Newsletter 79 August 06
Contents
Malpractice Filings Against Health Care Providers, Jan 2001 – June 2006
LOWERING PLI INSURANCE LIMITS FOR
LOWER PREMIUMS - “A GOOD TRADE”?
Southern Nevada Health Officer
Report
Considerations
in Improving Nevada's Health Care in the 21st Century
2006 Endorsement List Primary
Election
INSTALLATION DINNER SPONSORS
The
sponsors at the Installation and Awards
Ceremony
Platinum Sponsors
BankWest of
Community Bank of
MLAN
NAI Horizon
Nevada Cancer Institute
St Rose Dominican Hospitals
Women's
Gold Sponsors
Priority One Commercial
Steinberg Diagnostic Medical Imaging
Silver Sponsors
Health Insight
Prudential CRES Commercial
Real Estate
Congratulations and appreciation go to
the following members for their
committment and dedication in continued
50 Year Members: Joined
in 1956
Gerald W. Jones, MD - Retired, Family Practice
Albert Merkin, MD - Retired, Pediatrics
30 Year Members: Joined in 1976
Loren Little, MD - Ophthalmology
William Schrader, MD - Retired, Pathology
20 Year Members: Joined in 1986
Victor Kershul, MD - Retired, Psychiatry
10 Year Members: Joined in 1996
Nancy Donahoe, MD - Cardiovascular & Thoracic Surgery
William Evans, MD - Pediatric Cardiology
Steven Hansen, MD - Ophthalmology
Jon Hazen, MD - OB-Gyn
David Kahan, MD - Internal Medicine
Gregory Kwok, MD - Internal Medicine
Juan E Martin, Jr, MD - Cardiothoracic & Vascular Surgery
William Rifley, III, MD - Plastic Surgery
Benjamin Rodriguez, MD - Plastic Surgery
Annette Teijeiro, MD
- Anesthesiology
PRESIDENT’S MESSAGE
By
The world is changing fast and so must our health care delivery system. How many of us have family, friends, staff, and significant others who do not have health insurance? More and more doctor's offices and small businesses do not provide insurance for their staff because they can't afford it.
As physician and patient frustration with our current health
care delivery system increases, more and more people are talking about health
care system reform. This includes
everything from more volunteer services to universal health care underwritten and
managed by the federal government. Volunteer
services are an important part of caring for the uninsured and
At a recent meeting at a Mayo Clinic, policy leaders agreed on one thing: The nation needs health care coverage. However, they could not agree on how to accomplish this goal. Some argued states should take the lead and others argued for a national approach. An electronic poll of attendees found that 74% agreed or strongly agreed there was a moral imperative for all citizens to have health insurance; on THAT we agree! Currently an estimated 46 million Americans are now uninsured.
Last April, Massachusetts Governor Mitt Romney signed
legislation that required all residents to purchase health insurance by July
2007. The new laws also help create a
state subsidized health insurance program for individuals with income from
poverty level up to 300% above the poverty level. Some people think
The AMA has a reform proposal that recommends incremental measures to first expand coverage for children, low income families and individuals through tax credits and insurance market reforms. It was considered unlikely that major national health reform would occur without the event of a major war or a serious economic depression.
So, with the number of uninsured growing and with no
consensus on how to deal with the problem, what do we do in the meantime? Do we stand by and watch people go without
medical care or do we start addressing the problem facing us? The answer is clear; we must develop a new
vision for health care in
As some of you read this you may be thinking to yourselves, "There is no
urgent problem - or that I am asking for answers to questions that don't
exist." Not so. In
The current ailing state of our health care delivery system
cannot be cured simply with more physicians, or the best TORT reform possible,
or a health sciences center. A successful health care delivery system will be
one which provides care to all people. Our current system needs revision,
either incrementally or through a total transformation. As President of
As we did with Question 3, let's show ourselves,
Clark County District Court Medical Malpractice Filings
Against Health Care Providers, Jan 2001 – June 2006
2001 2002 2003
2004 2005 2006
Jan 39 33 108 61 41 50
Feb 20 14 98 72 63 61
Mar 35 30 169 123 64 38
Apr 37 34 111 81 70 58
May 37 35 126 65 14 71
Jun 27 24 103 90 65 83
Aug 54 51 76 67 33
Oct 37 83 110 59 26
Nov 38 184 59 78 68
Sum
372 823
1246 867 581
Member News
Applicants to Go Before Credentialing Committee
If you have any pertinent information about the following membership candidates, please contact:
- Carl E Allen, MD - OB-Gyn
- Leslie K Avery, MD - Ped Critical
Care
- Tracy J Butler, MD - Ped Critical
Care
- L Eugene Daugherty, MD - Ped
Critical Care
- John H Duong-Tran, MD - Ped
Critical Care
- Ruchi Garg, DO - Pediatrics
- Joseph A Gassen, MD - Pediatrics
- Diane C Lipscomb, MD - Ped
Critical Care
- Michelle M Pastorello, MD -
Pediatrics
- Kevin Sinai, DO - Family Practice
- James D Swift, MD - Ped Critical
Care
- Paula A Vanderford, MD -
Pediatrics
For information on becoming a member of the
LOWERING PLI INSURANCE LIMITS FOR LOWER PREMIUMS - “A GOOD TRADE”?
