A frequently asked question is: "How many physicians have left Nevada during this 3-year medical liability crisis?" Nevadans facing declining availability of physicians & some specialty services know the truth. Nevada has lost too many physicians to this crisis.

There are official numbers that only those who advocate for the personal injury lawyer interest can avoid or deny. During the 15 years (1987-2001) preceding Nevada's medical liability crisis, there was an annual average net increase of 136 Medical Doctors actively practicing in Nevada. That makes sense. After all, Nevada has been the nation's fastest growing State for each of the last 16 years.

In 2002, the Nevada State Board of Medical Examiners (NBME) reports that Nevada had a net increase of 23 (over 2001 levels) of Active License Medical Doctors in the State. (According to the Osteopathic Physician Board, there was in 2002 a net decrease of 16 Doctors of Osteopathy, so there was actually a total net increase of MDs & DOs in 2002 of only 7 physicians). In 2003, The NBME reports that there was a net increase of 70 Active License Medical Doctors, even with relaxed licensing rules adopted by the Legislature in the 2003 Session. These 2 years represent the smallest net increases in Medical Doctors licensed in Nevada in more than a decade.

According to the Nevada State Demographer, there was a 73,524 net increase of Nevada residents in 2002 & a 90,544 net increase of Nevada residents in 2003. One would think that the availability of physicians for Nevadans probably decreased during this crisis. Indeed, Nevada population growth has resulted in a decade during which the Nevada medical system has been unable to keep up with growth.

In 1985, when the State population (969,370) began its unprecedented growth rate, there were 148 physicians for every 100,000 Nevadans. The US average was 220 physicians per 100,000 population & Nevada ranked 34th in the nation. By 1990, when the population had soared to 1,283,490, there were 141 physicians per 100,000 Nevadans & the State ranked 44th in the nation (when the national average had risen to 237 per 100,000). In 2002, as a result of the medical liability crisis, Nevada dropped to 48th in the nation with 162 physicians per 100,000 population to compare with the national average of 288 per 100,000. The national comparison data for 2003 aren't yet available, but Nevada's physician to population ratio had slipped again to 157 per 100,000 persons.

The most dramatic impact of both population growth & the loss in availability of physicians has occurred in Clark County. In 2001, there was a net increase of 161 MDs in Clark County. In 2002, there was a net increase of 7. In 2003, this improved only to a net increase of 45 MDs. Therefore in 2 years, which saw a net increase of 134,893 Southern Nevadans, there were 52 additional physicians to treat them. In 2002, only 30% of newly licensed physicians moved into Clark County, less than half the average for the previous 2 decades.

Throughout 2002, NSMA reported on the exodus of physicians & reported the difficulty in recruiting new physicians. Now you have the official data confirming our reports.

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President’s Message

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

MEDPAC-endorsed candidates were winners in 5 out of 6 races in September's Primary Election. MEDPAC, lead by Dr. David Steinberg, will meet again prior to the general election, as we have further funds to distribute and will make further endorsements.

The Southern Nevada Medical Industry Coalition (SNMIC) hosted a "Meet the Candidates Night" at Sunrise hospital in August. There were nine of the Coalition's endorsed candidates present. It was well attended. The candidates rotated tables every 15 minutes allowing small groups to get to know them better and make our views known to them. The Co-Chairman of the legislative branch of the Coalition are Ann Lynch and Charles Perry.

The CCMS Scholarship fund committee will meet again within the next two months. We may award more scholarships to nursing and medical students who intend to stay in Southern Nevada. Earlier this year, we awarded a total of $16,000.00 to twelve nursing students and four medical students.

The nursing shortage continues, but on an optimistic note, we now have many more applicants for our three nursing schools. This has been one of our goals and the goal of the SNMIC nursing education committee. The CCMS will continue to work with the Coalition to maintain and build quality health care for the people of southern Nevada.

