Newsletter LXII March 2005
Contents
High-Low Arbitrations and Physician Reporting
Avoiding Unnecessary Use and Misuse of Antibiotics
Malpractice Filings Against Health Care Providers, Jan 2001 – Jan 2005
Clark County Health District Disease Statistics – January 2005
High-Low Arbitrations and Physician Reporting
By Weldon (Don)
Havins, MD, Esq.
At the beginning of February, there were 319 medical malpractice cases in Clark County District Court heading for a jury trial. This number of cases, should they all go to trial, would swamp the resources of the Court and elbow out virtually all other civil trials. To address the impending crisis, Clark County judicial authorities appointed three District Court judges to hold hearings on the status of the cases. While the results of those hearings have not found their way into the local media, some newspapers did quote a few of the plaintiff personal injury attorneys complaining that attendance at the conferences was like a "cattle call". One can reasonably infer that there is more than the usual pressure to settle these cases short of resorting to a full civil trial by jury.
Defendant physicians generally have two major concerns about medical malpractice cases. First, physicians are concerned about the effect that a medical malpractice payment made by their insurer will have on that physician's future professional liability insurance premiums. The second concern is that any payment made for medical malpractice must be reported to the National Practitioner Database and to the Nevada Board of Medical Examiners or Nevada Board of Osteopathic Medicine. Insurers are also required to report payments made for the medical malpractice of an insured to these same governmental entities.
Since the implementation of S.B. 250 of the 2003 Legislative session, licensees are statutorily mandated to report, within 45 days, any medical malpractice settlement, award, or other disposition of the case against the physician. Failure to report is a violation of NRS 630 or NRS 633 and subjects the violator to a fine of up to $5,000. If the licensee physician reports a settlement or award, the licensing board is required to investigate and to sanction the physician at the discretion of the board. A single act of malpractice, defined as a breach of the standard of care, can base a licensure sanction by the Board of Medical Examiners, including revocation of license to practice medicine.
The Board of Osteopathic Medicine (NBOM) has somewhat conflicting statutes. The NBOM must investigate every settlement, award, or judgment for malpractice and determine whether discipline is indicated. See NRS 633.528. However, under indications for licensure discipline, osteopathic physicians are subject to licensure discipline for "repeated acts of malpractice or gross malpractice." See NRS 633.511(4). Interestingly, the NBOM must investigate every settlement, award, or judgment for medical malpractice to determine whether licensure discipline is indicated, but may not/ cannot discipline unless there are repeated acts of malpractice.
The reporting and mandated investigations to determine whether licensure discipline is indicated threaten the viability of a physician's license. Any payments made for physicians' medical malpractice must be reported to the National Practitioner Database which is queried by hospitals. This potentially threatens the staff privileges of a physician. Plaintiff medical malpractice attorneys are cognizant of the congested trial calendar and the recent poor (from their perspective) chance of obtaining a plaintiff jury verdict in a medical malpractice case against a physician.
All these factors combine to motivate both physicians and plaintiff attorneys to consider options other than a jury trial to settle an alleged medical malpractice dispute. One of these options, which we hear is used with increasing frequency, is the High-Low Arbitration. Plaintiff and defense attorneys negotiate the highest loss that could be suffered by the defendant. Plaintiffs' attorneys will attempt to negotiate this number as high as possible and still be within the physician's policy limits. Physicians are unlikely to agree to a potential award exceeding policy limits. The plaintiff's attorney will then attempt to negotiate the "low" or least the plaintiff would receive in the arbitration. Usually this number is at least enough to cover the plaintiff's costs. The plaintiff is thereby virtually guaranteed to cover his costs and may receive up to the maximum negotiated.
Why would a physician agree to such a deal? First, arbitration avoids a jury trial, with its historical wild unpredictability, and which has the potential to exceed the physician's policy limits. Such jury verdicts are rare in the last two years, but are devastating when they occur. Arbitrations can be scheduled and completed much sooner than a jury trial, so the misery of the unknown is concluded much sooner.
Second, arbitration is a final adjudication. If the physician prevails at arbitration, the physician is found not to have committed medical malpractice. The "low" payment made to the plaintiff is an administrative payment, and not a payment for medical malpractice. The physician does not report anything to the National Practitioner Data Bank. The physician reports to his or her licensing board that the claim was concluded with no medical malpractice found on the part of the physician. There is no award or judgment for medical malpractice, and thus there is no mandated investigation by the licensing board. The physician's insurer does pay something to the plaintiff, but this may well be less than just the cost of taking the case to trial. The insurer is not mandated to report to the National Practitioner Database since the insurer made no payment for medical malpractice.
