County Line
Newsletter LIII June 2004
Contents
2004 Legislative Dinner: AMA President Elect calls Nevada physicians to action
Community-associated MRSA identified in Clark County
Health Savings Accounts (HSAs)
Malpractice Filings against Health Care Providers, Jan 2001 – Apr 2004
Clark County
Health District Disease Statistics – April 2004
2004 Legislative Dinner: AMA President Elect calls Nevada physicians
to action
More than
150 attended the 2004 Legislative Dinner, co-sponsored this year by the Clark
County Medical Society and the
Pictured
are Dr. Nelson (above), Craigie (top right) and
Community-associated MRSA identified in Clark County
By Donald S. Kwalick,
MD, MPH Chief Health Officer
The Clark County Health District Office of Epidemiology has received reports of 91 cases of methicillin-resistant S. aureus (MRSA) among people inbound to the Clark County and North Las Vegas Detention Centers. The identification of these cases can be credited to the efforts of the detention centers to step up their medical screening process. Most of these infections meet the criteria for community-associated MRSA (CA-MRSA) infections, which include:
- Diagnosis of MRSA made in the outpatient setting or by a culture positive for MRSA within 48 hours after admission to the hospital
- The patient has no medical history of MRSA infection or colonization
- The patient has no medical history in the past year of:
- Hospitalization
- Admission to a nursing home, skilled nursing facility, or hospice
- Dialysis
- Surgery
- The patient has no permanent indwelling catheters or medical devices that pass through the skin into the body
Additional CA-MRSA cases have been reported by a local health care facility. The infection has been identified in persons ranging from 2 months to 75 years of age. Frequently, in the initial stages, the infection can resemble a spider bite or present as cellulitis. It is important to raise awareness of the presence of MRSA in the community in order for health care providers to make an accurate diagnosis and provide the appropriate treatment. Because the infection can spread to close contacts of the patient, it is advisable to educate the patient (and family) regarding infection control in the household setting. A patient information sheet on infection control for CA-MRSA can be downloaded from the Clark County Health District website at: http://www.cchd.org/physician/physician_only.htm.
Antimicrobial resistance is a growing concern of the public health and medical communities. The first identified incidence of MRSA in the United States occurred in 1968 in a hospital setting. Since that time, the incidence of MRSA infections in hospitalized patients has risen from 2 percent in 1974 to about 40 percent in 1997. Until recently, infections with MRSA have been limited primarily to patients in hospitals or long-term care facilities, making increased reports of community associated cases of concern.
In May 2003 the Council of State and Territorial Epidemiologists (CSTE) published a position statement supporting the development of surveillance systems for invasive and CA-MRSA in select states.
According to the CSTE position statement the surveillance goals are to:
- Monitor and describe the incidence, prevalence, distribution and etiology of reportable MRSA in select states or communities.
- Rapidly recognize and characterize the emergency of new patterns of disease and populations affected.
- Guide prevention programs to control and prevent the further spread and deleterious public health consequences of MRSA.
- Develop recommendation for national surveillance and consideration of MRSA for inclusion on the national notifiable diseases list.
Steps CDC is taking to address CA-MRSA include:
- Working with four states on a project to define the spectrum of disease, determine populations affected, and developing studies to define who is at particular risk for infection
- Working with state health departments to assist in the development of surveillance systems for tracking MRSA in the community
- Utilizing the National Health and Nutritional Evaluation Survey (NHANES) to estimate the number of individuals in the United States who carry staph bacteria in their nose
- Working with laboratories across the country to improve the detection of MRSA through training personnel and use of appropriate testing methods
- Providing technical expertise to hospitals and state and local health departments on infection control in healthcare settings, including control of MRSA
- CDC laboratories are working to characterize the unique features of MRSA strains from the community.
MRSA is not presently a reportable condition in Nevada. However, with the identification of community-associated cases in our jurisdiction the health district is encouraging health care providers to report cases to our Office of Epidemiology at 759-1300. I am considering mandatory reporting of MRSA pursuant to NAC.441A.040 in the near future.