The general election will soon be here, and we need to keep supporting KODIN- Keep our Doctors in Nevada, which will be question #3 on the ballot. If your office needs additional literature to distribute to your patients, please call CCMS at 739-9989.

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Endangered Species?

By Donald C. Mohs, M.D.

Like an old great African elephant, whose tusks are highly valued for their ivory, my professional carcass is prized by trial attorneys, worth more dead to someone than alive. And like that elephant, I am preparing, along with others of my herd, to move on to another living ground, one less populated with hunters, so I may continue to survive another day. Such is the life of a physician that had chosen to practice medicine in Nevada.

Events are unfolding that are scary for Nevada's physicians, for Nevadans in general, and for Americans. An attack has been made on Democracy. Not an attack by terrorists from without, but an attack by extortionists from within. An attack by those who have rigged our judicial system to become a money-making machine for themselves, resistant to any attempt at change or correction. They have usurped the machinery of justice to create a fantastical weapon that all Americans fear. That was the weapon used in this attack: The Lawsuit.

A painstakingly legally-qualified ballot initiative question #3, sponsored by Keep Our Doctors In Nevada, has been assailed, almost utterly wiped-out, by the legal maneuvering of the trial attorneys, using the very system they had usurped--cleverly, ingeniously, with the arcane legal weapons of their arsenal. Those weapons are out of the reach of the average citizen. It is the average citizen, the one who signed the petition, and the one who qualified the ballot initiative, who would have been stifled. And it will be the average citizen, the one who now fears the legal system rather than respects it, who will suffer if ballot issue #3 is now defeated.

Why will he suffer? He will find it increasingly difficult to obtain medical care in this state, and I dare say, elsewhere. Because Nevada physicians, whose careers are worth more dead here to a lawyer than alive to a patient, will move on to less threatening pastures. If ballot issue #3 is lost, those physicians will take notice of the increasingly hostile climate in which to practice, because there will be little chance for liability reform. And if ballot questions #4 or #5 pass, there will be virtually no chance of meaningful liability reform. The trial lawyers will have rigged our system of justice to advantage themselves to an even greater degree.

If this miscarriage of justice occurs, the attorneys will undoubtedly be celebrating their sly victory, cracking open bottles of champagne in their well-appointed offices, laughing over how much we physicians were duped.

Laughing.

It is Nevada's citizens, however, that will be crying.

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Professional Liability Insurance Premiums in Nevada

By Weldon (Don) Havins, MD, Esq.

As the debates on ballot Questions 3, 4, and 5 intensify, there will be individuals, and at least one group, insisting that the problem of increasing professional liability insurance premiums is due entirely to insurance company greed. The "insurance companies bad investments in the stock market are the reason for their insatiable need for cash." What are the facts?

"Loss ratio" is one of the four factors driving insurance rates. The others factors are insurance company investments, particularly the interest derived from bonds (secured interest bearing instruments); the cost of reinsurance; and, trial lawyers will contend, the insurance industry's exemption from federal antitrust laws.

"Loss ratio" is calculated by dividing "incurred losses" by premium dollars. Incurred losses are losses predicted on a claim at the time the claim is opened. A PLI insurer will open a claim when there is a written demand for compensation and an allegation of medical negligence. A claim often is opened, before the filing of a lawsuit, when the health care provider notifies the insurer of the threat or demand received. Some insurers will open a claim on the basis of an adverse event reported to them by their insured health care provider. When a claim is opened, money is placed "on reserve" to cover the potential cost of the claim. The amount of money placed on reserve is an estimate of the cost of administering the claim (the allocated loss adjusted expense or ALAE) and the predicted indemnity payout on the claim. All these funds on reserve constitute the numerator in the loss ratio equation. The denominator in the equation is the total premiums received or earned. Premium dollars are actual monies received. Monies held on reserve are based on predictions. When insurers report a profit ratio or loss ratio, they are using a prediction divided by a sum certain. This means the profit or loss ratio is a "best guess" prediction of what ultimately will occur.

