Newsletter 82 November 06
Contents
Malpractice Filings Against
Health Care Providers, Jan 2001 – Sep 2006
Not
Guilty by Reason of Insanity in Nevada
Southern Nevada Health Officer Report
Diversity - What This Country is All About
PRESIDENT’S MESSAGE
By
Calling Any Doctor
I'm standing in Labor & Delivery at the nursing station. There is an overhead page: "Calling any obstetrician to the OR now!" I race back to offer my assistance, not knowing what I will find. I step into the OR and inquire: "What is going on?" A Caesarean Section is in process, help is needed to get the baby out. I suit up and jump in. Since the case is now in litigation I will not go into any detail. I help out and the baby is quickly delivered. I was happy to help and went on my way to do my regular duties, rounding, etc. I reflected to myself that it is all just part of our job to help our fellow physicians in times of need. The reason I love working in medicine is because I get to work with people, physicians, who are dedicated to helping others.
A couple of years later during the holiday season, as I returned from a much needed vacation, I found out from an acquaintance that I had been named in a lawsuit related to the above case. I never received anything in the mail or via currier. They asked, "Did you know you are being sued?" Emotionally distraught, I replied, "no." I went to work on obtaining a copy of the lawsuit and informing my insurance agent.
My insurance company assigned me a lawyer. My lawyer said that I should not worry, that I was acting as a "Good Samaritan" and did nothing wrong. He told me: "It will be okay." So now, at least a couple of years later, I wait to go to court to defend myself against the accusation of a plaintiff's prostitute expert witness. I wonder, for helping to save this baby's life, what will the price be? Will my insurance take a hike? Will my premiums go up too high to afford this year? At $100,000 plus for insurance I now barely make it. Some of my peers are paying much more. I wonder if this is the end of my career. I hope not. I continue to be positive that truth will win out over the expert witness' false accusations and the lawyers' greed. But, as any of you know who have been through a lawsuit, even when you win, you lose. It discourages even the strongest from going on. Yet, we must go on. We must continue to serve. Some say they will no longer help out in emergencies. They can't afford the liability. What a crazy world it has become! Whoever thought we'd think twice about helping someone because of a lawsuit that will end our career? Whoever thought it would come to this?
Some people no longer walk through Labor & Delivery, just to stay out of harm's reach. Despite the warnings, most doctors who find themselves present in Labor and Delivery, will still respond to a cry for help. As the lyrics of the song, The Impossible Dream say, "I will rush into hell for a heavenly cause." And I will continue to do my best and to do what is right. As a medical student we had our innocence and our dreams. Now we are all too educated as to the evil forces in life. Our dream of practicing medicine for many of us, family practitioners, pediatricians, and OBs has almost become an impossible dream. However, we must not lose our dream, dreams take hard work. To keep alive we must work now. We must defend Question 3.
The above case was filed before Question 3 passed. Many more lawsuits were filed before Question 3, and a great deal of those are frivolous suits. Since Question 3 passed we have seen a dramatic reduction in the number of lawsuits filed. We cannot lose Question 3 and go back to the days of practicing medicine before it passed. I know for sure that I will have to close my office if we lose Question 3.
In medicine we say, "An ounce of prevention is worth a pound of cure." If we get the right Supreme Court Justices elected we will go a long way to keeping Question 3 in place. We must get our candidates, Cynthia “Dianne” Steel and Nancy Saitta, into the Supreme Court. It is unbelievable that last week there were a few prominent physicians opposing Steel and Saitta; instead they were supporting Douglas and Becker. Let us not forget that Michael Douglas and Nancy Becker are the individuals who signed to have Question 3 removed from the public ballot. If we are not diligent, we may lose the precious rights that we gained in that election.
In a poll published September 27th, 25% supported Michael
Douglas, 21% were for Dianne Steel , and 48% were undecided. We need to reach this 48%, as well as the 25%
of voters who are already committed to Michael Douglas. We need to educate them. For access to health, to maintain Question 3,
and keep doctors in
That same poll put Nancy Becker at 26% and Nancy Saitta at 13%, with 55% undecided. This is a tough race. We must work hard!! We must pick up the phone, call CCMS (739-9989), call me (262-9682), the Steel Campaign office (393-4337), or the Saitta campaign office (382-0533).
