Clark County Medical Society

County Line

Newsletter 70      November 05

Contents

Response toResponse to Review Journal Column Criticizing Local Pediatric Care Review Journal Column Criticizing Local Pediatric Care

President’s Message

Malpractice Filings Against Health Care Providers, Jan 2001 – Aug 2005

New Members & Membership Applicants

“Dear Doctor” Info

CEO Article

CCHD Report

How to Respond When You Are Notified of a Complaint Against You

Alliance Message

NSMA’s Annual Meeting Info

Minutes Synopsis

Classified Ads

CME Calendar

Clark County Health District Disease Statistics – Aug 2005

County Line Advertisers

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President’s Message

By Ron Kline, MD, 2005-2006 CCMS President

Cleaning Up Our Act

A great deal of attention has recently been focused in the press on the lack of punishment meted out to a very few errant physicians by their respective medical boards (MD and DO). While I was certainly not privy to the details of these cases, the lack of sufficient punishment in one case caused the deputy executive director of the Board of Osteopathic Medicine to resign the day after this decision by its physician board members.

What concerns me most is the public perception that we are not policing our own. If you read these articles as a member of the lay public would, rather than as a sympathetic physician, one gets the distinct impression that physicians who have repeatedly done harm to patients and have abused their trust have been let off the hook. Since enforcement of regulations and granting of licensure is under the purview of the regulatory boards, there is nothing that most of us can do about these decisions, yet these physician board members speak for all of us in the eyes of the public when they render judgment on our fellow physicians.

So is the problem with a biased press or with a lack of enforcement. I have been very involved in the Academic Medical Center debate over these last few months, and it is very clear to me, in reading the reporting of events that I am very close to, that supposedly objective reporters incorporate their biases (or those of their editors) in their stories. Clearly, the errant physician caught in the provision of sub-standard care or unethical behavior has a sensationalist "man bites dog" character to it. To a degree greater than for any other profession, physicians are respected members of their community who are trusted by their patients. Nevertheless, I continue to be haunted by a friendly chat that I had with a thoughtful, supportive community leader who very politely told me that the problem with physicians was that we all covered up for each other. If intelligent thoughtful people really believe this, then what does the average guy on the street believe?

Certainly doctors are no different than police officers, firefighters, or other individuals with high-pressure occupations. We all understand the stresses that our colleagues are under, no matter what the job, and try to give every last benefit of the doubt to our peers who have (hopefully) temporarily gone astray. Yet we must realize that "going astray" in the medical world means the potential to do harm to other human beings, and we must draw a distinct line in the sand between our colleagues who have temporary problems that can be resolved (and who are willing to face their problems by seeking help), and those who have repeatedly demonstrated a lack of skill, clinical judgment, or ethical behavior. As Larry Matheis, executive director of NSMA recently pointed out, these articles in the press simply validate in the minds of the public the trial lawyer argument that malpractice litigation is the only protection the public has from a medical profession that refuses to police its own. (Talk about the pot calling the kettle black!)

The physician-patient relationship depends on trust to a degree unprecedented in any other human relationship with the exception of marriage. We interpret complex tests, administer life-threatening treatments, and perform complex surgeries based solely on the faith that our patients have that we are competent in what we do and acting in their best interests. Besides our own hard work to establish our individual reputations, we must be grateful to the generations of physicians who have come before us, who through their skill and dedication have placed the medical profession on the pedestal on which it still stands. We squander this legacy at our own peril.

Since our patients are so completely dependent on their trust and faith in us as individuals, and our profession in general, a very few bad examples can create great damage. We are all tarred with the same brush. The most recent concrete example is legislation passed this last session that requires all new physicians to undergo criminal background checks. It was spawned by the case of the Las Vegas pediatric resident who was arrested for possessing child pornography. The physician had no previous criminal record, so the legislation enacted would not have made a difference, but the media coverage of this case resulted in the bill being enacted unanimously by both the Assembly and the Senate.

