County Line
Newsletter LVIII November 2004
Contents
California CME News: Pain Management and Care and Treatment of the Terminally Ill
Informed Consent to Medical Treatment in Nevada
Malpractice Filings Against Health Care Providers, Jan 2001 - Sept 2004
Clark County Health District Disease Statistics - September 2004
Commentary: What’s in a Word?
By Donald C. Mohs, Jr. MD
According
to the American Heritage Dictionary of the English Language, the
origin of the word “tort” derives from the Latin word tortum,
the neuter past participle of torquere, meaning
“to twist.” It appears today that
It is this
last point, the lack of predictability of the justice system that is of the
biggest concern. Supreme Court Justice Oliver Wendell Holmes, Jr. once defined
law as “prophecies of what the courts will do.” Today, no one can predict what
a court will do, writes lawyer and liability reform advocate Phillip K. Howard.
Given the choice between two actions, if an individual can't tell the right
action from the wrong one-the one that deserves legal merit,
and the other that deserves legal punishment-then he is essentially damned
either way. Physicians find themselves in this predicament constantly. They may
strive, with all the expertise and all the conscientiousness they can muster,
to do the right thing-only to be on the receiving end of a summons.
In fact,
this situation exists not only with civil (tort) liability, but also with criminal
liability. In the modern practice of medicine in
It's a big
problem when it is the good guys that are afraid of the
law.
Tort
attorneys, those self-styled and self-appointed purveyors of "justice"
for a price, take advantage of that fear. Because of the unpredictability of
juries, they can wrench settlements from frightened physicians-or for that
matter, from frightened citizens at large. When the law becomes a bludgeon, to
be used against its citizens in favor of its participants, there is a crisis of
massive proportions. It is a crisis that, if uncorrected, will grow, and change
the American way of life forever. It threatens the very existence of our
beloved democracy, establishing in essence, a jurocracy
- a rule of lawyers.
Of course, from those very lawyers, I must now expect a sharp … retort.
Pain Management and Care
and Treatment of the Terminally Ill
By
Weldon (Don)
California
Business and Professions Code 2190.5 mandates that California-licensed
physicians complete, as a one-time requirement, 12 hours of Category I CME in
"pain management" and "the appropriate care and treatment of the
terminally ill" by December 31, 2006.
Only pathologists and radiologists are exempted from this requirement. The 12 units of CME may be divided in any way
that is relevant to the physician's specialty and practice setting, presumably
at the licensee's discretion. Any
combination of CMEs in these two subject areas will
be acceptable to the Medical Board of California (MBC), according to the MBC's website.
Unlike the
4 hours Category I CME of Weapons of Mass Destruction required under A.B. 250
of the Nevada Legislature, the 12 hours of CME will count toward the 25 hours
of annual approved continuing education required of each licensee by the
MBC. While many of appropriate CME
courses are offered in
The Clark
County Medical Society, as a benefit of membership, now has available Category
I CME courses in the subject areas in videotape format. Any of the courses may be viewed at the CCMS
office during normal working hours. A
short written multiple choice exam is completed after
viewing the programs and is sent to the sponsor of the programs. Costs for the programs are $10 per CME credit. The completed exam will be mailed to the
sponsor, along with the check for the appropriate number of CMEs. The sponsor will grade the exam (70% is
passing) and send the Category I CME certificate to the
physician.
The
following courses (with cost and number of CME credit hours) are available in
videotape format at CCMS:
Advanced
Care Planning, $20, 2 hours
Communicating
Bad News, $30, 3 hours
Depression,
Anxiety and Delirium, $20, 2 hours
Elements
and Models of End-of-Life Care, $10, 1 hour
Gaps in
End-of-Life Care, $10, 1 hour
Last Hours
of Living, $20, 2 hours
Managing
Physical Symptoms, $30, 3 hours
Pain
Management, Part I and Part II, $30, 3 hours
Responding
to Assisted Suicide Requests, $20, 2 hours
Sudden
Illness and Medical Futility, $30, 3 hours
Withholding
and Withdrawing Therapy, $20, 2 hours
Please call Marlaina at the Clark County Medical Society, 739-9989, to reserve a time to view programs. These programs are available as a membership benefit to CCMS members only.