The longer the average time from opening claims until closing claims makes predictions of costs progressively more uncertain. In an environment of increasing severity of awards and settlements and in an environment of an increasing frequency of claims, insurers will need substantially more money on reserve than if severity or frequency of claims were stable. In the past few years, Nevada has seen increasing severity of claims. Since the elimination of the Medical Dental Screening Panel in 2002, Nevada has experienced at least a doubling in the frequency of claims. All this has predictably resulted in insurers needing more money on reserve. The need for more money on reserve is met by raising cash in the form of increasing insurance premiums charged to insureds. The Insurance Commissioner is compelled to grant insurance premium increases to fund the increase in reserves to assure solvency (and reasonable financial return) of the insurer. The Insurance Commissioner has the unenviable task of evaluating premium rate increase requests with the need to have sufficient insurers in the state selling PLI insurance, and the need of health care insurers to purchase affordable PLI insurance.

In 1999 there were seven professional liability insurance (PLI) companies selling medical malpractice insurance to physicians in Nevada. There were even more when you count those companies which insure within a single specialty, such as ophthalmology. In 2000 there were fifteen Professional Liability Insurance (PLI insurers) selling medmal insurance. By December 2002 the number of PLI insurers had reduced to ten. PLI insurers have dwindled down currently to seven in the state, with five in Clark County (MLAN, NMIC, PIC Wisconsin, MedPro, and The Doctors Company) selling PLI insurance to physicians in more than one specialty (ophthalmology and anesthesiology societies sell PLI insurance to some of their specialty through insurance companies formed through their own specialty societies). Many physicians believe that only MLAN and NMIC are selling new policies to physicians in high risk specialties such as obstetrics.

In the past several years, the Nevada Insurance Commissioner has granted increases in PLI insurance premiums. Insurance Division press releases and local newspapers have reported these increases:

2001

January 2001 - The Doctors Company was approved for a 13.9% increase affecting Clark County physicians only.

May 2001 - the Physicians Insurance Company of Wisconsin (PIC Wisconsin) was approved for a 7.5% increase affecting Clark County hysicians only.

August 2001 - American Continental (CAN) raised their premiums 52%.

September 2001 - the St. Paul Group received a stepped 70% rate increase.

The Nevada Division of Insurance suspended the license of the Pennsylvania Physicians Insurance Company (PHICO) due to the threat of insolvency.

October 2001 - MIEC was approved for a 19.5% premiums increase.

December 2001 - PIC Wisconsin raised rates 20.7% in Clark County.

December 12, 2001 - the largest PLI insurer in Nevada, the St. Paul Companies announced they were quitting the PLI business due to heavy losses.

2002

May 2002 - MIEC was approved for another 30% increase in premiums in Clark County.

May 2002 - APA was approved for a 147% increase in Clark County. Many obstetricians insured with APA stopped delivering babies. In September 2002, the Doctors Company was approved for another 26% increase in premiums.

2003

January 2003 - PIC Wisconsin was approved for another 25% rate increase in Clark County. January 2003 - CNA received a 93% rate increase.

January 2003 - The Doctors Company was approved for another 16.9% increase in premiums.

At the end of 2003 - MIEC, the PLI division of Farmers Insurance, and the APA Insurance Company all stopped selling PLI insurance in Nevada.

2004

2004 - PIC Wisconsin was approved for a 15% rate increase effective April 1st, MedPro increased premiums 24% effective July 1st, and The Doctors Company was approved for a 36.5% rate increase effective July 1st.

Clearly, many PLI insurers have left Nevada within the last three years. Others who remain have been granted substantial premium rate increases. Insurers leaving the state report an excessive "loss ratio" as a major reason. PLI insurers remaining use an excessive "loss ratio" as the justification for requesting rate increases.