The case of Dr. Francis D'Ambrosio certainly bears mentioning in this column. According to the Reno Gazette-Journal, Dr. D'Ambrosio was named in 60 malpractice cases between 1994 and 2002, when he surrendered his Nevada medical license while under investigation by the NBME. He has settled in 23 of those cases for a total payout of $14.5 million. Amazingly, California subsequently investigated Dr. D'Ambrosio and determined that because Nevada's BME did not formally discipline him, his voluntary surrender could not be used in California to restrict or deny renewal of Dr. D'Ambrosio's California medical license. The trial lawyers featured him prominently in the malpractice debate as an example of the very few unqualified physicians in Nevada that caused malpractice premiums to explode (I am not saying that I agree with their reasoning). The entire physician community was faulted for covering up for one of our members, when in reality, this responsibility belonged to the BME, and it was their failure to act that resulted in this fiasco.

So how do we go about cleaning up our act? These issues are complex and detailed solutions are beyond the scope of this column. Potential solutions require that a delicate balance be maintained. We must show compassion towards physicians who have erred in their ways and are repentant, while demonstrating to our patients that we regard their safety as paramount. We must afford due process to physicians, as we do to other Americans, while bringing charges to a speedy resolution so that the public does not perceive justice delayed as justice denied.

Physicians in our state must know that disciplinary action can be brought against them if they fail to "report any person the licensee knows, or has reason to know, is in violation" of the medical practice act or the regulations of the NBME (NRS 630.3062(6)). While this creates a duty on our part to report such physicians, we are immune from civil action for furnishing "information concerning an applicant for a license or a licensee in good faith and without malicious intent" (NRS 630.364(1)). One local physician explained to me that he tried to inform the BME about a colleague's lack of skill as a surgeon, but stopped when he was threatened with legal action. Anyone can file a lawsuit, but in this situation the plaintiff would need to prove by clear and convincing evidence that the report to the BME was made in bad faith or with malice. I am aware of the potential for mischief to be caused by some of our colleagues reporting each other for anti-competitive and interpersonal reasons, but I am hopeful that a competent BME will be able to discern valid complaints from groundless ones, and that physicians making repeated false claims will themselves be subject to scrutiny.

I believe it is clearly in the best interests of our profession to show our patients that we are worthy of the trust they continue to place in us and that we regard their safety as the highest priority. If we cannot police our own profession, then the legislature, in the interests of "public safety" will take away this responsibility from us, and the public will come to believe that unfettered malpractice litigation is their only protection against unscrupulous and unqualified doctors. Let us at least begin to act before it comes to this.

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Clark County District Court Medical Malpractice Filings

Against Health Care Providers, Jan 2001 – September 2005

                        2001     2002    2003    2004    2005

Jan                   39        33        108      61        41

Feb                  20        14        98        72        63

Mar                  35        30        169      123      64

Apr                  37        34        111      81        70

May                 37        35        126      65 14

Jun                   27        24        103      90 65

Jul                    19        100      114      45 66

Aug                  54        51        76        67 33

Sep                  20        65        105      79 36

Oct                  37        83        110      59

Nov                 38        184      59        78

Dec                  9          170      67        47

Sum                372      823      1246     867

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New Members

Congratulations and Welcome to the Clark County Medical Society New Student Members – September 2005

• Carla L Ellis, University of Nevada
• David Freeman, University of Nevada
• Yosef N Martel, University of Nevada
• Lausanne P Orendain, University of Nevada
• Huy N Truong, University of Nevada
• Angela K Weiner, University of Nevada
• Jonathan H Gifford, University of Nevada

Reinstated Members

• Margo Hendrickson, MD, Pediatric Surgery
• Nutan K Parikh, MD, Oncology
• John E Herr, MD, Orthopaedics

Applicants To Go Before Credentialing Committee

If you have any pertinent information about the following membership candidates, please contact: 

Clark County Medical Society, 2590 E. Russell Rd., Las Vegas, NV 89120

· Imran Ahmed, MD, Oncology/Hematology

· Mitchell D Forman, DO, Internal Medicine

· Ara Gueyikian, MD, Internal Medicine

· W Tracy Hankins, MD, Plastic Surgery

· Thomas J Hunt, MD, Family Practice

· Prasad R Kudalkar, MD, Family Practice

· Rupesh J Parikh, MD, Internal Medicine

· Benjamin U Samuel, MD, Infectious Disease

· Satish K Sharma, MD, Anesthesiology

·

For information on becoming a member of the Clark County Medical Society, call Marlaina Burns at 739-9989.

