCATIONAL OPPORTUNITIES.

(C) WILL ASSIST NEVADA PUBLIC HEALTH AUTHORITIES IN IDENTIFYING ROLES FOR PHYSICIAN VOLUNTEERS TO ASSIST IN THE RESPONSE TO BIO-TERROR OR OTHER MASS EXPOSURE AND ACCIDENT SITUATIONS AND WILL SUPPORT THE IMPLEMENTATION OF PROGRAMS LIKE THE MEDICAL RESERVE CORPS.

(D) WILL JOIN IN WORKING WITH: THE STATE PUBLIC HEALTH AUTHORITIES (NEVADA STATE DIVISION OF HEALTH, WASHOE COUNTY HEALTH DISTRICT, AND CLARK COUNTY HEALTH DISTRICT), OTHER APPROPRIATE STATE AGENCIES; THE AMERICAN MEDICAL ASSOCIATION, LOCAL, AND MEDICAL SPECIALTY SOCIETIES; AND, OTHERS AS APPROPRIATE TO: (1) ENSURE ADEQUATE RESOURCES, SUPPLIES, AND TRAINING TO ENHANCE THE MEDICAL AND PUBLIC HEALTH RESPONSE TO TERRORISM AND OTHER DISASTERS; (2) DEVELOP A COMPREHENSIVE STRATEGY TO ASSURE SURGE CAPACITY TO ADDRESS MASS CASUALTY CARE; AND (3) IMPLEMENT COMMUNICATIONS STRATEGIES TO INFORM HEALTH CARE PROFESSIONALS AND THE PUBLIC ABOUT A TERRORIST ATTACK OR OTHER MAJOR DISASTER, INCLUDING LOCAL INFORMATION ON AVAILABLE MEDICAL AND MENTAL HEALTH SERVICES.

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Clark County District Court Medical Malpractice Filings Against Health Care Providers, Jan 2001 - Jun 2004

2001 2002 2003 2004

Jan 39 33 109 50

Feb 20 14 88 68

Mar 35 30 148 104

Apr 37 34 101 74

May 37 35 108 48

Jun 27 24 98 77

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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CCHD issues report on West Nile Virus

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

West Nile Virus is an acute viral disease caused by the bite of an infected mosquito.

The Clark County Health District Environmental Health Division, in collaboration with Clark County Vector Control, is conducting surveillance to monitor for West Nile virus. There are three categories of surveillance currently underway: dead bird testing (crows, ravens and magpies), mosquito testing and sentinel chicken flock testing. No West Nile virus activity has been detected in the Las Vegas valley. In July, mosquito testing will be expanded to neighboring Lincoln and Nye counties.

Although the virus has not been detected in Clark County, virus activity has been high in neighboring states and it is important to remember to take precautions to avoid mosquito bites, especially when traveling to mosquito-prone areas.

Following is information for clinicians provided by the Centers for Disease Control and Prevention:

Clinical Features

Mild Infection

· Most WNV infections are mild and often clinically unapparent.

· Approximately 20% of those infected develop a generally mild illness (West Nile fever).

· The incubation period is thought to range from 3 to 14 days.

· Symptoms generally last 3 to 6 days.

Reports from earlier outbreaks describe the mild form of WNV infection as a febrile illness of sudden onset often accompanied by:

· Malaise

· Anorexia

· Eye pain

· Myalgia

· Lymphadenopathy

· Nausea

· Vomiting

· Headache

· Rash

The full clinical spectrum of West Nile fever has not been determined in the United States.

Severe Infection

Approximately 1 in 150 infections will result in severe neurological disease.

· The most significant risk factor for developing severe neurological disease is advanced age.

· Encephalitis is more commonly reported than meningitis.

· In recent outbreaks, symptoms occurring among patients hospitalized with severe disease include:

o fever

o weakness

o gastrointestinal symptoms

o change in mental status

· A minority of patients with severe disease developed a maculopapular or morbilliform rash involving the neck, trunk, arms, or legs.

· Several patients experienced severe muscle weakness and flaccid paralysis.

· Neurological presentations included:

o ataxia and extrapyramidal signs

o cranial nerve abnormalities

o myelitis

o optic neuritis

o polyradiculitis

o seizures

Although not observed in recent outbreaks, myocarditis, pancreatitis, and fulminant hepatitis have been described.

Clinical Suspicion

Diagnosis of WNV infection is based on a high index of clinical suspicion and obtaining specific laboratory tests.

· WNV, or other arboviral diseases such as St. Louis encephalitis, should be strongly considered in adults >50 years who develop unexplained encephalitis or meningitis in summer or early fall.

· The local presence of WNV enzootic activity or other human cases should further raise suspicion.

· Obtaining a recent travel history is also important.