By Weldon (Don) Havins, M.D., Esq.,
Executive Director, Special Counsel & President-elect
A couple weeks ago, active staff
members of
One factor facilitating this
reduction is the elimination of Joint Liability as provided in the 2004 medical
liability tort reform contained in ballot initiative Question 3. Prior to A.B. 1 of 2002, the Legislature's
statutory medical tort reform effort, there was no limitation on Joint and
Several Liability. This meant that a
physician, for example 5% at fault, was liable for the entire amount of the
jury award. In substance, this happened
in the case of
The medical liability provisions in
the 2004 ballot Question 3 eliminated the "deep pocket" health care
professional defendant. This includes
hospitals. Traditionally, hospitals have
been the "deep pocket" in medical malpractice cases because of the
higher insurance PLI limits and greater assets of hospitals compared to
physicians. Because hospitals are no
longer the "deep pocket" in medical liability cases, hospitals can
afford to reduce their staff medmal insurance requirements. Although
The risk to hospitals of adopting the lower PLI insurance limits is that the Nevada Supreme Court may, sometime in the future, hold the elimination of Joint Liability to be unconstitutional. Should that occur, hospitals would likely raise their staff PLI limit requirements back to the $1 million/$3 million level. Until or unless that occurs, hospitals will be liable for their proportion of fault in a case, just the same as physician defendants found to be proportionally at fault.
What is the advantage of lower limit
requirements to physicians? Physicians
will have the option of changing the limits of liability coverage of their PLI
insurance and thereby pay less in annual premium for this insurance. The question then becomes, how much reduction
in premiums will occur for half their prior insurance coverage?
Is this a reasonable option for practicing physicians? OB-GYNs who deliver babies commonly pay $100,000 for the standard $1 million/$3 million PLI policy limits. A $20,000 reduction in their annual premium appears substantial, and may permit some who were considering ceasing the obstetrics component of their practice to continue delivering babies. For physicians paying $40,000 for the standard limits policies, an $8,000 reduction in annual premium may not be as enticing. Unfortunately, those in the higher premium categories, such as OBs, are also in the higher risk categories. Even in the most problematic medical malpractice cases, almost all plaintiff lawyers will, usually early in the case, offer to settle for the policy limits of the physician. This has been the case when the policy limits were at the $1 million dollar level. How likely will plaintiff lawyers and their clients offer to settle a medical malpractice claim for half of that amount because the physician has lower policy limits?
For cases in which awards exceed the policy limits, physicians are personally liable for the amount in excess of their policy. How many physicians opting for the lower limit policy have $500,000 in assets to pay a million dollar claim?
Some physicians will claim they will
protect their assets before they opt for the lower limit policy. This asset protection can be in the form of a
The lower PLI limit physician with
an excess award may conclude that bankruptcy will be his or her salvation.
All these miserable scenarios are predicated on a medical malpractice award or settlement above policy limits. What are the chances of a physician being sued, and what are the chances of a physician sustaining an award (or settlement) greater than $500,000? In 2003, the Reno Gazette-Journal produced a special section on the NBME and the amounts paid for medical malpractice. This information was based on information in the National Practitioner Data Base. Investigative reporter, Francis X. Mullen, noted that 51% of payouts over the prior 10 years were attributed to what he euphemistically dubbed "the top 50 docs". One physician accounted for 14% of the total payouts during the period examined. Other than these 50 physicians, who had multiple paid claims, very few physicians had more than one claim. From his data, the chance of being sued more than once was very small. Awards or settlements over 1 million dollars, other than for "the 50 top docs", were very rare.
