In response to Mark Hansen's Las Vegas Sun's recent article that Medical Malpractice Tort Reform was a failure at reducing malpractice insurance rates and providing protection for both doctors and patients, according to doctors, patients and lawyers, this is simply not true.

One of the greatest threats to health care providers during the crisis was the excessive number of medical malpractice lawsuits filed. The number of such cases between 2002 and 2005 has been dramatically reduced. If you look at the Clark County District Court Medical Malpractice Filings Against Health Care Providers between the period January 2001 and February 2006, the filings peaked during the crisis in 2003 at 1,246. In 2005 the number of cases filed against health care providers was 581, showing that the passage of Ballot Question 3 dramatically reduced the number of cases filed, making the state less litigious for healthcare providers.

The article states that attorneys are suffering from a lack of lawsuits filed. If you examine 2001, just before the crisis, there were 372 cases filed during that year. If you compare those figures to 2005, after the implementation of the Ballot Question 3, there were 581 cases filed. Attorneys are still filing numerous cases.

Mr. Hansen's article suggests that tort reform did not stabilize insurance rates. Again, this is inaccurate. The fact is that no professional liability insurance (PLI) company has left Clark County since the passage of Ballot Question 3. In 2001 there were 17 PLI insurers; 12 companies left prior to the passage of Ballot Question 3 and only 5 insurers remained insuring physicians in Clark County. Those companies are: Medical Liability Assurance of Nevada (MLAN), Nevada Mutual Insurance Company (NMIC), Physicians Insurance Company of Wisconsin (PIC Wisconsin), The Doctors Company, and Medical Protective Company (MedPro). Since the passage of Ballot Question 3 tort reform, two new PLI insurance companies have begun selling PLI insurance in Nevada, the Premier Physician Insurance Company and the Nevada Doc's Company. So, insurance companies are no longer leaving the state, and new insurance companies are selling insurance in the state.

NMIC has decreased their rates by 2 1/2 %. PIC Wisconsin has lowered their insurance rates. However, it is true that MLAN raised their rates to meet the market levels in order to be competitive. This was the company set up by the governor as a life raft when no other insurance was available. In the by-laws of this company, it was written that this company would never be allowed to undercut the rates of other companies in the state, leading them to increase rates. At this point, it is considered that rates will drop even further once the Question 3 medical tort reform measures hold up against attacks by trial lawyers in the Nevada Supreme Court. Med Pro did increase their rates slightly but insures very few Nevada physicians. The two new insurance companies in the state are currently writing policies below the rates of other carriers, which should drive rates down in general. My own rates almost tripled during the crisis. I was almost put out of business. This year my rate is going down approximately 18%.

In my own experience after practicing for 21 years here in Clark County, the medical tort reform measures passed in Ballot Question 3 have been effective. It has stopped doctors from leaving the state. Please go to the Clark County Medical website to see the County Line newsletter article by Dr. Williamson in the November, 2003 regarding physicians leaving the state during the crisis. Doctors are now looking at Nevada as a viable place to practice and have started coming to our state in unprecedented numbers. For details on the number of doctors entering and exiting our state, call the Nevada Board of Examiners toll-free number 888-890-8210 and ask for their Annual Report which details the number of licensed medical doctors in Nevada.

As an OB/GYN in this state, over the period of the crisis I was unable to solicit any doctors to come to Nevada. Since the passage of medical tort reform, several interested physicians are responding. As the chief of OB/GYN at Sunrise Hospital, during the crisis years, there were many months without any physician applications for new privileges. Today, there are several applicants each month. Most importantly, if medical tort reform had not passed, I would not be here. But, thanks to the voters in Nevada who passed Ballot Question 3 medical tort reform, I am still practicing OB/GYN. It is my honor and joy to take care of thousands of Southern Nevada women and help bring new Nevada babies into the world.

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President’s Message

By Ron Kline, MD, 2005-2006 CCMS President

Time for all of us to pull together: The Status Quo will not hold

After nearly a year of vigorous, albeit informal discussions prompted by Mayor Goodman's proposal to bring the University of Pittsburgh Medical Center (UPMC) to Las Vegas (and the Cleveland Clinic prior to that), discussions regarding a Health Sciences Center (HSC) in southern Nevada are now progressing forward rapidly with definitive actions hopefully just over the horizon.

These discussions have now focused on three groups: the legislature's interim health committees (both Assembly and Senate), the Governor's commission on Medical Education Research and Training (MERT), chaired by Don Snyder and ably staffed by Lisa Serwin, and the Regent's Committee on the HSC, chaired by Regent James Dean Leavitt with its parallel advisory group (which is part of the committee) chaired by me.