Get posters, banners, brochures, and buttons. Send out messages with your bills, send emails. Get creative. Your request with a warm handshake and a flyer at the door will speak volumes louder than any ad on the TV. Your posters of who you support in front of your office or at the counter will be remembered at the polls. Put up posters for Cynthia Steel and Nancy Saitta, side by side.
We are all so very busy. But, we must find the time to do this now. If we fail to take action in this election, it will be too late. There is no second chance! Tell your family, staff, patients and friends to vote, and inform them of the importance of voting for our candidates. Don't leave the house or office without a stack of flyers to put out. Send voter information out with your bills. Our livelihoods and the health care of valley residents depend upon the action we take now!
In the next 5 to 10 years, medicine could make a wonderful
transformation in
With the passage of Question 3, doctors stopped leaving
On September 30th, Chancellor Jim Rogers allowed himself to
be roasted at the first fund raiser for our
I believe that I will be able to continue to practice
obstetrics in
Let us joyfully meet the challenges that lie ahead for us. Let us go shoulder to shoulder to share the burden of this project together. Together we are stronger. Together we can get Cynthia Steel and Nancy Saitta elected, as well as our other candidates.
Calling all doctors!
Calling all doctors! Pick up your
stethoscope and listen to the breath and heartbeat of medicine in
Your Doctor
Urges You to Vote in November
For Candidates who have vowed to assist Access to
Medical Care and
Keep the KODIN Initiative Question #3 unchanged
Your support is Critical in this Election Year
Governor: Jim Gibbons
NV Supreme Court: Michael Cherry, Cynthia “Diane” Steele, and
Nancy Saitta
Attorney General: Catherine Cortez Masto
Senate: Sandra Tiffany, District
5
Barbara Cegavske, District 8
Dennis Nolan, District 9
Warren Hardy, District 12
Assembly:
Linda West Meyers, District 1
Garn Mabey, MD, District 2
Francis Allen, District 4
Valerie Weber, District 5
Joe Hardy, MD, District 20
Brian Keane, District 21
Lynn Stewart, District 22
Steve Grierson, District 23
Michael Smith, District 29
District Court: Timothy
Williams, District Court 16
Susan Johnson, District Court 22
Bill Henderson, District Court 23
Initiative #5: Vote YES
Initiative #4: Vote NO
Stay alive, vote yes on 5
Shut the door, vote no on 4
Endorsed by the Clark County Medical Society’s
political action committee, MedPac
Clark County District Court Medical Malpractice Filings
Against Health Care Providers, Jan 2001 – Sep 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 82
Sep 20 65 105 79 36 51
Oct 37 83 110 59 26
Nov 38 184 59 78 68
Sum
372 823
1246 867 581
Member News
Congratulations
and Welcome to the
October 2006
Harry W Donias, MD - Cardiothoracic
Surgery,
- Michael D Gouvion, MD - Diagnostic Radiology, 2020 Palomino Ln, 100, Las Vegas, NV 89109
- Margaret A Terhar, MD - General Surgery, 3006 S Maryland Pkwy 250, Las Vegas, NV 89109
Applicants to Go Before Credentialing Committee
If you have any pertinent information about the following membership candidates, please contact:
- Aaron J Goodrum, MD - Radiology
- Ashok K Gupta, MD - Radiology
- David S Lin, MD - Diagnostic
Radiology
- Sikisam A Magoyag,
MD- Internal Medicine
- Sanket L Patel, MD - Internal Medicine
- Alan J Sacks, MD - OB-Gyn
- Ronald A Shockley, MD - Infectious
Disease
For information on becoming a member of the
Not Guilty by Reason of Insanity in Nevada
By Melissa Piasecki,
M.D. Associate Professor, and Steve Zuchowski, M.D.
Assistant Professor, University of Nevada School of Medicine, Department of
Psychiatry (Reprinted by permission of the State Bar of Nevada.)