Legislation passed in August 2002 attempted to ameliorate Nevada's PLI insurance affordability. The statute of limitations was changed from two years from notice of the negligent injury, with a four year maximum time limit to file the case in District Court, to a three year maximum time to bring a claim (certain exceptions apply). The time in which a filed case in District Court must be brought to trial was reduced from five years to three years (for causes of action accruing - similar to occurring - after October 1, 2002). Noneconomic damages were limited to $350,000 from each defendant to each plaintiff (certain exceptions apply) for causes of action accruing after October 1, 2002. The implementation of A.B. 1 of the 2002 Special Session of the Legislature has not, thus far, generated a reduction of PLI insurance premiums to health care providers.

Insurance companies invest money held in reserve. Some individuals and groups contend that poor investments by insurance companies are the cause for the insurers need for increased cash reserves, which in turn necessitates increased premiums charged to physicians and other health care providers. In fact, however, insurers are tightly regulated as to investments permitted. Like many other states, Nevada law requires a minimum of 85% of insurance money be held in secured interest bearing instruments (bonds). Insurers have a relatively small percentage of their money to "play in the stock market." It is true that in the past few years insurance companies have earned much less on investments, but the reason for this is the historically low interest rate on bonds. Clearly, insurers have been less able to use investment income to supplement necessary reserves. In times of high interest rates, insurers can utilize investment income to supplement reserves collected from premiums - thus permitting relatively lower premium increases, or even premium reductions.

In addition to money on reserve, insurers are required to maintain a certain amount of "surplus" funds. These might be considered "rainy day" disaster funds. The amount of surplus required is regulated by insurance laws and administrative rules. Insurers reduce their exposure, and the associated requirement for higher surplus, by purchasing reinsurance. Reinsurance is insurance for insurers. Insurers are liable up to a certain limit; above this, reinsurance covers the loss. In the last few years, the cost of reinsurance has increased greatly with few reinsurers available in the market.

Some individuals contend that only baseball and insurance companies are not subject to anti-trust laws. Unlike baseball, insurance company regulation was given to the states by the McCarran-Ferguson Act passed by Congress in 1948. Insurance companies do share data regarding judgments and settlements. This is necessary to establish risk levels for certain specialties. The responsibility for overseeing competition among insurers falls within the authority of the state insurance commissioner. While there is no federal law precluding collusion and price fixing between insurers, the Insurance Commissioner has the duty and authority to require premiums be set at a reasonable level to maintain insurance company solvency and profitability. Insurance companies compete for premium dollars so it is in the insurance company's interest to set premiums at a lower level than competitors in order to gain market share and increase their profit. Clearly, however, the fewer insurance companies there are in a market, the less the competition and the less the drive to set premiums at the minimum profitability level.

In states with tort laws that limit the upside exposure of awards with firm caps on noneconomic damages at $350,000 or lower, with shorter statute of limitations, with shorter times to bring a filed case to trial, and which provide for periodic payment of future damages, the insurance market is stable and affordable, notwithstanding fluctuations in the business cycle. In California, where the Medical Injury Compensation Reform Act (MICRA) has been law since 1975, medical liability premiums have been stable compared to other states. In California, there is a cap on noneconomic damages of $250,000 per injury, a one year/three years statute of limitations, a greater than 90% chance that a civil case will be brought to trial or settled with one year, and periodic payment of future damages over $50,000 permitted. California juries are also permitted to be informed as to collateral sources of payments (usually the injured parties' health insurance) to the injured party.

California's MICRA laws have fostered a stable insurance premium environment regardless of the business cycle. The graph on page 8 demonstrates the stability of medical PLI insurance premiums compared to the average of all other states.

For several years following the implementation of MICRA medical liability premiums consistently fell, insurance companies returned to the market and provided more competition, and California medicine flourished. The graph to the right illustrates the reduction in malpractice loss payments by the insurance industry (as a percentage of national payouts) and the associated reduction in average PLI insurance premiums (as a percentage of national premiums).

California's MICRA laws have permitted premium rates at far lower levels than those of Nevada. Below are examples of insurance premium costs from the same company selling insurance in California and Nevada, at the same point in time. The top graph on page 13 demonstrates premium rates of The Doctors Company at the end of 2002.