Executive Secretary of Nevada Nevada
"Much
has been made about my statements regarding the number of physicians that have
applied to be licensed in
"The
State Board of Medical Examiners tracks the number of new and active licenses
for medical doctors in the state of Nevada, however, it has no mechanism in
place to determine how many of these doctors are currently practicing medicine,
seeing patients, reducing the services they provide or leaving the state,"
said Clark.
Doctors who
have an active license in
"The
small net gain of active licensees in state is significant when you consider
the dramatic growth of our population," said
The number
of new licenses issued between 2001 and 2003 was 1,140,
however, the total number of active licensees in the State of
"It
was accurate to say that the number of medical doctors seeking a new license in
President’s Message
By Michael P Colletti, M.D., 2004-2005 CCMS President
We, as Americans, frequently become disillusioned with
Government on the local, state and federal levels. In many instances, we have come to view the
Government as our enemy, instead of as our protector and servant. In one of the wealthiest, best educated,
countries in the world, with incredible natural resources, it is hard for one
to imagine, at times, the choices we are forced to make regarding many of our
elected and public officials. At the
same time, we realize the enormous problems and challenges facing the
In our dealings with politicians, judges, appointed and
elected officials, and others working in Government, we come to know, either
personally or through their actions, individuals who we greatly admire. Many of these people will not be intimidated
and cannot be corrupted. They are an
inspiration to us and give us hope that, ultimately, our Government will make
the best decisions for us and our children.
The Clark County Medical Society acknowledges that we have many
excellent people in governmental positions in
Applicants To
Go Before Credentialing Committee
If you have any pertinent information about the following
membership candidates, please contact:
·
Michael P Donahue, DO, Orthopaedic
Surgery
·
Craig A Hartman, DO, Ob-Gyn
·
Joseph J Heck, DO, Emergency Medicine
·
Robert P Kaplan, DO, Family Practice
·
Beata J Kwiatkowska, MD, Blood Banking/Pathology
·
Conrad O Yu, MD, Orthopaedic
Surgery
·
Daniel H Zee, MD, Radiology
For information on becoming a member of the Clark County Medical Society, call Marlaina Burns at 739-9989
Reinstated Members
·
Arthur B Pitterman, MD,
Internal Medicine
·
Richard M Groom, MD, Ob-Gyn
·
Noel S Yumiaco, MD, Pathology
·
John A Bowers, Jr, MD,
Cardiology
· Graham M Wilson, MD, Emergency Medicine
Informed Consent to Medical
Treatment in Nevada
By
Weldon (Don) Havins, M.D., Esq.
Consent Generally
Consent to
treatment in
By statute
consent for any medical or surgical procedure is implied if, in competent
medical judgment, the proposed medical, surgical or dental procedure is
reasonably necessary and any delay in performing such a procedure could
reasonably be expected to result in death, disfigurement, impairment of
faculties or serious bodily harm, and a person authorized to consent is not
readily available." 1
Informed Consent
In 1975,
the legislature provided a statute (NRS 41A.110) defining when the consent of a
patient was conclusively established. A physician licensed to practice under
the provisions of NRS 630 (the medical practice act), or a dentist licensed to
practice under NRS 631 (the dental practice act) has conclusively obtained the
consent of a patient for a medical, surgical or dental procedure if he has done
the following:
1. Explained to the patient in general terms
without specific details, the procedure to be undertaken;
2. Explained to the patient alternative methods
of treatment, if any, and their general nature;
3. Explained to the patient that there may be
risks, together with the general nature and extent of the risks involved,
without enumerating such risks; and
4. Obtained the signature of the patient to a
statement containing an explanation of the procedure, alternative methods of
treatment and risks involved, as provided in this section.