Nevada trial attorneys can be creative in addressing the concerns of all parties in medical malpractice disputes. CCMS hears of instances in which this "High-Low" concept has been applied in settlements of medical malpractice disputes. This is a more problematic area because a settlement, while disclaiming liability, may not constitute a judicial finding of no medical malpractice. Settlements are mandated to be reported to the Nevada licensing boards within 45 days of the settlement. Settlements require investigation by the licensing board, notwithstanding agreed disclaimers of liability contained within the substance of settlement agreement. Failure to report settlements to the National Practitioner Databank because the document disclaims liability of the physician treads on thin legal ice. The potential consequences of failure to report include fines up to $11,000 under the Civil Money Penalties Act.
While arbitration, a judicial finality, can clear a physician of medical malpractice just as effectively as can a jury, a settlement disclaiming liability signed by both parties, appears not to do so under Nevada law and probably not under the provisions of the Health Care Quality Improvement Act of 1986 which created the National Practitioner Data Bank.
President’s Message
By Michael P. Colletti, M.D., 2004-2005 CCMS President
The Nevada Legislature is now in session. We expect several health-related topics will be discussed by the legislators. Health care for Clark County and all of Nevada continues to be a top priority for the legislators. Health benefits for workers, according to many news reports, seem to be the last and most pressing issue to be settled between labor and management. The difficulties in providing and financing health care will continue in Clark County and across the United States. If present trends progress, the situation will only become more severe. Patients will be expected to pay even larger co-pays to visit their physicians and health care providers as well as pay a greater percentage of the cost of their medications. The practice of defensive medicine and advancing technology, combined with a dramatic increase in the number of residents without health insurance, will further shift the cost of healthcare to those still fortunate enough to have health insurance coverage and to the tax payer.
The CCMS continues to work with the Southern Nevada Medical Industry Coalition, particularly on legislative issues and the nursing shortage. The pool of applicants for nursing schools has greatly increased and the perspective students are better qualified. The "bottleneck" currently is at the instructor level. We are attempting to search the entire country for nurse educators with the necessary qualifications to teach our nursing students and to relocate to Clark County. The challenges in providing health care to Americans are increasing with no end in sight.
The CCMS Board of Trustees continues to discuss physician and healthcare worker response in the event of an act of bioterrorism by biological agents, toxic chemicals or nuclear explosion. We will work with those individuals most knowledgeable and involved to prepare ourselves, as much as possible, to respond to such emergencies.
NSMA Annual Meeting
Nevada State Medical
Association’s
101st Annual Meeting and
Scientific Session
John Ascuaga’s
Nugget, Sparks,
Call Dot Freel
at 739-9989 for delegation information.
Medical Reserve Corps Update
By Donald S. Kwalick,
MD, MPH
The Medical Reserve Corps of Clark County has made great progress since its inception at the Clark County Health District. Its efforts to recruit trained personnel who are capable of responding to local emergencies and disasters have been very successful. Paula Martel, the program coordinator, along with MRC volunteers have participated in a number of activities designed to provide training and education and promote their readiness to respond.
To date, the organization has recruited a total of 79 volunteers. This includes 12 physicians with a range of backgrounds: cardiology, oncology, endocrinology, internal medicine, obstetrics/gynecology, anesthesiology, neurology, gastroenterology and pathology. Additional volunteers include nurse practitioners, registered nurses, licensed practical nurses, pharmacists, emergency medical technicians, mental health professionals and other medical workers.
The MRC is an important component of the health district's emergency response plans and plays a vital role in both our "Mass Prophylaxis and Immunization Plan" and "Strategic National Stockpile Plan."
MRC volunteers also have free access to all classes available to health district staff, including:
· Medical Consequences of an Act of Terrorism
· American Heart Association CPR
· Basic Incident Command System
· Bloodborne Pathogens
· Crisis and Emergency Risk Communication
· Mass Antibiotic Dispensing: Volunteer Staffing
· Outbreak Support and Surveillance
· Community Emergency Response Team (CERT)
Volunteers and staff of the MRC have participated in emergency exercises and will have upcoming roles in a variety of activities such as Rotunda Thunda, an exercise being conducted in conjunction with the Clark County Office of Emergency Management and the Las Vegas Convention and Visitor's Authority that will utilize the LVCVA's convention space as a medical triage center. MRC will also participate in Operation Loaded Dice, a City of Las Vegas sponsored, multi-agency exercise. Additionally, MRC volunteers have been active in real-life events such as the health district influenza immunization clinics.