President’s Message
By Ed Kingsley, M.D.,
2003-2004
s my term as president for the Clark County Medical Society comes to a close, I reflect on some of my experiences this past year. This has been foremost a learning experience for me, especially in the political arena. As much as I dislike politics, I've also come to understand how the practice of medicine in America in the 21st century is inextricably linked to politics. I think most physicians dislike politics as much as I do. This plus the fact that most physicians think they are too busy taking care of their patients is the reason so few of us become involved in the political process as it relates to the practice of medicine. I know I felt that way for the first ten years of my practice in southern Nevada. We think we can satisfy our obligations to our profession and our patients by simply taking good care of them and leave the politics to someone else. This isn't surprising since our medical education does little if anything to prepare us for the politics of medicine and thus we feel uncomfortable venturing into those unchartered waters. Maybe some of us think that the doctors who spend their time in various medical societies and political activities relating to medicine do so because they probably don't have much of a life outside of their medical careers, or that somehow they have more time at their disposal. Of course, it is highly laudable to dedicate ourselves to our patients by staying current on the standards of good medical care and spending as much of our time, energies and talents as possible keeping them well. That is exactly what we were trained to do and most of us do it very well. Unfortunately, this is simply no longer good enough.
|
S |
o, just what exactly is "the politics of organized medicine"? To me it is doctors organizing themselves together in formal societies or informal groups to maintain and advance our ability to practice medicine in such a way that assures the best medical care to as many patients as possible at the least cost. Are these political activities really necessary? What do these groups actually do for me as a practicing physician or for my patients? Plenty! For one thing, there is a critical necessity of continually monitoring the political and regulatory processes routinely carried out by the legislature, the courts and the executive branch, both at the state and national levels, as they relate to the way you and I practice medicine. Many of us probably assume that the regulatory aspects of medicine simply take care of themselves with little if any input from us practicing physicians. Many of us probably assume that since our profession is founded upon such noble principles as the healing and caring for the sick; hard work; long, difficult hours of sacrifice in training and practicing medicine and frequently doing so without compensation from those we serve; and frequently volunteering for hospital and medical society committee and administrative work, this "hallowed ground" of medicine would never be trampled upon and that we will always be allowed to practice medicine the way we think it should be practiced. There couldn't possibly be any enemies seeking to alter the way we practice our art. Who would dare do such a thing?
|
U |
nfortunately, there are indeed plenty of people with agendas who in fact seek to either limit our ability to render good medical care or who would seek to extend prescribing, surgical and other privileges unique to our profession to other practitioners without the same training, experience and educational degrees. If you don't believe the magnitude of this second point, simply look at the numerous bills that the many and sundry individuals and groups routinely try to introduce every legislative session that would do just that if passed. Who's watching out for our best interests as this happens? Who is going to assure that we can practice medicine the way it should be if we ourselves don't? Simply put, we relinquish that duty to others outside of our profession if we don't do it ourselves. Can we trust that responsibility and obligation to anyone else?
|
T |
hat
is probably the most important reason I can think of why every one of us should
be active in our local and state medical societies. There is a very real need for all of us to be
involved in the politics of medicine, if not with our time and energies than at
least with our wallets. Joining and
becoming active in our County Society as well as the
|
F |
or example, as I hope everyone knows by now, Initiative #3, the Keep Our Doctors In Nevada (KODIN) question, will be on this November's ballot. To the best of my knowledge, this will be the first attempt for such medical tort reform at the ballot box ever in this nation's history. If passed, this should eventually provide doctors substantial relief from skyrocketing medical liability insurance premiums and vexatious and frivolous lawsuits. In addition, it will give significant impetus to legislate additional medical tort reform both within our own state as well as at the national level. Most importantly, it should improve health care affordability and availability to the citizens of this state. In response to this Initiative, the personal injury lawyers have launched a massive and well-organized campaign to collect the requisite number of signatures to place on the same ballot TWO Nevada constitutional amendment initiatives that, if passed, will essentially gut all of the potential gains from our Initiative! These are entitled: "The Insurance Rate Reduction and Reform Act" and "Stop Frivolous Lawsuits and Protect Your Legal Rights Act", and can be reviewed at http://sos.state.nv.us/nvelection/intref/2004intrefer.htm. These are so seductively worded it might be surprising if people don't vote for them for that reason alone. However, if voters actually take the time to read how these two amendments will change our constitution, it's hard to understand how anyone could vote for them. There's the problem, however - the actual amendments are quite wordy and many voters may simply vote "yes" because of their titles. This is just one example of how important it is going to be for everyone to become involved during the next five months in educating our patients, friends and families about voting "yes" for Initiative 3 and "no" on the two constitutional amendment initiatives (which have not yet had a number assigned to them). This will realistically be our last and only shot at passing meaningful medical tort reform in Nevada for a very long time. If our initiative doesn't pass with the voters, how many politicians do you think will be willing to go out on a limb, against their own constituents, during the next legislative session that will begin just a few months after the November election, to support another attempt at medical tort reform? Very few, if any - not only for next year but also for many years thereafter. It's now or never, my fellow colleagues. We must do everything within our power to see that Initiative #3 passes. We must take the time to educate our patients about it during the next few months leading up to October, when early balloting begins. It is really up to US.