MERT is scheduled to issue its report to the Governor in September, and the Regent's committee will have its first meeting in May. MERT's mission is to set broad goals that the State should work towards to meet its healthcare needs. The Regent's committee will undoubtedly review MERT's recommendations, although it is not bound by them, and have the responsibility for implementing its own chosen goals (as long as the entire Board of Regents concurs) by virtue of its governance of the Nevada System of Higher Education, which include UNR (which includes UNSOM), UNLV (which includes the dental school, a nursing school, and various allied health programs), Nevada State College (nursing school) and the Community College of Southern Nevada (CCSN), which include nursing schools and allied health programs.

CCMS members are active in all of these venues. Physician/legislators Assemblyman Joe Hardy and Senator Joe Heck are legislative leaders on this issue and have the respect of their non-physician colleagues in the legislature. They also have close ties and excellent communications with CCMS. Dr. Ed Kingsley (past president of CCMS and NSMA President-elect) has actively participated on the MERT committee, and Dr. Don Havins will join me on the Regent's advisory group. Although the process may seem fragmented, the reality of a small state such as Nevada is that there is considerable overlap between the memberships of these different committees, and that many of us have been continually talking to each other in formal and informal venues for almost a year now.

The Board of Regents has formed this advisory group as part of their committee on the HSC since they understand that although they have clear statutory authority over UNSOM and many of the other educational institutions within the State that would compose an HSC; the initial and continued success of this venture will require the support of all of the stakeholders in this process. These include UNSOM, legislative leaders, community physicians, hospitals, business leaders, and the philanthropic community.

The development of an HSC will require many of us to compromise some of our interests. A stronger medical school with a larger and stronger faculty will undoubtedly compete more effectively with those of us in private practice. An inpatient facility (if it is part of the plan) will undoubtedly compete with the private hospitals in the community. So why should we do that? Why should we compromise our interests? Why not just continue as we have been?

Clearly, the status quo will not hold. Several large hospital corporations have looked closely at expanding into the southern Nevada medical community over the last several years, with the UPMC effort being the most serious. We have made credible arguments over the last year that the Nevada medical community (hospitals included) should be allowed the time to develop its own HSC; that the medical and managerial skills currently exist in our community, or can be easily recruited; and that a local institution will be more likely to reinvest its profits in the community, and have its mission more closely aligned with the healthcare needs of Nevada.

These needs include the expansion of cutting edge clinical care and research, the production of larger numbers of physicians by UNSOM, and the expansion of our current graduate medical education programs, as well as the addition of new programs (82% of residents and fellows stay in the communities in which they train).

The community has given us the opportunity to develop our own HSC, but our time is not endless. UPMC, the Cleveland Clinic, and other entities have not given up on Las Vegas. They are watching us and waiting for us to fail. If we fail, they will be able to make the strong argument that we have been given the opportunity to move our medical community to the next level, failed, and now it is their turn.

Lest you doubt that is the case, ask yourself how many marketing/CME brochures you receive monthly from UCLA, Stanford, UCSD and the like. These large California institutions see a rapidly growing metropolitan area of nearly two million people without a dominant medical center, and sense a tremendous opportunity for expansion. As physicians, an open staff model hospital may not hurt us, but a closed staff model (e.g. Cleveland Clinic, Mayo Clinic) certainly will. Imagine a large medical entity such as UPMC, with its own hospital, physicians and insurance products (which UPMC has) entering Clark County and we can all see why working together is in all of our best interests.

So what are the basic principles that need to guide us?

1. UNSOM (and the new president of UNR, to whom the Dean of UNSOM will report) needs to recognize that 70% of the population of the State resides in Clark County and that its efforts should be distributed accordingly. This does not mean that UNSOM should focus all of its efforts in the South, but that its efforts should be proportionally distributed according to the population. Similarly, the dental school, which is administered by UNLV, should make an effort to establish programs throughout the state (not just in the South) in keeping with its statewide mission.

2. Our medical community (and this includes our hospitals) has expanded tremendously over the last several decades. We have gone from a community that provided basic primary care, to one where nearly every type of tertiary care is available. We have done this on our own, without governmental support, and we should be proud of it! Although we understand and support the need for UNSOM to expand, we would encourage it to expand first in medical specialties that are clearly underserved.