The MRC will play an important role in the event of a local emergency and help to reduce the impact such an event would have on local hospitals and staff. MRC staff is planning an active recruitment for the Fall of 2005. Look for upcoming information on how you can participate. The organization is open to active or retired medical personnel and non-medical personnel may also apply. For more information on the Medical Reserve Corps of Clark County, call Paula Martel, program coordinator, at 383-6181.
Avoiding Unnecessary Use and Misuse of Antibiotics
A Practical Guide to Diagnosis and Treatment of Infection in the Outpatient Setting
Submitted By Nevadans
for Antibiotic Awareness
Note: The CCMS Board of Trustees would like to dedicate this article to
the memory of Dr. Reuben Diaz.
Overuse and misuse of antibiotics is rampant in our community and across the country. This serves to accelerate the rate of development of multi-drug resistant (MDR) organisms, leads to prolonged illness since MDR infections are harder to treat, heightens the chance of treatment failure, and leads to an increase in healthcare costs.
A sound understanding of a few general principles should aid primary care doctors in avoiding the pitfalls of antibiotic misuse. Please consider the following.
Take the time to
make the correct diagnosis before prescribing an antibiotic.
This necessitates a return to the basics taught in our medical schools and residencies: 1) obtain detailed history, 2) perform a thorough physical examination, 3) develop a differential diagnosis, and 4) order the appropriate tests.
Unfortunately, enormous patient loads force many doctors to rush through each patient, giving only superficial attention to each of the above four steps. As a result, many patients with viral illnesses, or illnesses that are not infectious in origin at all, are administered antibiotics unnecessarily. Better attention to history, physical exam, and obtaining appropriate confirmatory tests would prevent misuse of antibiotics.
If a bacterial
infection is diagnosed, know which antibiotics are first line for that
infection and use them.
First-line drugs are more efficacious than second or third line drugs, usually require a shorter treatment course and lower the risk of treatment failure. Additionally, they usually have a relatively narrow spectrum of antimicrobial activity. The more narrow the spectrum an antibiotic has, the fewer groups of bacteria to which it will apply selective pressure to mutate into resistant forms.
Use correct doses
- look them up if uncertain.
Under-dosing of antibiotics encourages development of resistant strains of microorganisms and leads to treatment failures. Perhaps fueled by a desire to be frugal, considering the rising cost of healthcare, under-dosing of antibiotics is widespread. In the long run, however, it will become more costly as MDR infections and treatment failures are more expensive to deal with. It behooves every physician that prescribes an antibiotic to take the time to look up recommended doses if he/she is not intimately familiar with the drug.
Get a detailed
drug allergy history.
Most doctors ask their patients to which medicines they are allergic, but few ask what reaction he or she had when he or she took them. Drug-induced rashes like urticaria are in and of themselves basically harmless, albeit annoying. More serious reactions include anaphylaxis, Stevens-Johnson syndrome and angioedema of the upper respiratory tract. Sometimes what a patient calls an allergy may not actually be one, for instance, GI upset. A complete antibiotic allergy history might allow a physician to use a first line drug to treat the infection more effectively than the alternatives, with little risk to the patient.
Interpret cultures
correctly - treat the patient, not the lab result.
The mere presence of an organism in culture does not necessarily equate with infection. Yet many doctors react to sputum cultures, wound cultures, urine cultures and blood cultures in a knee jerk manner by starting antibiotics without any consideration as to whether this culture represents a colonizer, a contaminant, or a true pathogen.
Each culture result must be interpreted together with other data points. If other lab and radiographic data, and the signs and symptoms of the patient point to infection, then treat the patient.
Communicate
effectively with the patient, especially when an antibiotic will not be
prescribed.
Many doctors complain that the reason why they prescribe antibiotics for infections that are obviously viral is that the patients expect to leave their office with some treatment in hand. Effective communication with patients can overcome this problem. If they understand their medical problems better, they are more likely to accept the withholding of antibiotics in the appropriate situations.
Article written by Gary Skankey, MD,
Infectious Disease.