Some
authorities consider this to be the most (? only) pro-health care provider
statute in
Please note
that the statute requires the medical doctor, or the dentist, personally to
perform the explanations and obtain the patient's signature. Utilizing a surrogate such as a nurse or
medical secretary to obtain the written consent loses the substantial
advantages provided in this statute. Why osteopathic physicians are not
included in the benefits of this statute is as mysterious as why osteopathic
physicians are excluded from the Weapons of Mass Destruction 4 (A.B. 250 of the 2003 Legislature) relicensure mandate burdening virtually all other health
care practitioners.
Some
physicians and dentists begin their written informed consent with,
"Pursuant to NRS 41A.100 …."
While this means nothing to the average patient, it signals to anyone
reviewing these medical or dental records with a mindset seeking a basis of a
professional negligence lawsuit that "lack of informed consent" is
not likely going to be available. This presupposes, of course, that the
informed consent complied with the statute. Prudent medical doctors and
dentists will utilize the protections provided by NRS 41A.110.
Who May Consent?
Emancipated minors
Individuals
who have reached the age of majority may consent.
A minor may
give consent for services for examination
and treatment for himself or for
his child if he is:
a. Living
apart from his parents or legal guardian, with or without the consent of the
parent, parents or legal guardian for at least 4 months;
b. Married
or has been married;
c. A
mother, or has borne a child; or
d. In a physician's judgment, in danger of suffering a
serious health hazard if the health care services are not provided. 6
Except for sterilization 7 and special rules governing Do
Not Resuscitate orders 8,
However,
the treating professional, before initiating treatment, must make prudent and
reasonable efforts to obtain consent of the minor to communicate with his
parent, parents, or legal guardian, and shall make a note of those efforts in
the medical record. If the treating professional believes that making such
efforts to obtain the minor's consent to attempt to contact the parents or
legal guardian would jeopardize treatment necessary to the minor's life or
necessary to avoid a serious and immediate threat to the minor's health, the
person may omit such efforts and note the reasons for the omission in the
medical record. To be clear, Nevada law does not require that the parents or
legal guardian be contacted; the law only requires that the treating professions
ask the emancipated minor for consent to contact the parents or legal guardian,
and then only if, in the judgment of the treating professional, such inquiry
would not seriously jeopardize the care of the emancipated minor.
A minor of
at least 16 years of age may petition the juvenile court for a decree of
emancipation. If the judicial decree of
emancipation is granted, the minor has all the rights of a person of majority. 11 The parental
obligation of support is terminated by a decree of judicial emancipation. 12
Non-emancipated minors
In cases of
emergency in which a minor is in need of immediate care, including
hospitalization and/or surgery, after reasonable efforts have been made under
the circumstances to contact the parents, consent for emergency medical care
may be given by any person standing in loco parentis
to the minor. In loco parentis means a person
standing in the position of the parents. 13
Any minor
who is under the influence, or suspected of being under the influence, of a
controlled substance may give consent, or if unable to give consent, shall be
deemed to consent to medical care, including hospitalization if necessary, for
the treatment of abuse of drugs or related illnesses. 14 Physicians and other
treating personnel are immune from civil or criminal liability for providing
such care, absent negligent diagnosis, care, or treatment. 15 While consent of parents or legal guardian
is not required to authorize care, after treatment is completed any treating
physician must make every reasonable effort to report the fact of treatment to
the parents or legal guardian within a reasonable time. 16
The consent
of a parent or legal guardian is not necessary to examine or treat a minor who
is suspected of being infected or is found to be infected with any sexually
transmitted disease. There is no requirement to notify the parent or legal
guardian then or later. 17
Consent of
a parent or legal guardian is not required to obtain contraception information,
devices, or medications from federally-funded clinics. The Nevada Attorney
General has opined that requiring parental consent is specifically prohibited
when a minor requests contraception information and materials in a federally
funded clinic.