***New Member Special*** $390 New members can join for half price their first year.

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“Dear Doctor”

The Clark County Medical Society's Community Health/Community Relations Committee is developing a weekly column called "Dear Doctor" with the Las Vegas Review-Journal. We encourage any interested physician members to submit a brief article on a mainstream health topic of your choice. If you would like to submit an article for publication in our new "Dear Doctor" column with the R-J, please submit it to the Clark County Medical Society.

Specifications: Articles should be of 750 words or less. The articles should be placed in the form of a Question/Answer and printed for legibility.

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CEO Article

By Weldon (Don) Havins, M.D., Esq., CEO, Special Counsel

There seems to be significant efforts among many parties to create an Academic Medical Center in southern Nevada. Local newspapers have published information indicating that the current Nevada hospital corporations are offering to create up to 250 new residency positions. The Dean of Touro University has indicated that Touro has an agreement with a local hospital for 74 residency positions, almost all of which are to be in primary care (OBGYN, Pediatrics, Internal Medicine, and Family Practice). These residency positions are due to begin in 2006.

The University of Nevada School of Medicine (UNSOM) has accredited residencies in primary care, as well as general surgery and plastic surgery. Residency positions at UNSOM are filled with United States M.D. graduates, United States D.O. graduates and a substantial number of Foreign Medical Graduates (FMGs). The new American Osteopathic Association residency positions will be filled with United States D.O. graduates and FMGs. The first graduates of the Touro University College of Osteopathic Medicine will graduate in 2008. There will likely be something more than 70 graduates in this inaugural class, with graduating class size rising nearly to 150 within five years. These graduates will likely fill a substantial number of the available southern Nevada residency positions.

From 2006 to 2008 however, there will be no graduates from Touro to fill the positions. There will be an insufficient number of graduates from UNSOM to fill the positions. Nationally, 25% of training physicians are FMGs. Particularly for the years 2006 to 2008, and substantially thereafter, FMGs will have a surfeit of opportunities for residency training in southern Nevada. Virtually all the FMG doctors will be training under a U.S. Immigration and Naturalization Service J-1 visa.

The J-1 exchange visitor visa is granted to a foreign medical physician who is sponsored by the Educational Commission on Foreign Medical Graduates (ECFMG) to seek graduate medical training in the United States. FMGs are admitted to the U.S. for training subject to a two year post-training ineligibility to apply for any of the following: a change to another non-immigrant visa status; permanent residency in the United States; or an H-1B resident visa status at a consulate abroad. The two years following the U.S. residency or fellowship training must be spent in the home country of the FMG.

In the past there was a limited H-1B visa program exception wherein qualifying J-1 visa physicians could remain in the U.S. after residency or fellowship training. Physicians with H-1B visas routinely remain in the United States and are usually granted a permanent residency ("green card") or become U.S. citizens. FMG physicians are eligible for waiver of the home residency requirement if he or she can demonstrate one of three conditions: their departure would cause an extreme hardship to a U.S. citizen or permanent resident spouse or child; they would face persecution if they returned to their home country; or a government agency declares that permitting the FMG physician to remain in the U.S. is in the public interest. This last category, the interested government agency or IGA waiver, is used by most J-1 visa physicians who wish to remain in the U.S. upon completion of their training. Until 1994, only federal agencies could sponsor physicians for IGA waivers. In 1994, Congress created what has become known as the Conrad 30 program which allowed state health departments to sponsor up to 30 doctors per year for IGA waivers. This program requires that physician employment be located in a Health Professional Shortage Area (HPSA) or Medically Underserved Area (MUA). The contract must be for a minimum of three years, and the physician must agree to work 40 hours per week at the qualifying facility. States are free to determine the acceptability of subspecialties, including additional contract terms. The Nevada State contact person for this program is Mary Mackenzie at the Nevada State Health Department, 775-684-4047. (Her email is: mmackenzie@nvhd.state.nv.us) In Nevada, the facility must show how it will retain the physician beyond the three contracted years, and there is a maximum of 3 waivers per facility in a fiscal year. (website: http://health2k.state.nv.us/primary) The Conrad program was due to sunset in June 2004, but Congress passed Public Law 108-144 which extended the Conrad program for at least two more years.