Edited by Donald S Kwalick, MD; Carol van der
Harten-Algier, MD; and Weldon (Don) Havins, MD, Esq.
Clark County District Court Medical Malpractice Filings Against Health Care Providers, Jan 2001 – Jan 2005
2001 2002 2003 2004 2005
Jan 39 33 108 61 41
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 79
Oct 37 83 110 59
Nov 38 184 59 78
Dec 9 170 67 47
Sum 372 823 1246 867
New Members - January 2005
Congratulations and Welcome to Clark County Medical Society:
·
Michael P Donahue, DO, Orthopaedic Surgery, 501
S Rancho Dr #I-67,
· George M Elkanich, MD, Orthopaedic Surgery, 501 S Rancho Dr #I-67, Las Vegas, NV 89106
·
Craig A Hartman, DO, Ob-Gyn,
·
Joseph J Heck, DO, Emergency Medicine, 1769
Harpsichord Way, Henderson NV
·
Robert P Kaplan, DO, Family Practice,
· Navid Kazemi, MD, Cardiovascular Disease, 9280 W Sunset Blvd, Las Vegas, NV 89148
·
Beata J Kwiatkowska, MD, Blood Banking/Pathology,
·
Bruce S Wang, DO, Ob-Gyn,
· Conrad O. Yu, MD, Orthopaedic Surgery, 3650 N Tenaya Way #301, Las Vegas, NV 89128
· Daniel H Zee, MD, Radiology, 2020 Palomino Ln #100, Las Vegas, NV 89106
Applicants To Go Before Credentialing Committee
If you have any pertinent information about the following membership candidates, please contact:
Clark County Medical
Society,
· Pavan K Janapati, MD, Hospitalist/Internal Medicine
· Daniel M Sabry, MD, Internal Medicine
· Michael D Thomas, MD, Pediatric Orthopaedics
For information on becoming a member of the Clark County Medical Society, call Marlaina Burns at 739-9989
Reinstated Members
· Anthony Ibay, MD, Ob-Gyn
· Lynda Tirao, MD, Cardiology
Retired Members
· Edward A Sherwood, MD, Ob-Gyn
· Anunciacion Yballe, MD, Pathology, MD, Family Practice
Member News
At the request of the CCMS Board of Trustees, Catholic Healthcare West has waived its $50 annual fee for courtesy staff privileges for all CCMS members at the St. Rose Dominican Hospitals.
This action is intended to show support for organized medicine as we all work together to make health care better in Nevada.
BOT Minutes Synopsis
CLARK COUNTY MEDICAL SOCIETY BOARD OF TRUSTEES MEETING
Tuesday, January 18, 2005;
Minutes Synopsis
Presentation by Dr. Bill Berliner
Dr. Berliner presented a slide show regarding "Nevadans for Antibiotic Awareness" and then answered questions from the Board members.
Financial Report
Dr. Steinberg reported the revenue for these 6 months of the fiscal year was more year-to-date compared to last year. Expenses are up compared to last year at this time. Dr. Steinberg reported the outside lights were vandalized and Staff will be looking into replacing those lights.
Approve Minutes (Nov 2004)
The minutes from the November BOT meeting were approved unanimously.
Health District Report
Dr. Don Kwalick reported there needs to be the capacity for mental health emergency services outpatient care so people can get their medications, and an increase in the number of beds available for mental health patients. Dr. Kwalick asked the Board members to support this issue with any legislators personally known to them.
Credentials Committee
The following 10 physicians were accepted for active membership: Michael P. Donahue, DO, Orthopaedic Surgery; George M. Elkanich, MD, Orthopaedic Surgery; Craig A. Hartman, DO, OB-Gyn; Joseph J. Heck, DO, Emergency Medicine; Robert P. Kaplan, DO, Family Practice; Navid Kazemi, MD, Cardiovascular Disease; Beata J. Kwiatkowska, MD, Blood Banking/Pathology; Bruce S. Wang, DO, OB-Gyn; Conrad O. Yu, MD, Orthopaedic Surgery; and Daniel H. Zee, MD, Radiology.
Membership Report
Dr. Kline reported there were 662 dues paid members, which was an improvement over the 591 last year at this time. Last year a total of 704 members paid dues for the entire year. Dr. Kline updated the Board on his contacts with the hospitals regarding waiving re-credentialing fees for CCMS members.
Community Health/ Community Relations Committee
Dr. Jameson reported the mini-internship program will be held in September this year.