3. Additionally, we encourage UNSOM to work hard to integrate community physicians into their plans for expansion, rather than trying to move us out of the way. A successful example of this is the Children's Heart Center of Nevada, which is a private practice, but has strong ties with UNSOM's Department of Pediatrics, and comprises its Pediatric Cardiology division. Shared governance will be critical if UNSOM is to successfully expand while maintaining the support of the medical community. "Town-Gown" rivalries have compromised the expansion of many medical communities over the years, and we hope that will not be the case here.

We welcome a stronger academic medical presence in the community, as our partner, but not as our master. Because southern Nevada continues its rapid growth and continues to be medically underserved, the expansion of UNSOM and the development of an HSC can be a "win" for all of us, if it's done right. We have now started down that road. Let's roll!

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Clark County District Court Medical Malpractice Filings

Against Health Care Providers, Jan 2001 – March 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

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 26

Nov 38 184 59 78 68

Dec 9 170 67 47 30

Sum 372 823 1246 867 581

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Member News

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

February 2006

· Adam A Arita, MD – Anesthesiology, Las Vegas, NV

· John M Bauldauf, MD - Orthopaedic Surgery, 2800 E Desert Inn Rd #100, Las Vegas, NV 89121

· Vasana Cheanvechai, MD - Vascular Surgery, 501 S Rancho Dr #F38, Las Vegas, NV 89106

· Victor YT Chou, MD - Family Practice, 4880 S Wynn Rd, Las Vegas, NV 89103

· Farida Khan-Sewani, MD - Internal Medicine, Las Vegas, NV

· Xin N Liu, DO – Orthopaedics, 9280 W Sunset Rd #422, Las Vegas, NV 89148

· Sara L Stephenson, DO - OB-Gyn, 98 E Lake Mead #201, Henderson, NV 89015

· James S Tate, MD - General Surgery, 501 S Rancho Dr E-32, Las Vegas, NV 89106

· Lisa K Wong, MD – Radiology, 2020 Palomino Ln #100, Las Vegas, NV 89106

Reinstated Members:

Daniel E Batlan, MD - Pain Management

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

Lesley R Dickson, MD - Psychiatry
Eric S Farbman, MD - Neurology
Nancy M Hsiao, MD - Internal Medicine
Peter A Mansky, MD - Psychiatry
Darren R Swenson, MD - Internal Medicine
Craig T Tingey, MD - Orthopaedics
Dean S Tsai, MD - Internal Medicine
Wilson T Watanabe, MD - Internal Medicine

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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2006-07 Slate for BOT

Clark County Medical Society Candidates

2006-2007 Board of Trustees

and Nominating Committee

Slate of Candidates

President-elect (vote for one)

Weldon (Don) Havins, MD, JD

Secretary (vote for one)

Jerry Jones, MD

Treasurer (vote for one)

David Steinberg, MD

Delegate Chair

(vote for one)

Annette Teijeiro, MD

Trustees (vote for five)

Howard Baron, MD

Keith Brill, MD

Mark Doubrava, MD

J. Parker Kurlinski, MD

Donald Mohs, MD

LeRoy Bernstein, MD

Nominating Committee (vote for four)

Frank Nemec, MD

Ronald Slaughter, MD

Carol Van der harten, MD

Michael Verni, MD

Nominating Committee Members

Appointed per the CCMS Bylaws

Ron Kline, MD

Michael Colletti, MD

Warren Evins, MD

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Mini-Internship Program Scheduled for May 22-25

Dear CCMS Members,

The Community Relations Committee of the Clark County Medical Society invites you to participate in our upcoming Mini-Internship Program, scheduled for May 22nd thru May 25th. This annual event is held to give non-physicians a chance to observe the practice of medicine for a day in the company of a practicing doctor in his/her daily medical routine.

Our goal is to offer insight into the professional life of physicians. We hope to facilitate lines of communication and expand perspectives on health care issues between the medical community and community leaders. The people we have invited over the years as interns include elected government officials, judges, educators, media representatives, and consumer advocacy groups - all designed to provide an exchange leading to better understanding of medical care in Southern Nevada.

Interns will accompany a doctor on his/her rounds, office care, surgery, emergency care, in fact anything in the daily routine of the doctor. Nothing will be set up and the intern will be encouraged to ask questions and discuss concerns throughout your mini-internship day. You will participate in our dinner, held the evening of Thursday, May 25th at a local restaurant to discuss the experience and share perspectives on health care delivery between physicians and our mini-interns.