This law also, most significantly, eliminated the H-1B numerical caps for state and federal agencies and permitted both state and federal agencies to sponsor specialists (only the VA could do so previously). Beyond the Conrad 30 program, J-1 visa physicians can be granted a waiver for the two year foreign residence requirement if they can demonstrate their departure would cause an "exceptional hardship" on a U.S. citizen or permanent resident spouse or child. The "exceptional" nature of the hardship must be more than the normal hardships associated with a two-year separation from a spouse or child. Factors considered in the determination of exceptional hardship include:

· physical or mental conditions of a spouse or child that would be adversely affected by resident abroad, such as the unavailability of treatment in the home country;

· conditions of severe discrimination and limitation of educational opportunities to a spouse or child of a particular race, religion, or gender;

· need for the spouse to remain in the U.S. to continue employment essential to family maintenance;

· interruption of the spouse's established career; and

· severance of one or more close family relationships.

Congress has determined that the liberalization of the caps on J-1 visa physicians' ability to remain in the U.S. will serve as one of the solutions to address the U.S. physician shortage. In Nevada, the physician shortage is being addressed by increasing enrollment in UNSOM, the establishment of Touro University College of Osteopathic Medicine, increasing the number of resident physicians under local hospitals corporations funding, and the establishment of AOA-accredited residencies in local hospitals. Because almost all the waiver programs involve a minimum three year commitment to serve in a HPSA or a MUA, the severe lack of access to medical care in rural Nevada should be preferentially addressed.

The VA (Department of Veterans Affairs) may sponsor an unlimited number of FMGs when it is clearly in the interest of the VA. Usually this requires a finding by the VA that the loss of the J-1 physician's services would necessitate a discontinuance of a program or a major phase of a program, and recruitment efforts to find a qualified U.S. resident have or would fail. VA positions do not have to be in medically underserved areas.

Some of the best physicians in Nevada are FMGs who have come to the U.S. and remain under one of the above programs. With increasing opportunities for J-1 visa physicians to train in southern Nevada, and the liberalization of opportunities of those physicians to remain in Nevada, the Nevada physician shortage will be addressed sooner rather than later. The quality of the specialists produced in these new residencies, will depend in substantial part, upon the commitment of current Nevada physicians to participate in the new residency training programs. Nevada practicing physicians should avail themselves of the opportunities to help train these future Nevada physicians.

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How to Respond When You Are Notified of a Complaint Against You

Reprinted from the Nevada State Board of Medical Examiners Newsletter Volume 31, Summer 2005

The Nevada State Board of Medical Examiners receives a significant number of complaints each month. Once it has been determined that the Board has jurisdiction over the matter, each complaint is appropriately investigated. As part of every investigation, a request for a response is made to the practitioner against whom the complaint is filed. If you receive such a letter from the Board's Investigative Division, then follow these simple guidelines. It will benefit all parties involved.

1. Your response should be timely. Normally, there is a specified number of days indicated in the Investigator's letter during which a response should be prepared and forwarded to the Board. If you have a conflict with the time allotted, all you have to do is call the Investigator and request an extension. In most cases, extensions are not a problem, provided there is reasonable cause.

2. The response should address the specifics raised in the complaint letter. The complaint letter is usually self-explanatory; however, if you have a question, call or write to the Investigator handling your case.

3. The response should be typed. Legibility is crucial, and illegibility will only lead to delay and require more time and effort on everyone's part.

4. The response should be focused and concise, but should adequately address the issued raised. If the complaint raises the issue of patient care and the issue of practitioner behavior, both issues must be addressed.

5. The response should be prepared and signed by the practitioner against whom the complaint is made. The response may be supplemented by other documentation and commentary, and the practitioner may, of course, seek outside advice and legal counsel.