Dr. Jameson reported she attended two events where she was able to discuss with Assemblywoman Barbara Buckley the problem with the current state law granting negligence immunity to physicians gratuitously rendering professional services only if the physician sees the patient in the health care facility of the governmental entity or nonprofit organization. She stated the Assemblywoman promised to correct this after she obtains the legal opinion of the LCB. Larry Matheis stated he has also discussed this issue with legislators and they also stated they would fix the language to match the intent of the bill.
CME Committee
Dr. Evins reported his committee decided to do less CME activities in order to get better attendance. The five chosen activities received the highest poll on the needs survey and Staff will work on scheduling the activities.
Scholarship Fund Report
Dr. Colletti asked that a meeting be set up prior to the next BOT meeting on February 15.
NSMA Report
Larry Matheis reported the Legislative Core group will meet every Thursday once the legislative session starts. The primary issues will be clean up on panel fees and Medicaid and mental health funding.
AMA Report
At the recent AMA meeting Dr. Horne attended, Nevada was congratulated for being the only state able to pass tort reform and defeat the lawyer's initiatives. Dr. Horne stated the AMA will be focusing on passing national tort reform.
NBME Report
Dr. Montoya announced Steve Quinn, Esq. has left the BME and attorney Bonnie Brandt has been hired. He stated the BME is in favor of reconstituting a better MDSP panel with more clout. Dr. Montoya said there has been interest in the BME creating regulations requiring credentialing office surgery. The issue of criminal background checks on physicians was discussed.
President's Report
Dr. Colletti informed the Board that his President's message in the County Line addresses the need to reconstitute an improved MDSP to control the frequency of claims. He stated he will be fax broadcasting this same message to all our database fax numbers.
Dr. Colletti announced the passing of member Ruben Diaz, MD.
Administrative Report
Dr. Havins stated two medical students expressed interest in joining the Society and he discussed this issue with Dr. Colletti. It was decided both the Touro University and UNSOM's medical students with Clark County addresses will be invited to join for free.
Dr. Havins explained the problem with the nursing board regulation which makes it impossible for private university nursing schools to open here. Dr. Kurlinski moved to have CCMS recommend that SNMIC propose a correcting amendment, which passed unanimously.
Dr. Havins reported Dr. Vinnik asked him to meet with Office Max representatives who discussed a group purchasing plan for CCMS members which would be substantially cheaper than retail purchases. Dr. Chowdhry moved to have an announcement placed in the County Line to let the members know that Office Max may be contacting them to offer this group purchasing plan, and that CCMS is involved.
Dr. Steinberg moved to allow CCMS to place a $500 ad in the annual UNSOM yearbook as has been done in the past. The motion was seconded and passed unanimously.
Dr. Evins moved to approve the Pictorial Directory rate sheet proposed by Deb Barton and to schedule publication of the Pictorial Directory to reflect the membership year. Deb Barton was directed to find a photography firm willing to take photos of the members at no charge to CCMS. The motions were seconded and passed unanimously.
Drs. Edward Sherwood and Anunciacion Yballe were both approved for "retired membership" status.
The next meeting will be on Tuesday, February 15, 2005 at 6 pm. A Delegates meeting will follow the BOT meeting. There being no further business, the meeting was adjourned at 8:40pm.
Alliance Message
By Marian Haas and Kathie Slaughter, 2004-2005 CCMS Alliance
Co-Presidents
On March 15th the Fashion Show Fundraiser will be held at Neiman Marcus in the Fashion Show Mall. This promises to be a very special event. We will have a silent auction and raffle of some wonderful items, which include a two-night stay at the Montage Resort and Spa in Laguna Beach; art pieces by Mackenzie Thorpe and Brian Henry; gift certificates for dinners, salons, art classes, fitness center memberships; and much more. We hope to raise funds for donations to CASA Foundation and Child Focus, two wonderful organizations that provide for the needs of foster children in Clark County with tutoring, educational scholarships, sports programs, camp, arts and music lessons, and vision and health needs. This, along with our continuing support of Child Haven, the emergency shelter that provides temporary care for neglected, abused, or abandoned children, will help the community of Clark County. We hope to also raise the awareness of our medical community to the needs of foster children. These children, through no fault of their own, are removed from their families and are too often forgotten in a society that neither sees nor hears their small voices. Both of these organizations welcome volunteers, as does the CASA Program that trains volunteers to become child advocates in juvenile court. You may contact Marian Haas for further information or contact these organizations directly: Child Focus - 436-1624, CASA Foundation - 455-4306.