Interns will be given a choice of specialties of the physicians whom they wish to observe. We make every effort to accommodate all interested physicians, but please be advised that not all volunteers may be assigned interns during this session. By indicating your interest in the CCMS Mini-Internship Program, you provide us with support and motivation for this program to grow.

Former participants are available to further discuss the program with you and answer any questions you may have. We eagerly anticipate your participation in this program.

Please respond at your earliest convenience to Dot Freel at the Medical Society to sign up for this program, 739-9989, and indicate if there are days when you routinely schedule surgery or surgical procedures.

Sincerely yours,

Florence Jameson, M.D.

President-Elect, Clark County Medical Society

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Southern Nevada Health District Report

By Donald Kwalick, MD, MPH, Chief Health Officer

Methicillin Resistant Staphylococcal Aureus Report

Health district personnel from the office of epidemiology worked with a local health care facility to study the prevalence of MRSA infections. A synopsis of the study is included below and the results emphasize the need for ongoing infection control practices to prevent and control MRSA in health care settings. The growing prevalence of MRSA is an ongoing concern of the health district and we will continue to conduct epidemiologic assessments of outbreaks in order to provide updated information to the health care community.

The Increasing Burden of Methicillin Resistant Staphylococcus Aureus Skin and Soft Tissue Infections in the Era of Community-Acquired MRSA

By Mu Mu Tha, MBBS, MPH, Sheniz Moonie, PhD, Alan Greenberg, MD, Judith Hollett, RN, BS, MS

Introduction: Community-acquired methicillin resistant Staphylococcal aureus (CA-MRSA) was first described in the US in the 1990's, and now accounts for a significant percentage of community skin and soft tissue infection (SSTI) isolates in some geographic locations. In affected areas there is concern about spread to healthcare-associated venues. The effect of CA-MRSA in Las Vegas on the burden of SSTIs was examined at a major municipal hospital. Analyses were done to ascertain if there were epidemiologic or clinical features that may enable differentiation between SSTIs caused by MRSA and Methicillin-sensitive Staphylococcus aureus (MSSA).

Methods: Microbiology culture and sensitivity results for staphylococcal isolates from all culture sites obtained between 03/01/2005 and 12/31/2005 were reviewed. Specimens were processed in the microbiology lab using standard clinical laboratory methodology for identification and sensitivity testing. A case-control study was performed using a convenience sample of available medical records of patients (ages 15 days -76 years) who were either seen in the Emergency Department or admitted to an urban municipal hospital in Las Vegas during the period 03/01/05 to 10/30/05 with SSTIs. Cases had SSTIs with laboratory-confirmed MRSA obtained by relevant specimen culture, and o extracted from medical records using a pre-designed data acquisition form. Since the chart review did not always allow unequivocal distinction between community-acquired community-onset, and healthcare-acquired community-onset infections, data for both categories were combined for this study. Odds ratios with 95% confidence intervals were determined, and chi-square analysis was used to compare group differences.

Forty percent of Staphylococcus aureus (SA) isolates were obtained from SSTI sites, representing the single largest source of SA isolates at this institution. SA isolates from SSTIs had a significantly higher frequency of MRSA than isolates from other specimen sites (p<0.01) (Table 1). One hundred eighteen patients presented with SSTIs from MRSA compared to 70 patients with MSSA. Patients with MRSA SSTIs were younger, presented earlier to the hospital after symptom onset, were more likely to report an insect or spider bite at the onset of the infection, and had a higher frequency of intravenous drug use (IVDU) than patients with MSSA SSTIs (Table 2). MSSA SSTIs were seen more frequently in patients with diabetes and surgical wound infections.

Conclusion: This single hospital-based study demonstrated that SSTI specimens were the most common source of SA isolates and that SSTI specimens had a higher frequency of MRSA compared to specimens from non SSTI sites. This likely reflects a high prevalence of CA-MRSA as a cause of SSTIs in the community. Patients with MRSA SSTIs had demographic and clinical features including younger age, earlier presentation from symptom onset, report of a "bite", and a higher frequency of IVDU than patients with MSSA SSTIs. MSSA SSTIs were seen more frequently in patients with diabetes and surgical wound infections possibly because these patients were older and had chronic staphylococcal skin and mucosal colonization, a known precursor of staphylococcal infection of long standing duration with onset prior to the era of CA-MRSA. If staphylococcal infections originate from chronic or newly acquired skin and/or mucus membrane colonization, it would be expected to observe a progressive increase over time in the rate of MRSA isolates from non-SSTI sites. The high overall rate of MRSA in SSTIs, suggests that initial antibiotic therapy should be directed against MRSA until sensitivity information is available. At present, community-onset MRSA SSTIs represent a significant burden of treatment in this institution, and possibly herald a higher frequency of MRSA infections at all sites.