Once the initial investigation is complete, the Board's Medical Reviewers examine the case. The Board's Medical Reviewers are licensed Nevada physicians. If relevant, the Medical Reviewers may request outside peer reviews and/or additional investigation. Collateral information may be sought from other practitioners involved in the patient's care or having knowledge of the events or care described in the complaint. If you receive a letter from an Investigator informing you that you are not a respondent, but nevertheless a statement about your treatment of the patient and copies of a patient's medical records are needed, then you, also, should follow the guidelines listed above.

When the investigation is ready to go forward, it is presented to one of two Investigative Committees of the Board. The Investigative Committee is composed of three members of the Board, two of whom are licensed medical doctors and one of whom is a public member. In every case, the legal staff reviews the investigation before presentation to the Investigative Committee. The Investigative Committee thoroughly reviews and discusses each case. It considers the case for closure, for expanding the investigation, for having the practitioner appear before the Committee, or for other action agreed upon by the Committee, which may include filing a Formal Complaint against the practitioner for a violation of the Medical Practice Act, NRS 630.

All investigations conducted by the Board are confidential by statute. However, when a Formal Complaint is filed with the Board against a practitioner, the Formal Complaint becomes a public document.

So, if you receive a complaint letter from the Board, whether as a Respondent or as a practitioner otherwise involved, take the time and effort to do your homework carefully and provide as accurate and complete a response as possible. Every Board investigation is a serious matter, and your cooperation in following the response guidelines benefits every practitioner involved in one.

On behalf of the Board's Investigations Division, Medical Reviewers and Legal Staff.

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CCHD Report

By Donald Kwalick, MD, MPH, Chief Health Officer

Avian Flu - Clark County Health District prepares for outbreak response

Outbreaks of a highly-pathogenic avian flu virus in poultry and other birds in several Asian countries are thought to pose the highest risk of sparking a human influenza pandemic. Based on historical patterns, influenza pandemics are expected to occur three to four times each century with the emergence of new virus subtypes that are readily transmitted from person to person. Public health experts agree an influenza pandemic is inevitable and possibly imminent.

The news that the Centers for Disease Control and Prevention, along with partner agencies, had successfully reconstructed the influenza virus strain responsible for the 1918 flu pandemic is encouraging. Based on this study we now know the H5N1 virus circulating in Asia has five of the 10 gene sequence changes associated with human-to-human transmission in the 1918 virus. Findings such as these will be instrumental in the development of anti-viral medications and vaccines to treat and prevent influenza.

At the local level the Clark County Health District continues to plan and practice for an outbreak response. These activities would be applicable to a response to an avian flu outbreak and are applied to every day activities, including small-scale outbreaks.

Health district staff representatives from different functional areas participate in outbreak response team meetings on a regularly scheduled basis. This has lead to enhanced coordination among the different sections of the health district and improved our response efforts. This team approach was employed during the response to a hepatitis A exposure at a conference with more than 25,000 people in attendance. The health district successfully notified more than 90 percent of those in attendance at the conference within 24 hours of receiving the information. This allowed attendees to determine if they were at-risk and afforded the health district ample time to set up a clinic and provide preventive treatment to those exposed.

Additionally, the health district participates in community-wide exercises where responses to a variety of disease outbreaks are tested. These scenarios involve setting up mass vaccination or dispensing clinics and test our plans to implement different levels of isolation and quarantine orders in our community.

Flu season also offers an opportunity to test our response capabilities. During the 2004-2005 season we operated the first day of our flu clinic as a mass vaccination drill. Public health nurses immunized more than 3,200 high-risk individuals in an 8-hour period and we were able to test our clinic layout to ensure it provided for an optimal flow of clients.

The health district will replicate the mass vaccination drill this flu season with the added element of running two vaccination sites simultaneously. The drill is scheduled for Saturday, November 19, 2005. One clinic will be held at the main public health center on Shadow Lane and the other will be held at Silverado High School in Henderson. This exercise will allow the health district to assess its staffing capabilities and its logistical plans, including supplying multiple sites and coordination of information between clinics.

These activities provide realistic scenarios we can use to hone our response to a variety of public health emergencies and we continue to seek out and create opportunities to improve upon our ability to respond to a variety of emerging public health needs.