Note: Severe neurological disease due to WNV infection has occurred in patients of all ages. Year-round transmission is possible in some areas. Therefore, WNV should be considered in all persons with unexplained encephalitis and meningitis.

Diagnostic Testing

West Nile virus (WNV) testing for patients with encephalitis, meningitis, or other serious central nervous system infections can be obtained through local or state health departments. For WNV diagnosis, public health laboratories usually perform an IgM antibody capture enzyme-linked immunosorbent assay (MAC-ELISA). Using this assay, virus-specific IgM can be detected in nearly all cerebrospinal fluid (CSF) and serum specimens received from WNV-infected patients at the time of their clinical presentation. Because serum IgM antibody may persist for more than a year, physicians must determine whether the antibody is the result of a WNV infection in the previous year and unrelated to the current clinical presentation. The following procedures are recommended:

· The most conclusive diagnostic method to identify persons with WNV infection of the central nervous system (CNS) is detecting WNV-specific IgM antibody in CSF using MAC-ELISA. This can be done with a CSF specimen obtained during initial clinical presentation. Because IgM antibody does not readily cross the blood-brain barrier, IgM antibody in CSF strongly suggests acute CNS infection

· If CSF is not obtained and serum samples are used to make the diagnosis, paired acute- and convalescent-phase serum samples should be acquired. The acute-phase specimen should be obtained during initial clinical presentation and the convalescent-phase specimen should be obtained 7-14 days later. Both samples should be tested with MAC-ELISA.

· If a convalescent-phase specimen cannot be obtained, the acute-phase specimen should be tested with MAC-ELISA. If the specimen is IgM-negative, then the illness is very unlikely to be an acute WNV infection. If the specimen is IgM-positive and the illness is clinically compatible, then it may be a recent WNV infection (presuming the test results for IgM antibody to St. Louis encephalitis (SLE) virus are significantly lower or negative; see below).

Ideally, MAC-ELISA testing should be performed, using both WNV and SLE virus. If the MAC-ELISA results for WNV and SLE are similar, it is necessary to use the plaque-reduction neutralization test (PRNT) to confirm either a WNV or SLE virus infection. Note: Patients who have been recently vaccinated against or recently infected with related flaviviruses (e.g., yellow fever, Japanese encephalitis, dengue) may have positive WNV MAC-ELISA results.

Treatment

Treatment is supportive, often involving hospitalization, intravenous fluids, respiratory support, and prevention of secondary infections for patients with severe disease.

Ribavirin in high doses and interferon alpha-2b were found to have some activity against WNV in vitro, but no controlled studies have been completed on the use of these or other medications, including steroids, antiseizure drugs, or osmotic agents, in the management of WNV encephalitis.

Reporting

Suspected cases should be reported the Clark County Health District Office of Epidemiology at 759-1300.

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Greetings from the Alliance

By Marian Haas and Kathie Slaughter, CCMS Alliance Co-Presidents

For those of you who do not know about the Clark County Medical Society Alliance, we wish to tell you something about this wonderful organization and invite you to join us. The Alliance is a group of spouses of physicians that meets on the third Tuesday of the month from September to May for exciting luncheons and programs. It is a great opportunity to meet people with common interests and make friends in the community. We have social time as well as programs to allow us all to become better acquainted. We promote the formation of special interest groups within our Alliance for those who want to pursue small group activities with their Alliance friends. Our current groups are the Book Club, and the Mommy and Me Playgroup. We are hoping to establish more groups which may include scrapbooking, photography, cooking, crafts, hiking, bridge, bunko, dinner groups, and many more. All we need are people interested and a member to head a group.

The purpose of the Alliance is to educate ourselves and the community about health related issues, to support health related charities, and to assist the Clark County Medical Society in programs to improve the health of our residents. We are planning a year which will involve us in the community helping children and families in need find medical, dental, and psychological services. We will be supporting charities that assist and mentor foster children throughout Clark County. We are looking at many ways to have "hands on" involvement for Alliance members who want to help these often ignored children. This is a very important year for the Nevada medical community. We will be actively involved in the fall election process in trying to educate our population about the need to pass tort reform and support issue Number 3 to Keep Our Doctors in Nevada.

Your $80.00 dues will give you full membership in the Clark County Medical Society Alliance, the Nevada State Medical Society Alliance, and the American Medical Association Alliance. Membership provides access to information on topics from lobbying to leadership training, kids and bullying to medical marriages, retirement planning to community projects, and much more.

Please join us! We are sure you can find enjoyable activities and new friends. Membership forms are available in the Clark County Medical Society Office on 2590 E. Russell Road or directly from the Alliance. Please contact Wendy Agrawal @ 228-6360, Swati Khamamkar @ 242-8542, Marian Haas @ 838-9840, or Kathy Slaughter @878-4981, or go to our website at www.ccmsa-lv.org.