Since January 2001, the Clark County
Medical Society has followed filings for medical malpractice against health
care providers in the Eighth Judicial District Court (
Occasionally, we become aware of
some settlement amounts. Medical
malpractice case settlements against licensed medical doctors were published on
the NBME's website until recently. While
these have now been removed, they are still available, regarding an individual
licensee, by calling the NBME.
In essence, each physician must evaluate whether the (up to 20%) reduction in annual PLI premium is worth cutting coverage by half. In particular, physicians must make the individual judgment of the possible impact on settlement or jury award of a policy with only one-half the coverage of the standard PLI policy. Into this mix, the physician must calculate the possibility of a medical malpractice claim being brought against him or her.
While the chance of being sued is small and the chance of a jury award or settlement rising above $500,000 even smaller, the devastating effect of such a cataclysmic event will induce many physicians to conclude that the reduction in annual PLI premium is not a "good trade" for the amount of the reduction in PLI coverage.
Southern Nevada Health District Report
The Southern Nevada Health
District initiates summertime surveillance activities
By Donald S. Kwalick,
MD, MPH, Chief Health Officer, Southern Nevada Health District
In order to detect potential outbreaks in the animal
population and prevent the spread of disease, the Southern Nevada Health
District conducts routine surveillance programs to monitor for diseases such as
plague and hantavirus and
Hantavirus
These surveillance activities have led to the identification
of hantavirus in mice near Cold Creek, approximately 25 miles north of
Health district staff distributed notification letters to
residents in the Cold Creek area, including packets with information on
prevention, transmission and a rodent proofing checklist. A total of 33 rodents
were sampled and of those, 11 tested positive according to the
In June 2006 the Nevada State Health Division reported that
an Elko county resident died from Hantavirus Pulmonary Syndrome (HPS). The
state is investigating the case to determine possible ways the person may have
contracted the disease. HPS was first recognized in 1993, in the
General precautions regarding hantavirus include reducing the availability of food sources and nesting sites around homes, storing garbage in rodent-proof containers and preventing rodents from entering homes by sealing all openings that are greater than a ¼ inch.
Clean-up procedures include: disinfecting and wet mopping areas to remove rodent droppings and urine; wearing rubber gloves, long-sleeved clothing and a dust mask; and properly disposing of the droppings and dead rodents by picking them up with tools and placing in a double plastic bag which is then sealed and placed in a garbage container or buried.
Mosquito Surveillance
Another important component of the health district surveillance system, the mosquito abatement program, is in full swing. By the end of June 2006, district staff had responded to 590 complaints called into the mosquito control hotline. These include complaints about un-maintained swimming pools, natural sources of standing water and mosquito infestations.
More than 3,000 mosquitoes trapped in
Additional prevention activities include the development of educational outreach materials for the public. The public is advised to follow simple precautions to protect themselves from mosquitoes and ticks such as the appropriate use of insect repellents containing DEET, Picaridin, or oil of lemon eucalyptus, eliminating standing water and wearing appropriate clothing when engaged in outdoor activities, such as long-sleeved shirts, pants and light-colored clothing.
Bird Surveillance
In addition to mosquito samples, more than 100 birds have been sent to the Department of Agriculture for testing. All specimens have been negative for West Nile Virus, Western Equine Encephalitis and St. Louis Encephalitis. Birds are also being tested for avian influenza. To date, two American Coots have tested positive for non-pathogenic influenza A.
More information on hantavirus and West Nile Virus can be accessed on the health district website at www.southernnevadahealthdistrict.org. Suspected illness should be reported to the health district Office of Epidemiology by calling 759-1300.
Alliance
By
Considerations
in Improving Nevada
By Harrison H. Sheld,
M.D., Professor of Obstetrics and Gynecology,
(Editor's note: In the
interest of consideration of all points of view on the nascent
Nationally,
our health care delivery system is in a period of transition, with the
fee-for-service model being phased out and being replaced by managed care.
Managed care organizations use physician extenders (physician assistants, nurse
practitioners, midwives) to deliver health care because such personnel are less
costly and are well accepted by patients. A majority of
The Health Care Provider "Shortage"?
The
Association of American Medical Colleges, as noted in a Las Vegas
Review-Journal article (
Two
studies show there is no physician shortage:
John
In
addition to the increasing use of physician extenders being used in managed
care settings here,
Federalization of Health Care
Uncertainty
prevails in considering both the future medical needs of the populace and the
structure and cost of its delivery. The following possibilities must be
considered: As the frustration of health care providers and patients with the
workings of the present health care delivery system increases, the inclination
to accept a broader government role in health care delivery is likely.