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Alliance Message

By Shanila Choudhury, 2005-06 CCMS Alliance President

October is designated Breast Cancer Awareness month and there are signs of this everywhere. The Clark County Medical Society Alliance has chosen to participate by having a Breast Cancer Awareness Fundraiser in honor of our charity, the Susan G. Komen Foundation at the Red Rock Country Club on October 18, 2005. We want to get our members, mostly women, aware of this deadly disease. Jackie Brown, of the Susan G. Komen Breast Cancer Foundation will be the keynote speaker at this event.

I encourage those of you who have not yet joined the Clark County Medical Society Alliance, to do so soon so you can be part of our yearly membership directory. This will allow you to continue to get our beautiful and very informative newsletter, created by Pauline Lee and Andrea Yu. The newsletter keeps you posted on our many activities. The deadline is October 30, 2005. We are also accepting advertisements for $75 for those who would like ads in our directory. Please contact Estela Hansen 496-0456 for more information.

The Alliance Greeting Card Project is under way since the summer. Kim Watson, Lisa Gollard and Annette Mohs have been working very hard to make this year surpass the goals of last year. For those who are not familiar, there will be 5,000 request letters mailed throughout the community, soliciting donations of only $50 each. In turn we will be sending out a greeting card listing all the donors. This will enable us to offer awards of approximately $1,000 each to at least 10 Nursing School Graduates and the remainder will benefit the Nevada Benefits Society, a local charity. You will find an insert in this newsletter. Please help us with your kind donation.

Please join us at the next lunch which will be at the Capital Grille located in the Fashion Show mall on Tuesday, November 15 at 11:30 am. The Alliance is a great avenue for networking and using your free time to help many local charities. Please find out more about us at our website which is info@ccmsa-lv.org or contact Shanila Choudhury (702) 355-2019 or email me at choud@aol.com for more information.

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Nevada State Medical Association’s 102nd Annual Meeting and Scientific Session

Mark Your Calendars! April 27-30, 2006 at the Alexis Park Resort in ***Las Vegas, Nevada***

This is the first time in years that this meeting will be held in Las Vegas. We need Delegates. We hope to have the best attendance ever. The number of Delegates we are allowed is based on a percentage of our membership. Last year we could have had 36 Delegates and we only had 11. This annual meeting determines the policies and programs of the Association. Listed below is a sample of what happens at the annual event:

1. A half day Scientific Session

2. President’s Luncheon (usually has an interesting speaker)

3. Very Informative Governmental Affairs Meeting

4. Reference Committee meetings where resolutions are discussed and perfected to become policy

5. Dinner and Awards ceremony where the NSMA and NSMAA Presidents are inaugurated

This year the Delegation Chair for CCMS is Dr. Marietta Nelson. Please call Dot Freel at 739-9989 to sign up or get more information.

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Minutes Synopsis

CLARK COUNTY MEDICAL SOCIETY

Executive Council MEETING

Tuesday, September 20, 2005; 6:00 P.M.

Minutes Synopsis

The minutes for the August meeting were approved unanimously.

UNSOM Report

Dr. Lenhart gave a brief report about the meeting to discuss the current hospital AMC proposal. Dr. Lenhart stated the proposal constituted a 23 million dollar increase in funding but the proposal did not describe an environment for this AMC.

Allscripts Presentation

Glen Tullman, CEO of Allscripts made a proposal for an electronic prescribing program which they would like CCMS, in cooperation with Sierra Health Services, to offer to the CCMS membership. All adopting physicians would provide their own hardware to host this web-based electronic prescribing. The conditions of this agreement would allow CCMS members' participation for a minimum of 2 years without the $20 per provider monthly maintenance services fees.

Financial Report

Dr. Steinberg reported the revenue was $27,332.48 for the first month of the new fiscal year which is down about $9,000 from last year at this time due to a decrease in new members and renewal dues collected. Employee related expenses are down with one less employee. Expenses are about $3,000 less than the same time last year.

Membership Report

Dr. Kline reported there were 91 dues paid members, which was a decrease from the 147 last year at this time. There were a total of 767 members.