|
M |
any of us attended the 100th annual NSMA meeting in April, held this year at the Wigwam Resort in Litchfield, AZ. This proved to be a productive and, at the same time, relaxing and enjoyable meeting with our colleagues from throughout the state. The House unanimously elected the 2004-2005 NSMA officers: President Michael J. Fischer MD; President-Elect Warren H. Evins MD; Secretary Ed Kingsley MD; Treasurer Wayne C. Hardwick MD; and two of the four members of the AMA Nevada Delegation: Robert Lynn Horne MD and, as alternate, Marietta Nelson MD.
|
O |
ver
150 attended the
|
D |
on't
forget to make plans to attend the
|
I |
'd
like to take this opportunity to thank all of you who have been so helpful in
making my tenure as
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
· Saul Ruben, MD, Diagnostic Radiology
· Anthony P Shaya, MD, Ob-Gyn
For
information on becoming a member of the Clark County Medical Society, call
New Members for April 2004
Congratulations and Welcome to the Clark
County Medical Society
- Keith S Blum, DO, Neurological Surgery, 7730 W Sahara #109, Las Vegas, NV 89117
- Ian G Haycocks, MD, Diagnostic Radiology, 2020 Palomino Ln #100, Las Vegas, NV 89106
- Kelly A Kogut, MD, Pediatric Surgery, 3121 S Maryland Pkwy #400, Las Vegas, NV 89109
- Carlos F Luna, MD, Pediatric Cardiology, 3006 S Maryland Pkwy #690, Las Vegas, NV 89109
- Alexander Norton, Jr, MD, Ob-Gyn, 9280 W Sunset Rd #220, Las Vegas, NV 89148
- Abraham Rothman, MD, Pediatric Cardiology, 3006 S Maryland Pkwy #690, Las Vegas, NV 89109
HEALTH
SAVINGS ACCOUNTS (HSAs)
By Weldon (Don) Havins, M.D., Esq., CCMS
CEO and Special Counsel
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 substituted the scheduled 4.5% decrease in physician Medicare reimbursements with a 1.5% increase in reimbursements. This federal law also added a section to the Internal Revenue Code (Title 26, Section 223) establishing Health Savings Accounts (HSAs). HSAs replace the Archer Medical Savings Accounts (MSAs). HSAs may be established any time after January 1, 2004.
What
are the benefits of a Health Savings Account?
1. Contributions to a qualified HSA are deductible from gross income on the federal income tax return (Line 25 on Form 1040). No itemization is necessary to receive the deduction. Contributions to the HSA may not exceed the health insurance policy deductible, and are maximized at $2,600 for an individual and $5,150 for a family health insurance policy. The maximum contribution limits are subject to cost of living adjustments annually.
2. Funds accumulating in the HSA grow tax-deferred. Amounts of the HSA used to pay qualified medical expenses of a beneficiary of the health insurance policy shall not be included in the calculation of gross income for federal income tax purposes. However, any amount paid or distributed out of an HSA which is not used to pay qualified medical expenses of an account beneficiary are to be included in gross income for federal income tax purposes. Withdrawals from the HSA for other than qualified medical expenses prior to the Social Security retirement age (see 42 USC 1395c) are subject to an additional 10% tax penalty (110% of the amount withdrawn is includible as gross income). There is no penalty if a distribution or payment is made after a beneficiary becomes disabled (as defined in 26 USC 72(m)(7)) or dies.
3. Health insurance premiums are usually significantly lower due to the large deductible.
4. The owner of the HSA is the individual, whether self-employed or an employee. Thus a change of employment does not disrupt the continuity of the HSA, and the HSA moves with the employee.