We are looking forward to our April Luncheon on April 19th, which will be in the home of April Stewart. At the luncheon we will award the nursing scholarships to graduating nurses in all of the nursing programs in Clark County. We will also be electing officers for our 2005-2006 board. These officers will then be installed in May at our luncheon in the Black Mountain Golf and Country Club.
If you wish to join the Clark County Medical Society Alliance, please contact Wendy Agrawal @ 228-6360, Swati Khamamkar @242-8542, Marian Haas @838-9840, or Kathie Slaughter @ 878-4981.
CME CALENDAR
Clark County Medical
Society 739-9989
4/27 - “Medical Ethics,”
5/28 - “The Physician as an Expert Witness,”
2 CME hours
MLAN 364-4962
4/2 - “Risk Managment & Ethics
Program,”
Pri-Med Institute (877) 4PRI-MED
5/20-21 - “Pri-Med Updates,” up to 16.25 CME hours,
FREE to CCMS members, for details or to register visit www.pri-med.com/updates/lasvegas
Southwest Medical
Associates 242-7735
3/10 - “Men’s Health: Sexual Dysfunction in the Elderly”
4/14 - “GI Malignancies: Screening and Surveillance”
3/12 - “Bioterrorism and Weapons of Mass Destruction Training,” 8 a.m., 5 CME hours
3/26 - “Bioterrorism and Weapons of Mass Destruction Training,” 8 a.m., 5 CME hours
Sunrise Hospital 731-8210
3/1 - “Drug-Induced Liver Diseases,”
3/5 - “Bioterrorism (WMD),” 9 a.m., 4 CME hours
3/8 - “Medical Ethics,” 5 p.m., 2 CME hours
3/9 - “Medical Ethics,” 5 p.m., 2 CME hours
3/15 - “Solving Workplace Challenges,”
UMC 383-2604
3/19 - “Weapons of Mass Destruction & Ethical Issues,” 7:30 a.m., 7 CME hours
4/9 - “Weapons of Mass Destruction & Ethical Issues,” 7:30 a.m., 7 CME hours
Valley Hospital 388-4847
3/8 - “Update on COPD,”
3/22 - “Advances in Spine Surgery,”
4/12 - “What You Should Know about Patient Falls and Their
Impact on You,”
To have your CME courses listed on our calendar, contact Deborah Barton at 739-9989 prior to the 12th each month.
Clark County Health District Disease Statistics* - January 2005
DISEASE CASES REPORTED YEAR
TO DATE
Jan 2004
Jan 2005 2004 2005
VACCINE PREVENTABLE DISEASES
DIPTHERIA 0 0 0 0
HAEMOPHILUS
INFLUENZA 0 1 0 1
(invasive)
HEPATITIS A 0 0 0 0
HEPATITIS B 3 2 3 2
INFLUENZA 49 22 49 22
MEASLES 0 0 0 0
MUMPS 0 0 0 0
PERTUSSIS 0 2 0 2
POLIOMYELITIS 0 0 0 0
RUBELLA 0 0 0 0
TETANUS 0 0 0 0
SEXUALLY
TRANSMITTED DISEASES**
CHLAMYDIA 358 453 358 453
GONORRHEA 194 220 194 220
SYPHILIS
(Early Latent) 1 0 1 0
SYPHILIS
(Primary & Secondary)2 3 2 3
ENTERICS
AMEBIASIS 1 2 1 2
BOTULISM-INTESTINAL
0 0 0 0
(INFANT)
CAMPYLOBACTERIOSIS 2 4 2 4
CHOLERA 0 0 0 0
CRYPTOSPORIDIOSIS 1 2 1 2
E. COLI
O157:H7 2 0 2 0
GIARDIA 3 2 3 2
ROTAVIRUS 156 84 156 84
SALMONELLOSIS 12 14 12 14
SHIGELLOSIS 5 4 5 4
TYPHOID
FEVER 0 0 0 0
VIBRIO 0 0 0 0
YERSINIOSIS 0 0 0 0
OTHER
ANTHRAX 0 0 0 0
BOTULISM INTOXICATION 0 0 0 0
BRUCELLOSIS 0 0 0 0
COCCIDIOIDOMYCOSIS 5 7 5 7
ENCEPHALITIS 0 1 0 1
HANTAVIRUS 0 0 0 0
HEMOLYTIC
UREMIC 0 0 0 0
SYNDROME(HUS)
HEPATITIS C 0 0 0 0
HEPATITIS D 0 0 0 0
LEGIONELLOSIS 1 0 1 0
LEPROSY 0 0 0 0
LEPTOSPIROSIS 0 0 0 0