Ultimately, there will be universal health care underwritten and managed by the
federal government. Reimbursement changes not only for health care providers
but also hospitals are likely. Hospital reimbursement will be contingent upon
approved federal guidelines, including control on the number and kind of
residency positions that are underwritten by hospitals. This will impact
post-graduate medical education. No doubt the needs of underserved localities
will be considered on a national basis as a determining factor on the
composition and location of each resident class. As Medicare prescription coverage matures,
demands will be made to extend it universally. The federal government will then
control "Big Pharm" in terms of the price they will pay for drugs,
and assessing costs for drug development that are considered reimbursable. The
impact of drug price controls on medical research is obvious.
In
undergraduate medical education, as medical school tuition becomes less
affordable, the role of the federal government in underwriting student loans
will increase to the point that the awarding of loans to the number and kind of
candidates will be controlled. Some or
all of these changes may take place in the next 5 to 20 years, to a greater or
lesser extent. They portend a
significant loss of autonomy in entities involved in medical education and
health care delivery.
Therefore,
it does not seem prudent to commit state (public) indebtedness for present and
future generations, estimated from $500M to $1BN, for implementation of the
health science center project when broadening government intrusion into health
care may make the function of a health science center irrelevant or
economically not feasible.
Understanding the Use of Health Indicators
In
discussing and justifying medical needs, population statistics using health
care indicators can be cherry-picked to support any particular point of view.
Such is the case when health care indicator data from the National Healthcare
Quality Report for 2004, apparently critical of health care in
The Present Environment for Medical Practice
Our
expanding economy and population should make
The Possibility of Expanding Our Post-graduate Residency Programs
The
procedure for initiating or enlarging residency training programs is formidable
and tightly controlled for graduates of approved allopathic medical schools. An
institutional commitment to a comprehensive educational program, including
resident and faculty salaries and perquisites (including malpractice coverage),
support facilities, administrative assistance, and preferably affiliation with
a medical school are required. Deciding to enlarge, or applying for new
residency positions to meet patient care needs is not sufficient for assuring
approval of a residency program; proof must be shown that they are teaching
programs first and foremost, with patient care needs (which hospitals find most
useful) secondary. Meeting these requirements makes dramatic increases from 194
to 444 (Nevada News,
Obstacles to Increasing Qualified Faculty
Likewise,
the success of the proposal to increase UNSOM physician teaching faculty from
189 to 500 is improbable. First, the pool of qualified candidates is small.
Second, faculty salaries must be competitive. Our full-time clinical faculty is
required to participate in a UNSOM "practice plan" and the proceeds
of the medical practices are given to the medical school. In essence, faculty
members earn a salary so they can be allowed to teach. A significant portion of
the UNSOM budget is derived from practice plan income.
In
the past, qualified candidates for senior faculty positions have withdrawn
because of unsuccessful salary negotiations. If the starting point for a great
Health Sciences Center, indeed the number one priority as stated in the
Larson-Allen report, is the development of a more robust faculty, consideration
has to be given to an innovative salary structure as well as improving the
environment for successful medical practice and research. A medical school
should be a resource to the community, offering academic expertise, guidance
and education in areas not available in the community. Recruiting qualified faculty fairly
compensated can provide this resource. The present structure of faculty
salaries is not compatible with the proffered huge increase in teaching
faculty.
Financial Resources and Partners.
Cleveland
Clinics and the
A Second Opinion for a Cost Effective Approach.
For
the estimated large financial obligation ($500M to $1BN ) this project will
require of Nevadans, a second opinion is mandatory. If the project itself is
found feasible, an effort made to complete it in an alternative, more
cost-effective manner is essential. Leaders at the state and local level must
have the vision, courage and fortitude to anticipate the forces of change
shaping the future of health care delivery, and react responsibly.
Thus
far, at least in the information made available to the public, the details and
the mode of financing this massive project have not been adequately
elucidated. Unless and until this is
done, the taxpaying citizens of
2006 ENDORSEMENT LIST PRIMARY ELECTION
(Early voting starts July 29 -
Election is August 15)
US Congress
District *NEMPAC
*MEDPAC
2 Dean Heller X X
Seat F Cynthia Diane Steel
X X
Seat G
Senate 2 Maggie Carlton (D) X X
Senate 5B Sandra Tiffany (R) X X
Senate 8 Barbara Cegavske (R) X X
Aseembly 7 Morse Arberry (D) X
Assembly 11 Bob McCleary (D) X X
Assembly 14 Ellen Koivisto (D) X
*NemPac is the NSMA’s political action pac and MedPac
is the
Classifieds
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