The bottom graph on page 13 indicates premium amounts of the Medical Insurance Exchange of California (MIEC) in May 2002. Despite these premiums levels, and other subsequent raises in premiums, MIEC ceased selling insurance in Nevada in 2003.

Ballot Question 3 (the Keep Our Doctors in Nevada or KODIN initiative) would change Nevada law to mimic the provisions of California's MICRA laws, with a couple minor exceptions. Whereas California limits noneconomic damages to $250,000 per injury, Question 3 would limit noneconomic damages at $350,000 per injury. Question 3 also would provide for elimination of Joint and Several Liability in favor of fault-based liability. Therefore, "deep pocket" liability would be eliminated. Question 3 also provides for periodic payment of future damages over $50,000, reduces the statute of limitations to one year from the date of discovery of the negligently caused injury, permits the defendant to enter into evidence information regarding payments received by the plaintiff from insurance and other collateral sources, and limits attorney contingency fees. The wording of all these provisions is exactly the same as the wording in California law. All the challenged provisions of MICRA were upheld by the California Supreme Court.

Threatening Question 3 are two constitutional amendment initiatives promulgated by the "People for a Better Nevada", a nonprofit corporation which did not disclose the identity of donors and the amount of donations. The Nevada State Medical Association and the Clark County Medical Society have lodged formal complaints about this issue with the Nevada Secretary of State who has initially taken a position that "People for a Better Nevada" is required to divulge the identity of donors and the amount of their donations. The "People for a Better Nevada" contends that, as a Nevada corporation, they are not required to reveal sources and amounts of donations. This issue may require litigation to settle the controversy. Initiative Constitutional amendments, such as in Question 4 and Question 5, require passage in two general elections, 2004 and again in 2006, to become effective.

Implementation of the constitutional amendments in ballot Question 4 will, since insurance premiums are going up (rather than down at 10% per year), void all limitations on damages in medical malpractice lawsuits. Implementation of the constitutional amendments in ballot Question 5 (Stop Frivolous Lawsuit and Protect Your Rights) will void the changes in Nevada law by the (anticipated) passage of ballot Question 3, and constitutionally guarantee that the Legislature could pass no law to limit attorney contingency fees.

Also now circulating for signatures is an initiative which would limit attorney contingency fees to 25% of the first $100,000 of an award, and 10% of any award over $100,000. If certified by the Secretary of State, this Initiative would be considered by the 2005 Legislature who would have 40 days to: 1) pass a statute with the same provisions, 2) pass a competing measure for the 2006 general election, or 3) do nothing. In the last two scenarios, the Initiative would be voted on by the citizens in the general election of 2006. To the best of our knowledge, this circulating initiative has no involvement by organized medicine.

One can expect the 2004 and 2006 general election initiatives to be heavily contested.

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

Jul 19 100 114 45

Aug 54 51 76 67

Sep 20 65 105

Oct 37 83 110

Nov 38 184 59

Dec 9 170 67

Sum 372 823 1246

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Referral Tallies

The following referrals were provided to CCMS members in the third quarter of 2004 (through September 17):