A qualifying health insurance policy must have a minimum deductible of $1,000 for an individual, to a maximum deductible and other annual out of pocket expenses not exceeding $5,000. Family coverage deductibles must be between a $2,000 deductible and total out of pocket expenses not to exceed $10,000. There may not be other health insurance coverage with a lesser deductible. The qualifying health insurance policy premiums may be paid by the employer, but the policy belongs to the employee and moves with the employee when the employee changes jobs. While contributions to the HSA are maximized at $2,600 for an individual and $5,150 for a family plan, for individuals age 55 or over, the maximum contribution is increased by the following: 2004, $500; 2005, $600; 2006, $700; 2007, $800; 2008, $900; 2009 and thereafter, $1000.
What
public policy supported the establishment of HSAs?
Concern over the rising cost and utilization of medical services was primary. It was felt that there would be less unnecessary utilization of medical services if there was a large deductible, especially if that large deductible would be tax advantaged. Individuals of means will be more likely to pay the deductible expenses out of pocket and leave the contribution to the HSA intact to grow tax free. Costs of a large deductible health insurance plan are likely to be substantially less expensive than standard deductible health insurance, thereby additionally motivating the purchaser (employer or self-employed) to implement an HSA. The concern of a sufficiency of funds during retirement is addressed by permitting withdrawals of HSA funds after retirement age when Medicare health insurance is available.
There are public policy-makers opposed to HSAs. Senator Edward Kennedy and Representative John Dingell have drafted a bill to repeal HSAs. Senate Minority Leader Tom Daschle has also introduced a bill to repeal the legislation creating HSAs. With Republicans in control of both Houses of Congress it is unlikely these bills will be successful. Some Democratic legislators are said to oppose HSAs because they are a tax benefit to the more wealthy of our society and are beyond the means of the less fortunate. Others contend that creation of HSAs will forestall initiation of a one payor public healthcare financing system.
Brokers here in Las Vegas are implementing conversions/roll-overs from the "old" Archer Medical Savings Accounts to the new Health Savings Accounts. To open a new HSA, one must first obtain a qualifying high deductible health insurance policy. There is a small fee for establishing the account and a small annual maintenance fee. The brokerage will issue a debit card and a checkbook from which qualifying medical service expenses can be paid. Again, a main benefit of HSAs is the ability to have a tax deduction on money placed into a tax advantaged account.
Clark County District Court
Medical Malpractice Filings against Health Care Providers
Jan 2001 –
Mar 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
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
Legislative Dinner Sponsors
The
Clark County Medical Society and the
Table and Vendor Booth Sponsors
Colonial Bank
Desert Radiologists
Medical Liability Association of Nevada
Nevada Mutual Insurance Company
Quest Diagnostics
Table Sponsors
Abdi Raissi, MD & Hugh Bassewitz, MD
Vendor Booth Sponsors
Bank of Commerce
Bolick, Boyer & Goodsell
Christopher Commercial
Ensemble Real Estate Services
Insight: Mountain Diagnostics & Parkway Imaging
Lymphatic Therapy Services, Inc.
Mobile Medical Services
ProTrans
Pueblo Medical Imaging
Shapin Medical Transcription, LLC
Shea Commercial
Steinberg Diagnostic Medical Imaging
Supplemental Benefit
West Valley Imaging
Minutes Synopsis
(Members can receive a full copy of meeting minutes by calling 739-9989.)
CLARK COUNTY MEDICAL SOCIETY BOARD OF TRUSTEES MEETING
Tuesday,
Action Items
Dr. Kingsley announced the meeting would be shortened in order for Board members to pay their respects at the viewing for Robert O'Connell, Senator Ann O'Connell's husband, who died last week.
Dr. Kingsley welcomed Dr. Stephen Montoya, the Nevada State Board of Medical Examiner's Liaison to the Board meeting.
The minutes from the March 16th meeting were approved.
Financial Report
Dot Freel reported the total revenue for the fiscal year is down from last year and from the amount budgeted for the entire fiscal year but there is still the possibility of obtaining the remaining amount projected in the budget. The expenses for the fiscal year to date are less than expenses last year at this time. The NSMA financials were distributed to the Board members for informational purposes.
Dr. Havins reminded the Board that the budget for next year will be created by June. Dr. Havins informed the Board members that there may be a leak under the foundation and he expects other maintenance will be needed to the building. He stated the Board may want to consider selling the building while there is a real estate bubble.
Committee Reports
Credentials Committee
The following applicants were approved for membership: Keith Blum, DO, Neurological Surgery; Ian Haycocks, MD, Diagnostic Radiology; Kelly Kogut, MD, Pediatric Surgery; Carlos Luna, MD, Pediatric Cardiology; Alexander Norton, Jr, MD, Ob-Gyn; Abraham Rothman, MD, Pediatric Cardiology.