See you at the first luncheon on September 21!

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Minutes Synopsis

Clark County Medical Society Board Of Trustees Meeting

Tuesday, June 15, 2004; 6:00 P.M.

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

The minutes from the May 18th BOT meeting were approved.

Dr. Steinberg reported the revenue total is less than last year but more revenue is expected the last month of this fiscal year from the Installation dinner. Total expenses are slightly higher than last year.

Committee Reports

Dr. Jameson reported the Community Relations Committee discussed the newly developed Speaker's Bureau. Dr. Jameson stated they intend to contact groups and offer their services to speak to the community and help build the physicians' images. She plans to contact the Washoe County Medical Society and the LA Medical Society to inquire about projects they found exciting.

The following applicants were approved for membership: Wen Liang, MD, Internal Medicine; and Gorden Chu, MD, Diagnostic Medicine. Dr. David Christensen was granted retired status and Dr. Dennis Gordon was granted Active Limited status.

Alliance

Marian Haas and Kathie Slaughter, the new Co-Presidents for the Alliance, were introduced. They asked to use the CCMS database to solicit membership for the Alliance and to consider holding a joint event with CCMS in February.

County Health District

Dr. Kwalick sent a report regarding community-acquired methicillin-resistant Staphylococcus aureus.

NSMA Report

Dr. Evins discussed NSMA's efforts to inform the rural counties of the hidden agenda of Trial Lawyers' Associations' two initiatives.

President's Report

Dr. Kingsley shared several articles regarding the publicity revealing the way the Trial Lawyers are trying to pass their hidden agenda initiatives with misleading titles.

Dr. Kingsley announced that Dr. Steven Montoya had been elected as the Nevada State Medical Board President and congratulated Dr. Montoya.

Administrative Report

Dr. Havins discussed the NBME meeting he recently attended. He stated the Board decided not to follow the recommendation of the Federation of State Medical Boards to hire a PR person; instead the NBME approved a year-long contract with the Nevada Broadcaster's Association. Family Practice residents were approved to do history and physicals on mental patient admissions at the state mental health facility. Dr. Havins gave synopses regarding four disciplinary cases which came before the Board. Dr. Havins noted Dr. Ed Parker's testimony to the NBME concerning individuals using Board Certification in Pain Management, which is not recognized by the AMBS as a medical specialty. The NBME will discuss using non-ABMS certification in advertising at a future Board meeting. Dr. Havins stated Stephen Montoya, MD was elected as the NBME President, Joel Lubritz, MD was elected as the Vice-President and Don Baepler, Ph.D. was elected as the Secretary/Treasurer. Dr. Kingsley and the Board members thanked Dr. Havins for attending the NBME meetings and reporting back to them.

The proposed budget was approved unanimously.

The Board held a closed personnel session regarding employee evaluations.

The next Executive Council meeting will be Tuesday, July 20, 2004 at 6 pm.

There being no further business, the meeting was adjourned by Dr. Kingsley at 8:15 pm.

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Classifieds

· FULL TIME PHYSICIAN WANTED. Nevada license and DEA required. No nights, weekends, emergencies. Family Practice/Personal Injury. Good Benefits. All responses confidential. Please respond to (702) 795-4479.

· MEDICAL OFFICE SPACE FOR RENT. Great location, currently renting half/full days. 1100 sq ft, 3-exam rooms/lab/Drs. Office, large check in/out. Fully furnished. Del Webb building/adjacent to Siena Hospital. Please contact Gayle at (702) 454-6226.

· MEDICAL PHYSICIAN WANTED: Immediate opening for established Weight Loss/Wellness center in Las Vegas, part time 8-12 hours per week. For information call 733-9797 and after hours call 860-9616. Great position for retired Doctor.

· MEDICAL (OR DENTAL) OFFICE SPACE for lease with 4 examination rooms or operatories. Located in the Charleston/Rancho medical corridor. Will provide office personnel staffing assistance if desired. For more information please call (702) 592-7317.

· WANTED: WELL ESTABLISHED 6 year old medical practice seeking part time Nevada licensed Family Practice, General Practitioner (M.D. or D.O.), flexible scheduling, No HMO, competitive salary. E-mail your CV to PmsJim@msn.com or call 326-4988 anytime.

· PHYSICIAN(S) WANTED TO SHARE OFFICE Space on E Flamingo in Desert Springs Hospital-area. Please call 734-2242 for details.

· NEEDED: PART-TIME RETIRED Physician with active Nevada license to work in a drug-free workplace. Please call John Ranc @ (702) 737-8376.