Specialty Referrals

Addiction Medicine 0

Allergy 1

Anesthesiology 0

Cardiology 6

Cardiovascular Surgery 2

Colon & Rectal Surgery 0

Dermatology 10

Diagnostic Radiology 0

Endocrinology 3

Family Practice 16

Gastroenterology 7

General Surgery 4

Geriatrics 1

Gynecologic Oncology 0

Hematology 0

Infectious Medicine 2

Internal Medicine 21

Nephrology 2

Neurology 7

Neurosurgery 0

Ob-Gyn 6

Occupational Med 1

Oncology 5

Ophthalmology 6

Oral/Maxillofacial Surg. 0

Orthopaedic Surgery 18

Otolaryngology 9

Pain Mgmt/Medicine 3

Pathology 0

Pediatrics 2

Ped. Surgery 0

Physical Med/Rehab 0

Plastic Surgery 12

Psychiatry 7

Pulmonology 3

Radiology 0

Rheumatology 6

Thoracic Surgery 1

Urology 3

Vascular Surgery 1

Totals 166

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Alliance Message

By Marian Haas and Kathie Slaughter, 2004-2005 CCMS Alliance Co-Presidents

As we approach Fall and the welcome change in weather, the Alliance is planning many activities geared toward the election. Our October Luncheon will be held on October 19th at 11:30 in the Spanish Trails Clubhouse. Annette Mohs, our wonderful Legislative Chairwoman and member of KODIN, will present a program about important legislative issues in the November election. She has been organizing our members to be active in getting out the word on Question 3 at a grass roots level. Annette has been spending countless hours in hospitals and medical offices distributing brochures, pins, posters, and information about this vital ballot measure We are talking to anyone who will listen about the need to pass this initiative.

We are also trying to educate our community on the need to look carefully at Questions 4 and 5. These two constitutional amendment initiatives would negate all of the efforts in passing Question 3. The Clark County Medical Society has asked the Alliance to look in medical offices to see if the informative materials are displayed and available to the public. We are in turn asking our spouses to educate their staff, employees, and patients about these issues. If every patient, nurse, medical assistant, technologist, file clerk, billing agent, front desk personnel, maintenance worker, and support staff went home and talked to their family and friends about these measures, we could have great success in getting out the word throughout the community.

The Alliance has also been looking for new members. We held a well attended New Member Coffee and hope to keep growing our membership throughout the fall. We are also organizing special interest groups in which members can meet in smaller groups centered around a common interest. These include Book Club, Mommy and Me Playgroup, Dinner Group, Cooking, Hiking, Scrapbooking, and many more.

We have been planning our fundraisers. You will soon see a request for donations to our Greeting Card Project. This is a wonderful way to send Holiday greetings to all physicians in the Las Vegas Valley and, at the same time, contribute to our Nursing Scholarships and local charities that benefit foster children in the community. In March we will have an additional fundraiser with our annual Fashion Show Benefit.

We are looking forward to seeing you at one of our events. If you wish to join us, please contact Wendy Agrawal @ 228-6360, Swati Khamamkar @242-8542, Marian Haas @838-9840, or Kathie Slaughter @ 878-4981. You may also get information from the Clark County Medical Society @ 739-9989

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Health District Adds Community Health Services Division

By Donald S. Kwalick, MD, MPH, Chief Health Officer

In order to better coordinate services and function areas the Clark County Health District is adding a new division, Community Health Services, to its organizational structure. The division will comprise existing health district sections including, Emergency Medical Services (EMS), Epidemiology, Health Education and Public Health Preparedness.

The new division will be lead by Larry Sands, DO, MPH, who will officially join the health district staff in January 2005. Dr. Sands comes to the health district from the Maricopa County Department of Public Health.

In addition to integrating existing services, the new division will launch a Chronic Disease Prevention Program that will include educational outreach, intervention, surveillance and data collection activities. The health district will pursue funding for this program through the restoration of Health Aid to Counties to the Governor's executive budget during the 2005 legislative session.

The increasing rates of obesity, diabetes and asthma make chronic disease prevention and management a growing public health concern. Overweight and obesity are overtaking tobacco use as the leading cause of preventable illness in the United States. In Nevada, data from the Behavioral Risk Factor Surveillance System (BRFSS) indicated the percentage of obese adults in 1996 was 16 percent and the rate has been increasing every year. In 2002, 21.6 percent of Nevadans were classified as obese.