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Arrangements with DME Vendors, Are You Asking for Trouble?

By Kelly Testolin, Attorney at Law, Hale Lane

Some durable medical equipment (DME) vendors propose arrangements to physicians which allow the physician to offer (and bill for) DME provided in the physician's office. Under these arrangements, the DME vendor supplies the involved DME inventory, the technicians and even a coding and billing service to process the patient's charges under the physician's billing number. There is little risk or effort involved for the physician in return for a new revenue source. In some instances, the physician's new in-office DME service is limited to private-pay (e.g., non-Medicare) patients to avoid risks associated with the federal anti-kickback law.

This looks like a good deal. Unfortunately, the federal government views these arrangements as violations of the federal anti-kickback law; --- even when they are limited to private pay patients. This point was driven home in a recent Advisory Opinion issued by the Office of Inspector General ("OIG") of the federal Department of Health and Human Services.

Advisory Opinion 06-02 considered whether two different types of arrangements offered by a DME manufacturer/supplier ("the DME Company") to physician practices would violate the anti-kickback law. Under arrangement No. 1, the physician's practice would become a DME supplier for private-pay patients only. The arrangement consisted of four interrelated transactions.

1. The DME Company would sell DME to the practice pursuant to a fee schedule. These sales would be structured to comply with the requirements of the anti-kickback law's discount safe harbor. The practice, in turn, would sell the DME to private pay patients.

2. The DME Company would lease Continuous Passive Motion (CPM) devices to the practice on an as-needed basis at fair market value rates. The practice, in turn, would lease the CPM devices to private pay patients.

3. The DME Company would contract to provide the practice with trained technicians to fit patients with DME items, manage product inventory, and provide related services. This was done under a contract that met the requirements of the anti-kickback laws' "personal services arrangement" safe harbor.

4. The DME Company would contract to provide the physician practice with comprehensive coding, billing, and collection services for the DME for a fixed monthly fee. This contract would also comply with the requirements of the anti-kickback law's "personal services arrangements" safe harbor.

The OIG viewed this arrangement as a likely violation of the anti-kickback law despite the fact that it was limited to private-pay patients. The OIG believes that in arrangements like this, the DME vendor offers the arrangement to the physician for his or her private pay patients in order to induce the physician to refer his Medicare patients to the DME vendor. Thus, they say, the whole arrangement is offered as a kick-back for the physician's referrals of federally-reimbursed patients to the DME vendor. Nor was the OIG deterred by the fact that most of the component transactions of the arrangement complied with anti-kickback law "safe harbors". The OIG stated its belief that even if the component parts of a joint venture arrangement satisfy applicable safe harbors, there may be a residual profit stream arising from the contractual joint venture as a whole that remains unprotected and could be prosecuted as a anti-kickback law violation.

The Advisory Opinion also considered an alternative arrangement where the DME Company would rent storage space from the practice for DME products and pay the physician a flat monthly rental fee. The lease would comply with the requirements of the space rental safe harbor. In addition, the DME Company would provide a technician on an as-needed basis to fit patients with DME items, manage product inventory, and provide related services. The practice would pay the DME Company a flat monthly fee for these services. The arrangement would also comply with the requirements of the personal services safe harbor. Last, the physician's practice would furnish inventory management and other administrative services to the DME Company. In return, the DME Company would pay the physician a percentage of the revenues derived from sales of the DME Company's products to the practice's private-pay patients. The OIG concluded that this arrangement was also a likely violation of the anti-kickback law despite the fact that it was limited to private-pay patients.

The fact is that the federal government is simply takes a hostile view of these arrangements. Physicians who get involved may be able to successfully defend themselves against anti-kickback charges, but who wants that kind of "victory". If you are approached by a vendor with a similar type of proposal, caution is advised.

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Alliance Message

By Shanila Choudhury, 2005-06 CCMS Alliance President

The CCMSA is proud to end its year surpassing all goals. The 5th Annual "Think Pink" Fashion Luncheon held in the Augustus ballroom at Caesars Palace on March 14, 2006 to raise money for the Susan G. Komen Breast Cancer Foundation was a huge success. We had a record number of attendees totaling over 400 alliance members and guests and raised $50,000, which is the most the CCMSA has ever raised. The event was emceed by Channel 8 KLAS-TV anchor Paula Francis who generously committed her time to us, along with our featured entertainer Clint Holmes, who is a survivor of cancer himself. I would like to thank Maritza Rayls for her help. The Fashions were provided by Nordstrom along with gift bags for our guests.