Dr. Michael Levin reinstated active membership on 3-8-04.
Membership Committee
MedPac
Dot Freel reported there will be an election for MedPac Officers and Directors soon.
County Health District
Dr. Kwalick was not able to attend the Board meeting but sent a report regarding the first annual Health Expo and information regarding the Great Basin Public Health Leadership Institute which will conduct training and development programs.
President's Report
KODIN Update
Dr. Kingsley reported the KODIN task force is currently distributing "Vote Yes on 3" packets and encouraged those present to speak to all of their patients about voting yes on 3.
Dr. Kingsley announced the passing of member Thomas Keyes, MD.
Administrative Report
Dr. Havins stated there are over 400 membership directories remaining, suggesting that fewer directories be printed in the future. Dr. Jones recommended giving away the outdated directories to the hospital medical staff offices and volunteered to take 100 to distribute. It was also suggested some be given to the public libraries.
New Business
Dr. Montoya talked about the tabling of the Proficiency Regulations because the climate was not right and the regulations were not needed. He stated the BME Board members were working under the idea that the Legislators were pushing for some kind of competency testing. He stated the Board members became aware that was not true.
Dr. Montoya stated there was a recent newspaper story regarding suspension by the BME of the medical license of an anesthesiologist. He reminded the Board members that practicing medicine is a privilege, not a right, and when the BME asks a licensee to provide something, it should be done immediately.
NV School of Medicine
James Lenhart, MD explained how the selection for the new Dean for the School of Medicine has been progressing. It has been narrowed to two candidates, a pulmonologist and a cardiologist. They hope to have a decision on the Dean position by next month.
The next Board of Trustees meeting will be Tuesday, May 18, 2004 at 6 pm.
There being no further business, the meeting was adjourned by Dr. Kingsley at 6:40 pm.
CME Calendar
Cardiovascular
Consultants 691-9154
Clark County Medical
Society 739-9989
- 6/2 - “HIPAA Regulatory Requirements Update,” 6 p.m., 2 CME hours
- 6/30 - “Physician Reporting, Patient Consent and Updates on the Medical Practice Act,” 6 p.m., 2 CME hours
- 9/18 - “Hospice and Pallative Medicine- What is it?” 9 a.m., 2 Ethics CME hours
Future Programs Planned
August 2004 - Obesity
Medical Malpractice
October 2004 - Cosmetic Surgery
HealthInsight (801) 892-0155
St. Rose
Hospital 616-5832
Southwest Medical
Associates 242-7347
Summerlin
Hospital 233-7572
Sunrise Hospital 731-8210
UMC 383-2604
Valley Hospital 388-4847
- 6/8 - “Implantable Device Therapy in Cardiac Management,” noon
- 6/22 - “What’s New in Joint Replacement?” noon
- 7/13 - “What’s New in the Lab?” noon
- 7/27 - “Spiral CT Scans,” noon
*Special Note:
To have your CME courses listed on our calendar, please
contact
of the 12th each month.