The rise in obesity prevalence is also associated with the development of type 2 diabetes. BRFSS data projects that between the years 2000 and 2050 there will be a 165 percent increase in persons diagnosed with diabetes in the United States - an increase from 11 million to 29 million. These numbers do not reflect undiagnosed cases, which are estimated to be close to 5 million by the American Diabetes Association. The diabetes problem is magnified in minority communities: Latinos are nearly two times more likely to develop type 2 diabetes and African Americans and American Indian/Alaska Natives have higher prevalence rates than non-Hispanic whites in every age group. In Clark County, an estimated 6.4 percent of adults reported having diagnosed diabetes.

Asthma is also a growing concern and the most common chronic disease of childhood. Nationally, 6.3 million children suffer with asthma and according to the Southern Nevada Community Assessment 2003, Nevada's asthma rates have nearly doubled from 1998 to 2001. Individuals who smoke or are exposed to tobacco smoke are more likely to develop asthma, and these factors exacerbate existing cases. Secondhand smoke exposure continues to be a significant health risk in Nevada. Despite the fact that adult and youth tobacco prevalence rates have dropped in the last few years, it is estimated approximately 84,000 children in Nevada are exposed to tobacco smoke in their homes.

In addition to the human toll chronic disease wreaks on our state, associated direct and indirect financial costs are staggering:

· The net cost of treating smoking related illness in the United States is $45 billion per year. (US Department of Treasury, "The Economic Costs of Smoking in the US and the Benefits of Comprehensive Tobacco Legislation 1998; FJ Chaloupka & KE Warner)

· The annual health care costs in Nevada directly caused by smoking total $440 million, $96 million of which is covered by the state Medicaid program. (Campaign for Tobacco Free Kids "Toll of Tobacco in Nevada" 2002)

· Among asthmatic respondents to a community assessment survey, 9.2 percent indicated they missed one week or less of work in the previous year due to asthma, 6 percent reported they missed between 8-24 days, 4.5 percent reported they missed every day of work and .6 percent indicated they missed more than 25 days. (PRC - 2002 Clark County Community Health Survey)

· The total economic cost of obesity in the U.S. is up to $117 billion per year, including more than $60 billion in avoidable medical costs, more than 5 percent of total annual health care expenditures. (Prevention: A Blueprint for Action, US DOH 2004)

· Estimates of the total attributable costs of diabetes are around $100 billion ($43 billion direct; $45 billion indirect). (Healthy People 2010)

· Over $58 million was spent on diabetes hospitalizations for Clark County residents in 2002. Of this amount, Nevada Medicaid paid over $12 million. (Nevada Interactive Health Databases 2002)

With the implementation of the chronic disease management program, Clark County Health District staff is looking forward to working with health care providers and community partners to address chronic disease and these associated issues.

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Classifieds

· OFFICE BUILDING FOR SALE. Ideal for medium/large Accounting (Attorney, Medical, etc.) firm. 16,414 SF net @ NEC Sahara & Lindell. Currently occupied by the Social Security Administration. Buy now and get the benefits of the Social Security Administration lease until May, 2005. Call Chuck or Don at Clifford Commercial (702) 889-9898 for additional information.

· 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.

· FOR LEASE: 2809 W. Charleston Blvd., 3,400 sq. ft. (+/-), one story, ample parking, close to UMC & Valley hospitals. Also for lease 3,000-6,500 sq. ft. Ft. Apache/Russell area near new Southern Hills Hosp. Please call either 804-4736 or cell # 232-3344.

· VIP SPACE FOR SPECIALIST: In Green Valley by Anthem/Seven Hills. VIP Clinic Mini-Suite -- in truly elegant setting. Ideal for sub-specialist to expand to Green Valley. Call 938-0190.

· OFFICE SPACE AVAILABLE FOR SUBLET: Monday, Wednesday Afternoon, and/or all day Friday, Saturday. Central location, Sunrise campus. Ideal but not limited to Primary Care Physician. 702-796-7000.

· 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.