LISTERIOSIS 0 0 0 0
LYME
DISEASE 0 0 0 0
MALARIA 1 0 1 0
MENINGITIS,
ASEPTIC/VIRAL 4 4 4 4
MENINGITIS,
BACTERIAL 2 2 2 2
MENINGOCOCCAL
DISEASE 2 0 2 0
PLAGUE 0 0 0 0
PSITTACOSIS 0 0 0 0
Q FEVER 0 0 0 0
RABIES
(HUMAN) 0 0 0 0
RELAPSING
FEVER 0 0 0 0
ROCKY MTN
SPOTTED FEVER 0 0 0 0
RSV 281 432 281 432
TOXIC SHOCK
SYNDROME 0 1 0 1
TOXIC SHOCK
SYN 1 1 1 1
(STREPTOCOCCAL)
TUBERCULOSIS 7 7 7 7
TULAREMIA 0 0 0 0
UNUSUAL
ILLNESS 0 0 0 0
WEST NILE
VIRUS 0 0 0 0
(ENCEPHALITIS)
WEST NILE
VIRUS (FEVER) 0 0 0 0
*Numbers include confirmed and probable cases.
**For
HIV/AIDS statistics please call the Clark County Health District Office of AIDS
@ 759-0730.
Classifieds
· PERFECT SOUTH HENDERSON LOCATION for medispa, new medical practice, or second office in new medical/office center. Three spacious treatment rooms with sinks. Numerous high-end upgrades - must see to appreciate! Assume low lease. (702) 526-9551.
· MEDICAL OFFICE SPACE FOR RENT. Great location, currently renting half/full days. 1100 sq. ft., 3-exam rooms/lab/Drs. Office, large check in/out. Fully furnished. Del Webb building/adjacent to Siena Hospital. Please contact Gayle at (702) 454-6226.
· WANTED: ESTABLISHED PRACTICE (8 YEARS) seeking a Nevada Licensed Family Practitioner or General Practitioner (semi-retired) part-time or full-time. Flexible schedule. Fax CV to (702) 920-8095.
· PRIMARY CARE OFFICE SUBLEASE IN Henderson (Pecos/Wigwam) available for M.D. and/or other health professionals - ancillary staff and use of scheduling system, phones, equipment all optional. Start your business here with referrals in house. Call 595-6168.
· MEDICAL OFFICE FOR RENT. 1100 square feet, 3 exam rooms. Next to Desert Hospital. Call 286-0906.
· PHYSICIAN WANTED: INTERNAL MEDICINE. Take charge of your career with IPC - The Hospitalist Company. We are searching for multi-talented individuals ready to take on a lead decision making role in hospital-based care. Contact John Barragan at 304-2144. www.hospitalist.com.
· FOR SALE: Quinton Treadmill with Defibrillator, Executive Desk, Chair, Bookcase, 2 Couches, 2 Typewriters, Computer and Monitors, Assorted Chairs. Call Dr. Carmena at 878-8108.
· ADVERTISE IN COUNTY LINE CCMS members get up to 3 free classified ads (up to 40 words) per year. For further information on rates, call Deborah at 739-9989.
County Line Advertisers
Bank of Commerce …..
949-9800 ….. www.bankofcommerce-nevada.com
Colonial Bank …..
304-3770 ….. www.colonialbank.com
DMSL Medical
Management & Billing Service ….. 558-2326
Hutchison &
Steffen Attorneys ….. 385-2500 ….. www.hsnvlaw.com
Investment Equity …..
871-4545 ….. www.investmentequity.com
Kennedy Commercial
….. 940-7815 ….. info@kennedycommercial.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
Nigro Development ….. 247-1915 ….. www.nigrodevelopment.com
Matthew Passalacqua,
Financial Advisor ….. 254-1263 ….. www.tricorfinancialservices.com
Red Rock Radiology
….. 731-2888 ….. www.redrockradiology.com
United Blood Services
….. 228-1111 ….. bkwiatkowska@bloodsystems.org