The question of criminal
responsibility in mentally ill defendants is one of the highest-profile topics
in forensic psychiatry. Perhaps no recent
case has generated more controversy than that of Andrea Yates, the
There is a wide variation among the
states in relation to how mental illness influences criminal
responsibility. Some states (
In 1996, Finger, who had a history of schizophrenia - a chronic mental illness often characterized by delusions (fixed, false beliefs) and hallucinations (false sensory perceptions) - killed his mother with a knife. In spite of limited statutory options, Mr. Finger initially pled NGRI and then refused to enter another plea when his NGRI plea was rejected. Ultimately, he pled guilty but mentally ill, planning to raise the constitutional issues on appeal. He was sentenced to a prison term. His appeal to the Nevada Supreme Court resulted in a ruling that stated, "To be legally insane, a defendant must be in a delusional state such that he cannot know or understand the nature and capacity of his act, or he cannot appreciate the wrongfulness of his act, that is, that the act is not authorized by law." (Finger v. State 2001).
The Court elaborated that the NGRI defense would apply only in very specific circumstances. One application would be if a delusional person was so cognitively disturbed that he did not know or understand the nature of what he was doing. For example, if a man, due to a delusional belief that he was shooting someone with a water pistol rather than a real gun, committed a killing, he would be eligible for an NGRI defense. Also, if a defendant's actions are based on delusions, which if true would be justifiable (i.e. he could not appreciate the wrongfulness), he would be eligible for the NGRI defense. For example, if a defendant held the delusional belief that his neighbor was shooting at him with a gun, the defendant, finding no alternative except for shooting back in misperceived self-defense, would qualify for the NGRI defense.
Many people confuse the concepts of competence to stand trial and criminal responsibility. Competence to stand trial is a present-state evaluation based on the Dusky standard (Dusky v. U.S. 1960). That is, can the defendant consult with a lawyer with rational understanding and does he have a rational and factual understanding of the proceedings? A criminal responsibility evaluation is a retrospective assessment of a defendant's mental state at the time of the alleged crime.
Key elements to the psychiatric evaluation of criminal responsibility are the presence of a mental illness at the time of the event and the role of the mental illness in determining the person's actions. In order to determine presence of mental illness, the forensic psychiatrist looks for past evidence of mental illness (as found in treatment records) and for evidence of disturbed thinking and behavior in the records from the time of the event, such as police reports and contemporaneous statements given by the defendant, the victim, and witnesses. Because an examination for criminal responsibility often occurs months or even years following the event, the mental state of the defendant at the time of the evaluation may not be critical in the evaluation of criminal responsibility. A defendant may develop symptoms of mental illness after the criminal act (e.g. triggered by the stress of incarceration) which likely has no bearing on his criminal responsibility.
In order to retrospectively determine the role of mental illness in the person's actions, the forensic psychiatrist again turns to past records. This is, in part, because many defendants no longer have clear recall of their thoughts and motivations at the time of the event. Defendants may also deliberately seek to deceive the examiner by retrospectively claiming false symptoms. A record review is central to sorting these issues out. Evidence of avoiding detection, evasion, and covering-up actions suggests that the person knew the wrongfulness of his actions.
A third important element in the
forensic evaluation of criminal responsibility is determining whether or not
the defendant was intoxicated by drugs or alcohol at the time of the
event. This is of critical importance
because
If a defendant is acquitted NGRI in
Nevada, he is committed to a forensic hospital (Lakes Crossing Center in
Sparks) for an evaluation to determine whether or not he continues to be a
"mentally ill person" as defined in NRS 433A.115. A hearing immediately follows and if the
person meets the statutory definition of being a mentally ill person, the Court
may recommit him with periodic reviews.
If mental illness symptoms remit or resolve to such an extent that he is
no longer dangerous to self or others, the Court may order his release. Unlike many states with NGRI provisions in
the law,
Southern Nevada Health District Report
By Donald S. Kwalick,
MD,
This year
it is expected there will be more than 100 million doses of influenza vaccine
available for distribution in the
Delayed production and shortages have posed challenges during the past few flu seasons. Now, with more than adequate supplies of vaccine, our new challenge is to encourage more people to make "getting-a-flu-shot" a part of their fall routine.
To this end, the Southern Nevada Health District is partnering with Carson City Health and Human Services and the Washoe County District Health Department to launch the "Fight the Flu" campaign throughout the state.