Abortion and the minor
Unless in
the judgment of the attending physician an abortion is immediately necessary to
preserve the patient's life or health, a physician shall not perform or induce
an abortion upon an unmarried and unemancipated woman
under the age of 18 unless a custodial parent or guardian is personally
notified before the abortion. If the custodial parent or guardian cannot be
notified after a reasonable effort, the physician shall delay performing the
abortion until he has notified the parent or guardian by certified mail at his
last known address. If the minor is emancipated, the minor can consent. 18 The physician
shall certify in writing the pregnant woman's marital status and age based upon
proof of age offered by her. This proof
could be, presumably, by the verbal declaration of the patient. 19
A judicial
procedure for obtaining a district court's consent for the minor to undergo an
abortion was held unconstitutional by the federal 9th Circuit Court because it
does not require the district court to consider the best interests of the child
as paramount. 20 It appears now that a
district court may authorize a minor to have an abortion if an abortion is in
the best interests of the minor, but not if "she is mature enough to make
an intelligent and informed decision or if she is financially independent."
21 By
Breast Implant
A competent
person of majority age may consent to breast implant, just as the person may
consent to any surgical procedure. If the person is less than 18 years of age,
the person must have the consent signed by the parent or legal guardian unless
the minor is "legally emancipated." 24 This use of the term "legally
emancipated" is ambiguous in that Nevada law elsewhere refers simply to an
"emancipated" minor or to a minor who has been "declared
emancipated" by a court decree. There has been no Nevada case law to
elucidate whether "legally emancipated" is the equivalent of
"emancipated" or whether "legally emancipated" means
decreed emancipated by a court decree. Most authorities predict "legally
emancipated" will be interpreted as the equivalent of "court
decreed." Physicians not interested in being involved in the "test
case" may choose to avoid breast implant procedures in persons of less
than 18 years of age.
Blood donation
A person
must be 17 years of age or older to donate blood without the consent of a
parent. 25 This
Treatment for communicable disease under
authority of a district or state health officer
A district
or state health officer may order any person who he reasonably suspects has a
communicable disease in an infectious state to submit to any medical
examination or test which he believes is necessary to verify the presence of
the disease. This includes minors. The health officer may order a quarantine or
isolation of a person if he believes it necessary to protect the public health.
26 If the
person objects to quarantine or isolation, the health officer may obtain a
court order requiring involuntary submission to quarantine or isolation. 27 Tuberculosis
patients may refuse treatment, but may be kept in involuntary isolation or
quarantine unless released by court order.
Consent for withdrawal of life support
These
declarations become operative when the person is in a terminal condition and no
longer able to make decisions regarding administration of life sustaining
treatment. The person may revoke a declaration at any time and in any manner
without regard to his mental or physical condition by communication to an
attending physician or other provider of health care. 29
Artificial
nutrition and hydration by way of the gastrointestinal tract is life sustaining
treatment and may not be withheld unless a different desire is expressed in
writing by the patient. For a patient without an effective declaration,
artificial nutrition and hydration may not withheld
unless authorized in writing by a family member with authority to consent or
withhold consent. 30
If a patient is known to be pregnant, life sustaining treatment
may not be withheld pursuant to a declaration so long as it is probable that the
fetus will develop to the point of live birth with continued application of
life sustaining treatment. 31
If a
written consent to withhold or withdraw life sustaining treatment, attested by
two witnesses, is given to the attending physician, the attending physician may
withhold or withdraw life sustaining treatment from a patient no longer able to
make such decisions and who has no effective declaration. The authority to
consent or to withhold consent to life sustaining treatment may be exercised by
the following persons, in order of priority 32 :
(a) The
spouse of the patient;
(b) An
adult child of the patient or, if there is more than one adult child, a
majority of the adult children who are reasonably available for consultation;
(c) The
parents of the patient;
(d) An
adult sibling of the patient or, if there is more than one adult sibling, a
majority of the adult siblings who are reasonably available for consultation;
or
(e) The
nearest other adult relative of the patient by blood or adoption who is
reasonably available for consultation.