Credentials Report

Marlaina Burns stated there were seven Student Members applicants, all from the University of Nevada, approved for membership: Lawrence R. Huff, Jr.; Kate E. Martin; David Freeman; Carla L. Ellis; Huy N. Truong; Laussane P. Orendain; and Yosef N. Martel.

There were 2 reinstatements, Margo Hendrikson, MD - Pediatric Surgery; Nutan K. Parikh, MD - Oncology.

Nevada AMC Report

The "Clark County Medical Society Recommendations for Establishing a Nevada Academic Medical Center" position paper was approved.

Community Health Committee

Dr. Jones reported his committee continues working on the service opportunity project began by Dr. Jameson last year. Articles for the "Dear Doctor" project were requested of Board members again. Dr. Jameson gave a brief presentation on information regarding Access Health.

Touro University College of Osteopathic Medicine Report

Dr. Forman stated their next D.O. class will have 125 students.

NSMA Report

Dr. Evins stated his commissions were appointed at the NSMA Counsel meeting. The Council approved staff performance reviews, added Dean Forman to the Counsel, set a legislative strategy, and discussed the AMC issue on great length.

AMA Report

Dr. Nelson urged members to call their legislators about the proposed Medicare cuts. Dr. Nelson reminded everyone that the NSMA Annual meeting will be in Las Vegas this year for the first time in a very long time, and she asked each Board member to do several things: 1) think of any good ideas and bring them forward; 2) consider giving all Delegates $100 for serving as a Delegate and; 3) make a commitment to be a Delegate and solicit one additional person to be a Delegate.

NBME Report

Dr. Havins explained the "Code of Ethics" which was proposed at the NBME meeting. He stated the first code would create a duty to treat in an emergency. However, this violates the "first do no harm" basic ethical code. The wording should be modified.

Health District Report

Dr. Kwalick was unable to attend the meeting but sent a report to the Board on current Health District topics.

President's Report

Dr. Kline assigned Drs. Havins, Nowins and Steinberg to an investment committee to look into asset protection for the Medical Society.

New Business

The Huntridge Clinic will be allowed to place a one time quarter page ad in the County Line asking for volunteering physicians.

The next BOT meeting will be on Tuesday, October 18, 2005 at 6 pm.

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Classifieds

Executive medical suites FOR RENT: includes phones, fax, copier, receptionist (Spanish & English), doctor’s office, exam room, procedure room (small surgery), I.V. room, Ex-ray and laser room, & conference room. Available for 1/2 day, day or weekly. Call Chuck @ 384-3027 or 326-2432. Valley View/Sahara area.

New Office Space: Near Southern Hills Hospital. 4,000 sq.ft. to share with established Family Practice Primary Care or specialty OK. Available 03/06. Call 951-3400 or 612-2111 (cell).

FOR SALE: Rosenthal China - Bettina pattern. Service for 20, includes some serving pieces. Retails at $3,500. Yours for $1,500 or best offer, call Joan at 255-3545.

LOOKING FOR BOARD CERTIFIED PHYSICIANS: in Hematology, Nephrology, Neonatology, Emergency Medicine, Thoracic/CV Surgery, Rheumatology, and Transplants to do chart reviews. URAC accredited Independent Review Organization. Hourly rate. Fax CV to Neva at (702) 385-1312.

physician turned author: death by any means By Leonard Kreisler, MD www.durbanhouse.com (publisher) Available at Barnes and Noble, Walmart.com, Target.com OR inscribed from the author: $14.95 + $3.00 S&H (Total $17.95) to Leonard Kreisler, MD, 2512 Silverton Dr, Las Vegas, NV 89134.

Spanish villa for Sale, costa del sol spain: 2,000sq meters of land, 350 sq meter house, 3 levels, 4 bedrooms, 1 office, 4 baths, olympic size swimming pool, 1 car garage, tropical garden, magnificent view for $635,000. Call Beata Kwiatkowska, MD (702) 228-4483 ext 267 or cell (702) 401-6420.

For Lease: 4000(+/-) sq ft, W Charleston frontage, one story, ample parking, located between Rancho & Campbell. Close to Valley & UMC hospitals and freeways. Call 804-4736 or cell 232-3344.