The campaign is funded with pandemic flu grant money and will serve to encourage the public to prepare for seasonal flu as well as educate them regarding a possible flu pandemic.
The campaign theme is designed to "rally people around resistance." It encourages the public to:
LAUNCH AN OFFENSIVE TO KEEP YOURSELF AND YOUR FAMILY FLU FREE. HERE'S HOW:
DO YOUR SEASONAL FLU DUTY!
GET YOURSELF AND YOUR FAMILY VACCINATED. ESPECIALLY THOSE AT HIGH RISK: Children ages 6 months to five years
· Household contacts and caregivers of infants under six months of age
· Pregnant women
· People over age 50
· People with certain chronic medical conditions, their household contacts and caregivers
TAKE THESE MEASURES TO PREVENT SPREADING ILLNESS:
· Wash your hands often with soap and warm water for at least 30 seconds
· Avoid touching your eyes, nose and mouth - they are entry points for germs
· Cough and sneeze into your sleeve, or use a tissue and dispose of properly
· Eat right, drink plenty of fluids and get enough sleep
PLAN A SICK OUT
IF YOU HAVE FLU-LIKE SYMPTOMS LIKE BODY ACHES, FEVER AND COUGH:
· Stay home to prevent spreading illness
· Get plenty of rest and drink lots of fluids
· See your doctor if you are concerned about your illness, especially if you are at high risk for complications from the flu
· Know that antibiotics are not effective against the flu
THE REAL ENEMY IS A FLU PANDEMIC -
BE PREPARED TO COMBAT ILLNESS. KNOW THE FACTS:
· A flu pandemic occurs with the emergence of a new flu virus
· There is no vaccine and it can spread easily from person to person
· Plan to avoid contact with others by keeping a two week supply of food, medications and pet supplies
· Avoid crowds, when possible stay 3 to 6 feet away from others
The campaign includes a website devoted to flu and pandemic flu information and everyone will be directed to log onto FLUREVOLUTION.COM for more information.
The campaign takes a novel approach and is designed to capture the public's attention and influence more people to get their flu immunization this season. Look for our campaign materials in your mailbox and join the health district in urging the public to "FIGHT THE FLU!"
Alliance
By Pauline Lee &
Andrea Yu, 2006-07 CCMS
The first ever
"Physicians Get Acquainted Reception" hosted on Thursday, September
21 by the Clark County Medical Society Alliance attracted a crowd of over 150
Beverly Daly Dix (
This momentous event would not have been possible but for the generosity of Fletcher Jones Imports, Prudential CRES Commercial Real Estate and ACCESS Medical and the hard work and dedication of the Alliance Board members. Special thanks goes to Lee's Discount Liquor and Regency Wines for their support in supplying the wine and spirits for our guests.
October is here and
By now, each of you should have
received a letter from Lisa Gollard, our Greeting
Card Project chairperson, asking for your generous support and donations for
our Annual Nursing Awards. Last year,
the
With gratitude,
Pauline Lee and Andrea Yu
Diversity - What This Country is All About
By HealthInsight
Diversity – What This
Country is All About
Disparities
in health care based on race and ethnicity have been well documented. One
needs only to scan the National Disparities Report from the Agency for
Healthcare Research and Quality (AHRQ) for a compelling and somewhat bleak
picture of what those disparities are and the groups that are
affected. While the disparities are well articulated, the causes for them
remain somewhat elusive. To that end, the American Medical Association,
the National Medical Association, and the National Hispanic Medical Association
brought together over 48 national health organizations to form the Commission
to End Healthcare Disparities.