This was a huge undertaking by my board members, whose dedication and commitment I very much appreciate. The Head Chairperson for the Fashion Show was Cheryl Samlaska. She shared a vision with me from the beginning and despite being pregnant, worked tirelessly with me to make it the most elegant affair we have ever had. Dr. Julie Leon coordinated the Silent Auction. She accepted this job, which was one of the most demanding areas we had. Our Silent Auction committee, a group of CCMSA members, worked hard to acquire 93 very unique items which helped raise a record amount of $36,000 for the charity. We accepted credit cards for the first time, thanks to the help of President-elect Pauline Lee. I want to thank the treasurers Tammy Johnson and Pam Tolan for their hard work in keeping track of everything.

For the first time we made a program book which helped with all of the expenses. I would like to thank Southern Hills Hospital and Annette Kinsman who helped underwrite this event and supported us from the onset in many ways. With the help of Estela Hansen and Andrea Yu we raised near $8,000. The décor was elegant and the "Think Pink" theme came alive because of the help of Christina Duke and Heather Gerson. The ballroom and silent auction room was decorated with elegant sprays of cherry blossoms and accented by pink tulle, and flowers were everywhere. I would like to thank all of our donors for their generous contributions that made this event a huge success. We could not have done it without your continued support.

We are proud to be presenting a check to the Susan G. Komen Foundation at MJ Christensen on May 19, 2006 at a Ladies Night Out event from 5:30 to 6:30 pm dedicated to the CCMSA members. Please join us for Hors d'oeuvres and drinks hosted by Mayor Oscar Goodman.

Join us the next CCMSA luncheon, which will be at Marche Bacchus Bistro in Desert Shores on April 18, 2006 at 11:30 am and will be wine tasting. We will be presenting eleven Nursing Awards for the selected candidates as well as electing the slate of officers for next year's board. Please RSVP to myself, Shanila Choudhury at 355-2019 if you wish to attend. I would like to thank you all for your support this year. I am thankful to have a board of enthusiastic and dedicated women who I am happy to have gotten to know. I want to thank the Clark County Medical Society Staff for its help all year.

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PLEASE SAVE THE DATE FOR THE CLARK COUNTY MEDICAL SOCIETY 2006 INSTALLATION DINNER AND AWARDS CEREMONY

Honoring Incoming President Dr. Florence Jameson

And presentation of the "Harold Lee Feikes Memorial Physician of the Year" Award

Saturday, June 24, 2006 at the Las Vegas Country Club

Six O'clock Registration and Cocktail Hour Seven O'clock Dinner and Awards Ceremony

Cocktail Attire

Invitations to Arrive in May

For more information, please call 739-9989

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Board of Trustees Meeting Minutes Synopsis

Tuesday, March 21, 2006; 6:00 P.M.

The minutes from the February meeting were approved unanimously.

Financial Report

Revenue was $347,146.99 which was up about $16,000 from last year. Expenses were $198,694.50 which was down almost $17,000. The bank account balance at the end of last month was $421,699.56, which was about $120,000 more than this time last year.

Membership Report

Dr. Doubrava reported there were 682 dues paid members, a decrease from the 718 paid members last year at this time. Currently, there are a total of 831 members, which includes the dues exempt members and student members. Dr. Amir Nasseri was granted "Inactive Status" for a year.

Nevada AMC Report

Dr. Kingsley stated that Greg Hart, on behalf of UNSOM, presented a phase-one proposal for creating a Nevada AMC to the Board of Regents. Dr. Kingsley has been participating in the Governor's Commission and CCMS will continue being represented. Dr. Havins added that Dr. Lenhart presented a plan, with similar data, a few years ago. Dr. Lenhart thanked CCMS for embracing the idea and he apologized for the length of time it took to present this new plan. Dr. Lenhart stated the proposal fundamentally embraces the two major universities, UNR and UNLV, and BOR have a clear understanding that the plan must include others, in order to be successful. UNSOM will double the class size to 96 over the next decade, increase residency programs and increase faculty.

Touro University Report

Dr. Forman thanked Dr. Lenhart for keeping Touro informed and for all of the work Dr. Lenhart has done on the AMC issue. Dr. Forman stated he looks forward to continuing the working relationship which has been established with UNSOM.