Clark County Health District Disease Statistics* -
April 2004
DISEASE CASES REPORTED YEAR TO DATE
Apr 2003 Apr 2004 2003 2004
VACCINE PREVENTABLE DISEASES
DIPTHERIA 0 0 0 0
HAEMOPHILUS
INFLUENZA 0 0 2 2
(invasive)
HEPATITIS A 0 1 4 2
HEPATITIS B 4 8 21 19
INFLUENZA 17 0 45 51
MEASLES 0 0 0 0
MUMPS 0 0 0 0
PERTUSSIS 2 1 3 1
POLIOMYELITIS 0 0 0 0
RUBELLA 0 0 0 0
TETANUS 0 0 0 0
SEXUALLY TRANSMITTED DISEASES **
CHLAMYDIA 396 241 1543 1334
GONORRHEA 164 153 576 638
SYPHILIS (Primary & Secondary) 2 2 3 2
SYPHILIS
(Early Latent) 1 1 11 5
ENTERICS
AMEBIASIS 1 0 8 6
BOTULISM-INTESTINAL
(Infant) 0 0 1 0
CAMPYLOBACTERIOSIS 2 2 23 19
CHOLERA 0 0 0 0
CRYPTOSPORIDIOSIS 0 0 2 0
E. COLI
O157:H7 0 0 0 1
GIARDIASIS 3 2 24 27
ROTAVIRUS 55 29 300 345
SALMONELLOSIS 4 9 20 27
SHIGELLOSIS 2 2 8 14
TYPHOID
FEVER 0 0 0 0
YERSINIOSIS 0 0 0 0
OTHER
ANTHRAX 0 0 0 0
BOTULISM
INTOXICATION 0 0 0 0
COCCIDIOIDOMYCOSIS 2 4 11 19
ENCEPHALITIS 0 0 0 0
HANTAVIRUS 0 0 0 0
HEMOLYTIC
UREMIC 0 0 0 0
SYNDROME (HUS)
HEPATITIS C 0 1 0 2
HEPATITIS D 0 0 0 0
LEGIONELLOSIS 0 0 1 1
LEPROSY (HANSEN'S DISEASE) 0 0 0 0
LISTERIOSIS 0 1 0 1
LYME
DISEASE 0 0 1 0
MALARIA 0 0 0 2
MENINGITIS,
ASEPTIC/VIRAL 14 3 27 14
MENINGITIS,
BACTERIAL 0 2 10 8
MENINGOCOCCAL
DISEASE 1 0 3 0
PLAGUE 0 0 0 0
Q FEVER 0 0 0 0
RABIES
(HUMAN) 0 0 0 0
RELAPSING
FEVER 0 0 0 0
ROCKY
MOUNTIAN 0 0 0 0
SPOTTED FEVER
RSV
(RESPIRATORY 129 46 1256 1002
SYNCYTIAL VIRUS)
TOXIC SHOCK
SYNDROME 0 0 0 3
TUBERCULOSIS 5 5 26 17
TULAREMIA 0 0 0 0
TYPHUS,
MURINE 0 0 0 1
UNUSUAL
ILLNESS 0 1 0 1
(Creutzfeldjakob)
* Numbers
include confirmed and probable cases
** For
HIV/AIDS statistics please call the Clark County Health District Office of AIDS
at 759-0730.
Classifieds
·
MEDICAL/DENTAL
OFFICE FOR LEASE: 2100 sq. ft. on campus of St. Rose de Lima Hospital. 4
exam rooms & minor surgery room. Fully furnished and equipped, ready to
start seeing patients. Call 289-9355.
·
OFFICE
SPACE AVAILABLE For Sub-Lease Location: 10001 South Eastern, Ste. 406 (Del
Webb) Days Available: Monday & Friday
Cost: 1/2 day ($1,000.00 per month) 1 full day ($2,000.00 per
month) Contact: Patricia Fletcher (702)
260-7707
· FOR SALE - OFFICE FURNITURE, DESK, Exam Table, Kodak Lab, Treadmill, Holter Monitor, EKG, etc. Call 878-8108.
County Line Advertisers
Bank of Commerce 949-9800 www.bankofcommerce-nevada.com
C D Smith Co. Medical Supplies 871-1877 www.cdsmithco.com
Christopher Commercial 243-2800 www.christophercommercial.com
Colonial Bank 304-3770 www.colonialbank.com
Consolidated Laboratory Services 933-4522
Desert Radiologists 382-XRAY www.desertrad.com
Diversified Office Services 796-0456
Hutchison & Steffen Attorneys 385-2500 www.hsnvlaw.com
Las Vegas Neurosurgery Associates, PC 240-4090
Scott Lehigh 349-6781
Longford Medical Center 454-5300 ext. 224 www.longfordmedical.com
Medical Group Management Association 697-5471 ext. 134
Medical Liability Association of Nevada (MLAN) 804-7333 www.mlan.org
Nevada First Bank 310-4000 www.nevadafirstbank.com
Nevada Mutual Insurance Company 798-6001 www.nevadamutual.com
Nevada State Bank 383-5122 www.nsbank.com
Novum Pharmaceutical Research Services www.novumprs.com
Matthew Passalacqua, Financial Advisor 254-1263 www.tricorfinancialservices.com
Plise Companies 871-4065 www.pdc-lv.com
Priority One Commercial 228-7464
Red Rock Radiology 731-2888 www.redrockradiology.com
Southwest Exchange Corporation 800-827-9150 www.southwestexchange.com
Steinberg Diagnostic Medical Imaging Centers 240-1288 www.sdmi-lv.com
WestPark Plaza Rainbow 250-9305