In
addition to the obvious need to inform various ethnic groups as well as those
who provide care for them, the report from AHRQ can serve as a road map for the
future elimination of disparities one at a time. Further, it needs to be
determined why people of color do not trust the American healthcare system and
what can be done to gain that trust? Many physician offices strive to meet the
needs of the minority populations they serve, but fall short due to the
cultural disparity that impedes optimal care of this patient population. Equity
of care is one of the major tenants of the Institute of Medicines (
HealthInsight,
the Medicare Quality Improvement Organization for
A select group of primary
care physician offices in
Resources: http://www.ahrq.gov/news/press/pr2006/nhqrdrpr.htm , http://www.iom.edu/CMS/8089.aspx
This material was prepared by
HealthInsight, the Medicare Quality Improvement Organization for
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PHYSICIANS
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an Otolaryngologist to compliment group. For more information contact Judy
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Office
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CME
CALENDAR
Bechtel
NV
Chapter
Pri-Med Institute (877) 4PRI-
Sierra
Health Services 242-7735
Nov 9 - “The Many Faces of Osteoporosis”
Dec 14 - “Evaluation of Sinus Disease, Sinus
Headaches and Tinnitus”
Southwest
Medical Associates 242-7735
Nov 1 - 8:30-9:30am - “Hospice Awareness”
Ethics 1 credit
Nov 8 - “Management of Complicated Skin
& Soft Tissue”
Nov 11 - “Immunology - Innate Immunity”
Nov 17 - “Understanding & Treating Acute
Bacterial Exacerbation of Chronic Bronchitis”
Only
Do
you need “pain management”
Advanced Care Planning (2
Establishing the Advanced Care Plan is the
basis for the total care philosophy of the patient facing the end of life. Learn how to make a very sensitive issue part
of routine medical practice.
Communicating Bad News & Establishing the
Goals of Care (3
No one wants to deliver "bad news",
but establishing the facts, planning the goals of care and implementing the
care plan are necessary skills for physicians.
Depression, Anxiety & Delirium (2
Responding appropriately to unrecognized and
untreated depression, anxiety and delirium improves the quality of life for
terminally ill patients and their families.
Elements & Models in End-of-life Care (1
Learn about the new and evolving palliative
and end-of-life care models that enhance the quality of patients' lives.
Gaps in End-of-life Care (1
Begin the EPEC series with an overview of the
history and current practices regarding end-of-life care in the
Last Hours of Living (2
Understand the death process and the
necessary tasks physicians must undertake to shift the focus of attention from
the dying patient to the support of the grieving family members.
Legal Issues (1
Many questions concerning the obligation to
"do everything" and other aspects of care for the terminally ill are
discussed.
Managing Physical Symptoms Part I & II (3
Controlling physical symptoms other than pain
affords patients the most comfortable death possible. Learn how to manage the most common
end-of-life physical symptoms.
Next Steps (1
Tools necessary for implementing changes in
institutions and health care professionals are presented along with outcome
information regarding pain management and end-of-life care from the Missoula
Demonstration Project.
Pain Management Part I & II (3
Managing pain may be the most critical task
for physicians caring for terminally ill patients. Learn about the best options available for
relieving pain and suffering.
Responding to Requests for Physician Assisted
Suicide (2
Being prepared to respond to patient requests
for assistance committing suicide is challenging for physicians. Learn to explore underlying motivation,
clarify requests and offer alternative options for such requests.
Sudden Illness & Medical Futility (3
Responding to sudden illness and accident
situations is a critical skill for physicians.
Learn to use time limited trials, begin to clarify goals of care,
medical futility and establish relationships with family members during times
of extreme crisis.
Whole Patient Assessment (2
The complete end-of-life patient assessment
requires evaluation of the physical, psychological, social and spiritual
needs. Learn the skills to perform
theses assessments and identify patients having spiritual crises.
Withholding and Withdrawing Therapy (2
Not providing therapy or removing established
therapies often causes physicians particular anxiety. Learn to set limits, utilized time limited
trials and know how to eliminate therapies not consistent with the goals of
care.
County
Line
Advertising & Marketing Solutions, Inc…..798-1819
Brown and Partners Advertising …. 967-2222
Clark County Credit Union … 383-4002 …www.ccculv.org
Consultants in Marketing….944-2464
Ensemble Real Estate Services ….562-7595
Investment Equity Development....702-871-4545.... www.investmentequity.com
IPC – The Hospitalist …..800-852-8155… www.hospitalist.com
Lee & Associates…………739-6222….. www.LeeLasVegas.com
Medical Group Management Association ….. 697-5471 ext. 134
Medical Liability Association of
MxSecure, Inc …..888-580-1010 …. www.mxsecure.