Allscripts Report

Dr. John Ellerton reported that his Allscripts program was working but there were still issues unrelated to Allscripts. One was that all prescriptions are faxed since the State Board of Pharmacy is still struggling with electronic filing. Dr. Ellerton feels it is difficult to look up pharmacies. He does feel it's easy to write prescriptions in the program. Dr. Ellerton's next step will be to use a PDA to write prescriptions and he will update the Board on the progress of that later. Dr. Havins stated he told Allscripts that CCMS was ready to assist with their marketing efforts.

Delegation to the Annual Meeting

Dr. Nelson stated there were not many resolutions by CCMS or by WCMS. She reminded the delegates they could still bring up issues at the meeting, and to register if they had not yet done so.

MedPac

There were 95 MedPac contributors. MedPac has a bank balance of $27,861. Judge Michael Cherry was endorsed and MedPac contributed $2,500 to his campaign for the Supreme Court Justice open seat. Judge Diane Steele was interviewed. She has recently formally announced that she is running for the Supreme Court. Four were appointed to the MedPac Board: Ron Kline, David Steinberg, Florence Jameson, and Marietta Nelson.

Mini-Internship

Dot Freel reported the Mini-Internship program has been scheduled for May 22-25.

Health District Report

Dr. Kwalick was unable to attend but provided a written report to the Board on current Health District concerns.

UNSOM

Dr. Lenhart stated they had great student matches in the resident matching program, and all residency programs filled in the match.

Scholarship Report

Dr. Ellerton stated he delayed the Scholarship Fund Board meeting in order to get more details on how to deal with the contracts from the University system.

NSMA Report

NSMA President, Dr. Warren Evins, stated CCMS will need to nominate a new person to be Secretary of NSMA. Nominations will be needed for both the AMA Delegate and the AMA Alternate Delegates.

AMA Report

Dr. Horne reported the next AMA meeting will be June 10. Any AMA member wishing to submit a resolution should contact Dr. Horne.

NBME Report

Dr. Rodriguez stated the NBME Board recently met. At that meeting it was determined that if a license was suspended for non-payment of fees, in order to change the license status, such as to inactive status, the fees would have to be paid prior to a change. Dr. Havins stated the BME asked NSMA to consider passing a resolution saying that NSMA members adopt a code of ethics endorsed by the NBME. The BME Board also discussed regulating the use of lasers as the practice of medicine. Further information was needed prior to making a decision on that issue.

President's Report

The May meeting will be held at the Sunrise Pediatric Hospital. Dr. Kline presented a letter from the Community Bank of Nevada detailing their offer being presented for CCMS members. The Bush administration is very concerned about the Nevada marijuana initiative and asked that the CCMS oppose the initiative. No decision was made. Dr. Kline stated the question has come up about whether or not CCMS should have new headquarters. A commercial real estate representative estimated the property to be valued at $800,000. It was agreed more information was needed and Dr. Steinberg offered to present some options at the next meeting for discussion.

New Business

Dr. Kline stated a female member suggested CCMS lapel pins be offered. A patient of Dr. Kline’s designed three different formats. A 4-color blue background was selected. Staff was directed to obtain 3 quotes on the cost of producing the pins.

After discussion, the Board decided not to go forward with the CCMS website refurbish idea.

Dr. Havins relayed Dr. Peter Mansky's request that CCMS support the Nevada Health Professionals Assistance Foundation (NHPAF) in their attempt to make a change in legislation that would provide some liability protection for their actions conducted in good faith. They have limited funds and have four lawsuits pending, which they need to defend. It was decided that CCMS support the NHPAF in their attempt to obtain legal liability protection.

Dr. Colletti requested the Board discuss, at the next meeting, the issue of nurses who teach being required to have a Masters degree. Dr. Colletti feels a Bachelor's degree would be sufficient for teaching with the critical nursing shortage. Dr. Colletti stated the SNMIC Nursing Committee will meet in April and he will attempt to bring more information to discuss this issue at the next CCMS Board meeting.

Future Meetings

The next BOT meeting will be on Tuesday, April 18, 2006.

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Classifieds

family practice physician seeks:

specialist to sublease large, brand new medical space. 1612.5 sqft available. X-Ray room, exam rooms, lab, office, staff lounge, storage, waiting room available. Great location. Close to hospitals. Call Yvonne Saunders, MD at 256-4646.

highest % reimbursement, increase your profits. Don’t gamble with your income. We’re the best choice for your medical billing needs. 10+ years experience. Electronic claims submission. The Billing Office, LLC: accurate, fast, lowest price. Call Diane at 702-992-0890.