It is a
curiosity of
If one
class of priority declines to decide, then the next class has the authority. If
one class of priority votes in a tie, the next class may not decide. In that
case, there may be no withdrawal of life sustaining treatment. The decision of
the attending physician acting in good faith that a consent
is valid or invalid is conclusive. 33
Lastly, no
hospital or other medical facility, physician or person working under the
direction of a physician is subject to criminal or civil liability for failure
to follow the directions of a patient to withhold or withdraw life sustaining
treatments. 34
Do Not Resuscitate Orders (DNRs)
A DNR may
be issued only by a physician licensed in this state on a qualified patient
deemed to be in a terminal condition. 35 A terminal condition is one in which,
without life sustaining treatment, the patient would die in a relatively short
period of time. 36 DNR
orders apply only to emergency medical services rendered to a qualified patient
before he is admitted to a medical facility or while being transferred, or
being prepared to be transferred, from one health care facility to another. 37 NRS 450B provides
specific information for obtaining DNR status from the health authority
(bracelet or medallion). 38
DNR orders
may be issued for a minor as well as an adult. The parent or legal guardian of
the minor must sign the DNR authorization. However, the minor, if capable, must
agree to the terms of the DNR, in writing, if the physician feels that the
minor is of sufficient maturity to understand the nature and effect of
withholding life sustaining treatment.
The minor may verbally revoke the DNR at any time by requesting his DNR
identification be destroyed or removed.39
A person
who administers emergency medical services and who is unwilling or unable to
comply with a DNR order shall take all reasonable measures to transfer a
qualified patient with a DNR to a physician or health care facility where the
DNR may be followed. Violation of this requirement is a criminal act, a
misdemeanor. 40
Distinguishing DNRs from Advance Directive declarations from Durable Power
of Attorney for Health Care Decisions
A DNR
applies to patients in a terminal condition ("qualified patient") and
involves emergency medical services rendered before the patient reaches a
medical facility, or during transfer from one health care facility to another.
Advance directive declarations are generally obtained upon admission to a
health care facility wherein the patient states his or her preference for
continuing, withholding, or withdrawing life sustaining medical treatment. The
patient can direct the physician to carry out the patient's wishes or can
appoint another person to carry out the patient's wishes in a time of
disability. If no advanced directive is effective,
A third
category of surrogate decision-making involves a Durable Power of Attorney for
Health Care. 41 The Durable Power of
Attorney (DPA) for Health Care permit a person ("a principal") to
designate an individual, and alternates, to make decision concerning health
care for the principal who executive the power of attorney if that principal
becomes incapable of giving informed consent concerning such decisions. This DPA for HC is not restricted to life
sustaining treatment decisions, but may grant the holder of the DPA a wide
range of authority to act in the best interests of the principal in any
circumstance where the principal is not capable of giving informed consent.
A Durable
Power of Attorney for Health Care Decisions must be notarized and witnessed,
and be substantially in the following provided in NRS 449.830. An example of
this form is available on the CCMS website, www.clarkcountymedical.org. The
Nevada Revised Statutes are available online through the Legislative Counsel
Bureau's website at: www.leg.state.nv.us CCMS members wishing
to implement a DPA for health care should be aware that free notary services
are available at the Clark County Medical Society office,
1 NRS 41A.120
2 NRS 41.505
3 Osteopathic
physicians who are licensed under NRS 633 are not included in the provisions of
this statute.
4 A.B. 250, passed
in the last hours of the 2003 Legislative Session, mandated four hours of
continuing medical education in weapons of mass destruction for virtually all
licensed health care professionals.