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CME CALENDAR

Cardiovascular Consultants 691-9154

Clark County Medical Society 739-9989

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

· 10/20 - “Current Trends in Cosmetic Surgery and Other Cosmetic Procedures,” 6 p.m., 2 CME hours

HealthInsight (801) 892-0155

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

St. Rose Hospital 616-5832

Southwest Medical Associates 242-7735

· 10/14 - “Rheumatology Update,” 7:30 a.m., 1 CME hour

Summerlin Hospital 233-7572

Sunrise Hospital 731-8210

UMC 383-2604

Valley Hospital 388-4847

· 10/12 - “Plastic, ‘Rejuvenating’, Surgeries (Medical Ethics),” noon

· 10/26 - “STD Update,” noon

· 11/9 - “Update on PET Scans,” noon

· 11/23 - “Atypical Anti-Psychotics,” noon

· 12/14 - “Current Developments Concerning Rhumatoid Arthritis,” 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* - AUG 2004

DISEASE CASES REPORTED YEAR TO DATE

Aug 2003 Aug 2004 2003 2004

VACCINE PREVENTABLE DISEASES

DIPTHERIA 0 0 0 0

HAEMOPHILUS INFLUENZA 4 0 8 6

(invasive)

HEPATITIS A 0 2 9 6

HEPATITIS B 7 2 45 39

INFLUENZA 0 0 47 53

MEASLES 0 0 0 0

MUMPS 1 0 2 0

PERTUSSIS 5 2 14 4

POLIOMYELITIS 0 0 0 0

RUBELLA 0 0 0 0

TETANUS 0 0 0 0

SEXUALLY TRANSMITTED DISEASES **

CHLAMYDIA 258 1095 2931 3346

GONORRHEA 119 507 1162 1663

SYPHILIS (Primary & Secondary) 1 4 7 18

SYPHILIS (Early Latent) 1 2 17 10

ENTERICS

AMEBIASIS 1 1 12 9

BOTULISM-INTESTINAL (Infant) 0 0 1 0

CAMPYLOBACTERIOSIS 13 4 60 53

CHOLERA 0 0 0 0

CRYPTOSPORIDIOSIS 0 1 5 1

E. COLI O157:H7 9 1 14 3

GIARDIASIS 7 11 55 52

ROTAVIRUS 8 8 464 420

SALMONELLOSIS 16 10 72 67

SHIGELLOSIS 3 0 24 18

TYPHOID FEVER 0 0 0 0

VIBRIO 0 0 0 4

YERSINIOSIS 0 0 0 0

OTHER

ANTHRAX 0 0 0 0

BOTULISM INTOXICATION 0 0 0 0

BRUCELLOSIS 0 0 0 0

COCCIDIOIDOMYCOSIS 5 4 23 45

ENCEPHALITIS 0 0 2 0

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 0 1 3 6

LEPROSY (HANSEN'S DISEASE) 0 0 0 1

LEPTOSPIROSIS 0 0 0 1

LISTERIOSIS 1 0 2 5

LYME DISEASE 0 0 3 2

MALARIA 0 0 1 4

MENINGITIS, ASEPTIC/VIRAL 24 14 81 44

MENINGITIS, BACTERIAL 2 2 19 9

MENINGOCOCCAL DISEASE 2 0 5 4

PLAGUE 0 0 0 0

RABIES (HUMAN) 0 0 0 0

RELAPSING FEVER 0 0 0 0

RSV (RESPIRATORY 7 4 1349 1047

SYNCYTIAL VIRUS)

ROCKY MOUNTAIN 0 0 0 0

SPOTTED FEVER

TOXIC SHOCK SYNDROME 1 0 2 3

TUBERCULOSIS 6 6 43 33

TULAREMIA 0 0 0 0

(WNV) WEST NILE VIRUS 0 5 0 5

* Numbers include confirmed and probable cases

** For HIV/AIDS statistics please call the Clark County Health District Office of AIDS at 759-0730.

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Membership Applicants

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

Applicants To Go Before Credentialing Committee:

· Richard A Byrd, MD - Anesthesiology

· Garland A Cowan, MD - Anesthesiology

Contents

Losing Ground - Nevada's Physician Population