Time Share Available: Excellent time-share opportunity with multi-specialty group in the new Southwest I-215 corridor or established Seven Hills location. Private entrance with reception seating and upgraded interior. For information, please contact Judy Duncan, Nevada Eye & Ear, 492-6928 or

jduncan@nveyepa.com

silver state medical billing:

The physicians take care of the patients...

We take care of the physicians...

Silver State Medical Billing is a premier full service medical billing firm. We specialize in providing

medical billing and coding solutions to physicians and groups. Kim\Mikel (702) 598-3829.

Physician wanted: Physician willing to learn hair transplantation by taking short course training. Part-time leading to full-time. Great opportunity to provide an elective service to very appreciative patients, receive excellent compensation and develop majority equity interest in practice. Low stress, very low malpractice liability. Call 839-2074.

for sale: Lucrative solo pediatrics practice, 20 years old, in 2 locations near major Las Vegas hospitals. Many newborns and new patients. Cash flow excellent. Only serious buyers need call 458-3558 in early a.m. or after 7 p.m. or leave message.

physician licensed in nevada wanted: part time, competitive salary, Las Vegas area. Fax resume: 813-871-3170

medical office for lease: 1000 South Valley View at corner of W. Charleston. Former UMC Quick Care. 6400 sq feet. Lease rate $1.65sqft + NNN. Contact David Christensen at 702-528-3122.

Office space available: Desert Professional Plaza, 2225 E Flamingo Rd, 2 suites available - 1,200sqft and 1,100 sqft can be combined for 2,300sqft. Completely built out - call 221-7000 for more information.

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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

Southern Nevada AHEC 318-8452

5-11-2006 - “Management of Erectile Dysfunction”

6-8-2006 - “Evaluation and Management of Anemia”

Southwest Medical Associates 242-7735

Summerlin Hospital 233-7572

Sunrise Hospital 731-8210

5-5-06, 12:15-1:15pm - “Primary Care: Cultural Diversity 1 ethics credit

5-26-06, 12:15-1:15pm - “Primary Care: Pain Management” 1 ethics credit

5-30-06, “Pain Management” 1 ethics credit RSVP Required

UMC 383-2604

Valley Hospital 388-4847

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

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Southern Nevada Health District Disease Statistics* - March 2006

SOUTHERN NEVADA HEALTH DISTRICT

DISEASE STATISTICS* - March 2006

DISEASE CASES REPORTED YEAR TO DATE

Mar 2005 Mar 2006 2005 2006

VACCINE PREVENTABLE DISEASES

DIPTHERIA 0 0 0 0

HAEMOPHILUS INFLUENZA . 0 7 6

HEPATITIS A . 0 . .

HEPATITIS B . . 6 9

INFLUENZA 17 16 101 117

MEASLES 0 0 0 0

MUMPS 0 0 0 0

PERTUSSIS 8 . 11 8

POLIOMYELITIS 0 0 0 0

RUBELLA 0 0 0 0

TETANUS 0 0 0 0

SEXUALLY TRANSMITTED DISEASES

AIDS 17 16 70 46

CHLAMYDIA 487 473 1378 1387

GONORRHEA 192 167 616 554

HIV 43 30 96 69

SYPHILIS (Early Latent) 7 . 7 17

SYPHILIS (Primary & Secondary) 14 5 22 24

ENTERICS

AMEBIASIS . 0 . .

BOTULISM-INTESTINAL 0 0 0 0

CAMPYLOBACTERIOSIS . . 21 16

CHOLERA 0 0 0 0

CRYPTOSPORIDIOSIS . 0 . .

E. COLI O157:H7 0 0 0 0

GIARDIA 6 * 12 8

ROTAVIRUS 42 86 177 367

SALMONELLOSIS 11 . 27 22

SHIGELLOSIS 6 . 6 5

TYPHOID FEVER 0 0 0 0

VIBRIO 0 0 0 0

YERSINIOSIS 0 0 0 1.

OTHER

ANTHRAX 0 0 0 0

BOTULISM INTOXICATION 0 0 0 0

BRUCELLOSIS 0 0 0 0

COCCIDIOIDOMYCOSIS 5 5 20 15

ENCEPHALITIS 0 0 . 0

HANTAVIRUS 0 0 0 0

HEMOLYTIC UREMIC (HUS) 0 0 0 0

HEPATITIS C 0 0 0 0

HEPATITIS D 0 0 0

Contents

President-elect responds to Las Vegas Sun article