Licensed osteopathic physicians were not included in the mandate. By the terms of the mandate, this specific
training must be completed before
5 NRS 129.010
6 NRS 129.030(1)
7 NRS 129.030(4) A minor may not consent to sterilization.
8 NRS 450B.525
9 NRS 129.030(2)
10 NRS 129.030(6)
11 NRS 129.080
12 NRS 129.120(4)
13 NRS 129.040
14 NRS 129.050(1)
15 NRS 129.050(2)
16 NRS 129.050(3)
17 NRS 129.060
18 NRS 442.255(1)
19 NRS 442.252
20 Glick v. McKay,
937 F.2d 434 (9th Cir. 1991).
21 See NRS
442.255(2)
22 NRS 442.255(3)
23 NRS 442.255(4).
24 NRS 449.740(1)(b)(2)
25 NRS 460.040
26 NRS 441A.160(5)
27 NRS 441A.160(4)
28 NRS 449.600
29 NRS 449.620
30 NRS 449.624(3)
31 NRS 449.624(4)
32 NRS 449.626
33 NRS 449.626(5)
34 NRS 449.640
35 NRS 450B.510
36 NRS 449.590
37 NRS 450B.480
38 NRS 450B.520
39 NRS 450B.525
40 NRS 450B.580
41 NRS 449.800, et.seq.
Clark County District Court Medical Malpractice Filings Against Health Care Providers, Jan 2001 - Sept 2004
2001 2002 2003 2004
Jan 39 33 108 61
Feb 20 14 98 72
Mar 35 30 169 123
Apr 37 34 111 81
May 37 35 126 65
Jun 27 24 103 90
Aug 54 51 76 67
Oct 37 83 110
Nov 38 184 59
Sum 372 823 1246
Alliance
By Marian Haas and Kathie Slaughter, 2004-2005 CCMS
November is
here. Everyone needs to be sure to vote! The
Enclosed in
this issue you will find a request letter for our Greeting Card Project. Please
take a moment to read it and help us in our fundraising efforts. With your
contribution we will be able to support CASA Foundation, Child Focus, and also
our Nursing Scholarships. These scholarships are awarded to outstanding members
of our three nursing programs at UNLV and CCSN. We hope to recognize their
academic efforts and encourage these graduates to remain in the
The
We are looking forward to seeing you at one of our events. If you wish to join us, please contact Wendy Agrawal at 228-6360, Swati Khamamkar at 242-8542, Marian Haas at 838-9840, or Kathie Slaughter at 878-4981. You may also get information from the Clark County Medical Society at 739-9989.
BioWatch
By Donald S. Kwalick, MD, MPH, Chief Health Officer, Clark County Health
District
The
The DHS BioWatch system can measure aerosol pathogens to detect
both malicious and naturally occurring releases. This system could help us
determine the presence and geographic extent of a biological agent release,
allowing us to rapidly provide appropriate emergency response and medical care
along with our Federal and State partners.
The BioWatch system includes a team of field, laboratory and
response personnel from city, county, state and Federal organizations. This coordinated team is responsible for
installing sample collectors, analyzing samples, reporting results and
responding to alerts. The samples pass
through a multiple-tier test for biological agents, which to date, has produced
zero false alarms in over a million tests.
In the
event of a positive detection by the BioWatch system,
DHS can coordinate several Federal response assets to support the public health
infrastructure of an impacted area.
While the local public health and medical community will be the first
responder in the event of a biological attack, DHS is poised to quickly
dispatch Federal response resources such as the:
·
Strategic National Stockpile, the nation's
pharmaceutical reserve of millions of doses of life-saving and life-sustaining
medicines to aid people exposed to natural or man-made biological or chemical
threats, and the
·
National Disaster Medical System, comprised of
teams of medical personnel designed to support local public health officials
DHS
operates BioWatch in partnership with other Federal
agencies, each of which plays a crucial role:
·
The Centers for Disease Control and Prevention
provides technical expertise through their Laboratory Response Network.
·
The Environmental Protection Agency serves as
the liaison for field surveillance with state environmental departments.
·
National Laboratories such as
This program is an important element of our preparedness effort and we look forward to working with our federal and local partners.
Minutes Synopsis
Tuesday,
Minutes Synopsis
(Members can receive a full copy of meeting minutes by calling 739-9989.)