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CME Calendar

Cardiovascular Consultants 691-9154

Clark County Medical Society 739-9989

· 8/21 - “Obesity and Its Treatment,” 9 a.m., 2 CME hours

· 10/2* - “Hospice and Pallative Medicine- What is it?” 9 a.m., 2 Ethics CME hours (*new date*)

· 10/13 - “Current Trends in Cosmetic Surgery and Other Cosmetic Procedures,” 6 a.m., 2 CME hours

Future Programs Planned

August - Medical Malpractice

September - Ethics of Artificial Reproductive Tech., Treatment of Acute & Post-Op Pain

HealthInsight (801) 892-0155

St. Rose Hospital 616-5832

Southwest Medical Associates 242-7347

Summerlin Hospital 233-7572

Sunrise Hospital 731-8210

· 8/5 - “Multidisciplinary Breast Conference,” 7:30 a.m.

· 8/17 - “Documentation, Legal Perspective,” 7:30 a.m.

· 8/18 - “Medical Decision-Making in Children Who Have Been Seriously Injured As A Result of Abuse,” 6:30 p.m., 2 Ethics CME hours

· 8/25 - “High Risk Cardiology,” 6:30 p.m.

· 8/28 - “3rd Annual Regional Symposium on Cardiovascular Diagnosis,” 8 a.m., 8 CME credits

UMC 383-2604

Valley Hospital 388-4847

· 8/10 - “Current Guidelines for Lipid Therapy,” noon

· 8/24 - “A Different Approach to the Treatment of Diabetes Mellitus,” 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* - June 2004

DISEASE CASES REPORTED YEAR TO DATE

Jun 2003 Jun 2004 2003 2004

VACCINE PREVENTABLE DISEASES

DIPTHERIA 0 0 0 0

HAEMOPHILUS INFLUENZA 2 1 4 3

(invasive)

HEPATITIS A 3 1 9 3

HEPATITIS B 10 5 35 32

INFLUENZA 0 0 47 53

MEASLES 0 0 0 0

MUMPS 1 0 1 0

PERTUSSIS 2 0 7 2

POLIOMYELITIS 0 0 0 0

RUBELLA 0 0 0 0

TETANUS 0 0 0 0

SEXUALLY TRANSMITTED DISEASES **

CHLAMYDIA 414 108 2293 1707

GONORRHEA 171 108 894 1241

SYPHILIS (Primary & Secondary) 0 4 4 10

SYPHILIS (Early Latent) 0 1 15 6

ENTERICS

AMEBIASIS 0 2 9 7

BOTULISM-INTESTINAL (Infant) 0 0 1 0

CAMPYLOBACTERIOSIS 9 9 42 29

CHOLERA 0 0 0 0

CRYPTOSPORIDIOSIS 0 0 3 1

E. COLI O157:H7 2 0 4 4

GIARDIASIS 12 5 41 29

ROTAVIRUS 29 21 367 476

SALMONELLOSIS 6 4 48 49

SHIGELLOSIS 9 0 19 18

TYPHOID FEVER 0 0 0 0

VIBRIO PARAHAEMOLYTICUS 0 0 1 1

YERSINIOSIS 0 0 0 0

OTHER

ANTHRAX 0 0 0 0

BOTULISM INTOXICATION 0 0 0 0

BRUCELLOSIS 0 0 0 0

COCCIDIOIDOMYCOSIS 5 6 18 29

ENCEPHALITIS 1 0 2 0

HANTAVIRUS 0 0 0 0

HEMOLYTIC UREMIC 0 0 0 0

SYNDROME (HUS)

HEPATITIS C 2 0 3 2

HEPATITIS D 0 0 0 0

LEGIONELLOSIS 1 0 2 3

LEPROSY (HANSEN'S DISEASE) 0 0 0 1

LEPTOSPIROSIS 0 0 0 0

LISTERIOSIS 1 1 1 3

LYME DISEASE 0 0 1 0

MALARIA 1 1 1 3

MENINGITIS, ASEPTIC/VIRAL 9 7 46 27

MENINGITIS, BACTERIAL 5 1 16 9

MENINGOCOCCAL DISEASE 0 0 3 0

PLAGUE 0 0 0 0

RABIES (HUMAN) 0 0 0 0

RELAPSING FEVER 0 0 0 0

RSV (RESPIRATORY 44 8 1336 1024

SYNCYTIAL VIRUS)

ROCKY MOUNTIAN 0 0 0 0

SPOTTED FEVER

TOXIC SHOCK SYNDROME 0 0 1 3

TUBERCULOSIS 3 6 36 25

TULAREMIA 0 0 0 0

TYPHUS, MURINE 0 0 0 1

UNUSUAL ILLNESS 0 0 0 1

(Creutzfledjakob)