MOONLIGHT MEDICINE: A unique, well established (8 years) medical house call practice seeking a Nevada licensed FP or GP physician looking to supplement income working 2-3 days per week. Flexible schedule as well as competitive salary; transportation and medical assistant supplied. Fax CV to (702) 974-0108 or call James at (702) 474-6300.

LAS VEGAS FAMILY PRACTICE FOR SALE: Well-established, very successful private practice, near west side. All furnishings and equipment included. Yearly collections $500K with potential growth. Over 5,000 active charts. Owner retiring from private practice but will transition. Phone (702) 364-2044 for more information.

Office space available in Henderson on Horizon Dr & I95: Excellent location, ideal for Primary Care Physician or satellite office for Specialist. Office ready to move in. Fully equipped. Fax inquiries to (702) 567-9003 or call (702)567-9002/(702)604-4448.

HOUSE FOR SALE: Southwest, gated, 5584 square feet, 5 bedrooms, 7 baths, pool, 3 car garage. View at www.circlepix.com (virtual tour #MK4EYB) $1,350,000. Call Jody Lenzie/Century 21 - (702) 499-9494 or (702) 289-2835.

Physician Reviewers Needed: HealthInsight, the Quality Improvement Organization for the Medicare Beneficiaries of the state of Nevada, NEEDS Physician Reviewers. HealthInsight works in partnership with health care providers to improve the quality of healthcare in our state. If interested, please contact: Dr. Shreck at (702) 385-9933.

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CME CALENDAR

Bechtel Nevada 295-0208

NV Chapter AACE 434-8400

Pri-Med Institute (877) 4PRI-MED

Sierra Health Services 242-7735

11/10 - “Improving Your HEDIS Score”

12/8 - “Hand and Arm Problems from the Neurologist’s Perspective”

Southern Nevada AHEC 318-8452

Southwest Medical Associates 242-7735

Summerlin Hospital 233-7572

Sunrise Hospital 731-8210

11/22 - “Brain Death: Organ & Tissue Donation

1.5 CME Credits RSVP Required

UMC 383-2604

Valley Hospital 388-4847

11/22 - “Bipolar Disease”

11/22/05 - “Fibromyalgia: What it is and How it Should be Managed”

12/13 - “Chemodenervation: Pros and Cons

Only CME Activities held at the Clark County Medical Society office are specifically endorsed by CCMS.

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Clark County Health District Disease Statistics* - September 2005

CLARK COUNTY HEALTH DISTRICT

DISEASE STATISTICS* - September 2005

DISEASE CASES REPORTED YEAR TO DATE

Sept 2004 Sept 2005 2004 2005

VACCINE PREVENTABLE DISEASES

DIPTHERIA 0 0 0 0

HAEMOPHILUS INFLUENZA 0 0 5 10

HEPATITIS A 0 3 6 8

HEPATITIS B 2 2 40 19

INFLUENZA 0 0 53 119

MEASLES 0 0 0 0

MUMPS 0 1 0 1

PERTUSSIS 0 3 4 26

POLIOMYELITIS 0 0 0 0

RUBELLA 0 0 0 0

TETANUS 0 0 0 0

SEXUALLY TRANSMITTED DISEASES

AIDS 8 10 201 151

CHLAMYDIA 443 512 3759 4342

GONORRHEA 233 206 1941 1896

HIV 31 15 225 191

SYPHILIS (Early Latent) 0 0 8 17

SYPHILIS (Primary & Secondary) 10 1 28 80

ENTERICS

AMEBIASIS 1 0 9 11

BOTULISM-INTESTINAL 0 0 0 1

CAMPYLOBACTERIOSIS 18 4 67 61

CHOLERA 0 0 0 0

CRYPTOSPORIDIOSIS 0 0 2 6

E. COLI O157:H7 5 0 10 10

GIARDIA 5 8 51 46

ROTAVIRUS 10 2 503 399

SALMONELLOSIS 13 18 82 97

SHIGELLOSIS 12 5 32 36

TYPHOID FEVER 0 0 1 0

VIBRIO 0 0 4 0

YERSINIOSIS 0 0 0 1

OTHER

ANTHRAX 0 0 0 0

BOTULISM INTOXIC