Compilation of
Financial Statements Results
Martha
Ford, CPA from Piercy, Bowler,
KODIN Update
Dr. Rudy Manthei, Chairman of KODIN, reported Ballot Question 3 will
be on the ballot despite efforts by the Trial Lawyers Association to have it
removed. Dr. Manthei
stated Scott Craigie and Dr. Don Havins need to be
congratulated for working with the Secretary of State on Saturday to re-write
the question 3 explanation as ordered by the Nevada Supreme Court. Dr. Manthei stated
the fundraising was going well statewide but KODIN had not yet met their
projected budget.
Dr. Colletti stated he spoke to Dr. James Tate who wants to
establish a better working relationship with the Society and his group, the
National Medical Association. Drs. Evins and Kline both volunteered to attend their meeting
representing CCMS.
The minutes
from the August Executive Council meeting were approved unanimously.
Financial Report
Dr.
Steinberg reported the revenue for the first two months of this fiscal year
were up compared to last year at this time primarily because of dues and new
members. Expenses are also up.
Credentials
Committee
Dr. Cohler reported there were no new members to approve, but
there were 3 reinstatements and one transfer from
The
Membership Report
Dr. Kline
updated the Board regarding his ongoing talks with the hospitals about
providing a $50 discount for staff membership renewals for CCMS members.
Scholarship Fund
Report
Dr. Ellerton reported the Scholarship Fund Corporation did
receive a substantial donation. Dr. Ellerton stated he would like to have the donors at the
Scholarship Fund meeting and when he has a confirmed date that works for them,
he will contact Staff to set up a Scholarship Fund meeting with the Directors.
Health District
Report
Dr. Don Kwalick was unable to attend but sent a report on various
issues involving the Clark County Health District.
AMA Report
Dr. Evins reported the AMA gave NSMA a $100,000 grant which
NSMA gave to KODIN. The conditions were
that NSMA had to change their billing statements. NSMA also agreed to be involved in calling
AMA non-members to solicit AMA membership.
NBME Report
Dr. Montoya
reported he had spoken to the NBME administrative staff regarding a quote in
recent newspapers regarding the numbers of doctors in
Administrative
Report
Dr. Havins
reported there are two new NBME Board members.
He reported the new NBME staff operates professionally and cordially,
and that Dr. Montoya conducted the NBME meeting with admirable
efficiently.
Dr. Havins
reported the legislative initiatives which the NBME Board approved and plan to
pursue at the next legislative session.
Upon
inquiry by BOT members, Dr. Havins explained the subrogation clause in Question
#3.
MedPac
Dr.
Steinberg reported remaining funds for the upcoming election and that a MedPac meeting was to occur after the Board meeting for
consideration of MedPac Bylaws revisions.
New Business
Dr. Colletti announced the passing of Life Member Dr. Ralph
Litton.
Discussion
ensued regarding Dr. Don Kwalick's request that the
Board recommend to MedPac the endorsement of Dr. Joe
Heck for State Senate District 5.
The
proposed revisions to the job description for the Public Relations Coordinator,
with the addition of the duty of coordinating the mini-internship program's
hospitals participation, passed unanimously.
HealthInsight's Requests
Dr. Robert Shreck received approval from the Board for gratuitous
physician mailing labels in order to send information regarding lead poisoning.
Dr. Shreck presented information regarding the functions of
Health Insight, Inc., and asked for a letter of recommendation in an effort to
maintain the independence of the Quality Improvement Organization. Dr. Shreck stated
that the Center for Medicare and Medicaid Services is considering assuming the
authority to engage sub-contractors, a function heretofore within the purview
of the state's PROs.
Dr. Evins agreed to write the letter and
present it to Dr. Colletti for modifications and
approval.
Dr. Colletti received approval from the Board to use the CCMS
Executive Council for action on matters deemed time sensitive.
Comm. Relations/
Comm. Health Committee
Dr. Jameson
reported her committee decided to change future Community Relations committee
meetings to Wednesday evenings. Her
committee agreed they should be more active with the media, and they will be
working on this at future meetings. The
Committee is expanding the number of invitees for the upcoming Mini-Internship
in November to include the CEOs of gaming organizations and candidates running
in the upcoming election.
The next
board meeting will be
There being
no further business, the meeting was adjourned by Dr. Colletti
at
Classifieds
·
·
FOR SALE:
1.5 MILES FROM NEW SITE OF Valley Hospital, major corner Centennial Hills
shopping center, zoned for medical clinic, existing structure approved. Ample
parking. Owner financing. (702) 525-4668.
·
PHYSICIAN
WANTED OBSTETRICS AND Gynecology: Immediate opening for the right person,
partnership or employee whichever you prefer. Centrally located near UMC,
Valley and
·
GALLERIA
URGENT CARE FOR
·
OFFICE
SPACE AVAILABLE FOR SUBLET: Monday, Wednesday Afternoon, and/or all day
Friday, Saturday. Central location,
·
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 (702) 326-3309 anytime.
·
ADVERTISE
IN
CME CALENDAR
Cardiovascular
Consultants 691-9154
HealthInsight
(801) 892-0155
MLAN 364-4962
·
11/6 - “Risk Management and Ethics,”
Pri-Med Institute (877) 4PRI-MED
·
11/19-20 - “Pri-Med
Updates,” up to 16.5 CME hours, FREE to CCMS members, for details or to
register visit www.pri-med.com/updates/lasvegas
Southwest Medical
Associates 242-7735
·
11/11 - “Osteoporosis Update,”
UMC 383-2604
·
11/9 - “Update on PET Scans,”
·
11/23 - “Atypical Anti-Psychotics,”
*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.
Clark County Health District Disease Statistics* - Sept 2004
DISEASE CASES REPORTED YEAR
TO DATE
Sept 2003 Sept 2004 2003 2004
VACCINE PREVENTABLE DISEASES
DIPTHERIA 0 0 0 0
HAEMOPHILUS
INFLUENZA 0 0 8 6
(invasive)
HEPATITIS A 4 0 13 6
HEPATITIS B 5 2 50 41
INFLUENZA 0 0 47 53
MEASLES 0 0 0 0
MUMPS 0 0 2 0
PERTUSSIS 1 0 15 4
POLIOMYELITIS 0 0 0 0
RUBELLA 0 0 0 0
TETANUS 0 0 0 0
SEXUALLY TRANSMITTED DISEASES**
CHLAMYDIA 615 444 3546 3790
GONORRHEA 276 235 1438 1898
SYPHILIS 0 10 7 28
(Primary
& Secondary)
SYPHILIS
(Early Latent) 1 0 18 10
ENTERICS
AMEBIASIS 0 1 12 10
BOTULISM-INTESTINAL
0 0 1 0
(INFANT)
CAMPYLOBACTERIOSIS 13 18 73 71
CHOLERA 0 0 0 0
CRYPTOSPORIDIOSIS 0 0 5 1
E. COLI
O157:H7 2 5 16 8
GIARDIASIS 9 5 64 57
ROTAVIRUS 5 10 403 430
SALMONELLOSIS 16 13 88 79
SHIGELLOSIS 19 12 43 30
TYPHOID
FEVER 0 0 0 1
VIBRIO 0 0 1 4
YERSINIOSIS 0 0 0 0
OTHER
ANTHRAX 0 0 0 0
BOTULISM
INTOXICATION 0 0 0 0
BRUCELLOSIS 0 0 0 0
COCCIDIOIDOMYCOSIS 4 3 27 48
ENCEPHALITIS 0 1 2 1
HANTAVIRUS 0 0 0 0
HEMOLYTIC
UREMIC 0 0 0 0
SYNDROME(HUS)
HEPATITIS C 0 0 3 2
HEPATITIS D 0 0 0 1
LEGIONELLOSIS 1 0 4 6
LEPROSY 0 0 0 1
(HANSEN'S
DIS1EASE)
LEPTOSPIROSIS 0 0 0 1
LISTERIOSIS 1 1 3 6
LYME
DISEASE 0 0 3 2
MALARIA