Clark County Medical Society

County Line

Newsletter 81 October 06

Malpractice Filings Against Health Care Providers, Jan 2001 – Aug 2006

Member News

2006-2007 CCMS Committees

Southern Nevada Health Officer Report

Alliance Message

LIABILITY LIMITS OF $500,000/$1,500,000 - PRUDENT OR IMPRUDENT?

Congress Considering New Mandates for Medical Providers

Minutes Synopsis

Classified Ads

CME Calendar

County Line Advertisers

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PRESIDENT’S MESSAGE

By Florence Jameson, M.D., 2006-2007 CCMS President

Dear Fellow Medical Professional

I am writing to you this month on a very urgent matter. We are fast approaching the General Election in November. There are candidates who have vowed to help the medical community in providing better access to medical care. It is vital that we show our support and that we encourage our patients to show support to the candidates who have vowed to provide better access to medical care.

I wish to share with you a few key races that deserve our attention. I am also providing a handout which you can easily copy and pass along to patients. In the work on Tort Reform the medical community has shown that it can be a formidable force for progress. We must continue to show the same resolve. There are those who would unwind the progress that we have made.

Governor's Race

In the race for governor there are two candidates who have worthy credentials for being our next governor. While both have shown their support for the medical community, one candidate stands out, on balance, as being the better candidate, Jim Gibbons. The Democratic candidate, Dina Titus, opposed the Tort Reform embodied in Question "3". If we had lost that hard-fought battle, it is clear that many more physicians would have left the state. Jim Gibbons has always served our interests while in Congress, just recently by advocating in Congress for action on the Medicare sustainable growth rate (SGR) formula. If left unchecked under the current scheme, the SGR will cut payments to physicians and health care professionals by almost 5%, effective January 1, 2007. This is completely unacceptable, and Jim Gibbons is leading the fight in Congress to protect physicians.

Several physicians, including myself, have met with Jim Gibbons and he has assured us that he understands the issues facing access to good medical care in Nevada and will continue to fight hard for better access to medical care. Recent polls show the race for Governor to be extremely close. All of us need to work very hard for the election of Jim Gibbons. Please show your support by displaying banners and signs. In southern Nevada headquarters, call Brittney Evans at 702-987-3279. In northern Nevada headquarters, call Laura Woods at 775-322-4546.

Supreme Court Races

Next to the race for Governor, the next most important race is for the vacancies in Nevada's Supreme Court. In electing a candidate for the Supreme Court, it is also vital that you understand that this position has the potential to either promote access to medical care or turn back the progress that we have made thus far. Again, Clark County Medical Society has met with the candidates. The candidates we are endorsing have a reputation for following the law, rather than being lawmakers. On the basis of our meetings with the candidates we encourage you to support in all ways Michael Cherry, Cynthia Diane Steele and Nancy Saitta for the Nevada Supreme Court. Thanks to support from the medical community and others, Michael Cherry is running unopposed. Don't ever underestimate the importance of your contribution to this process.

Senate and Assembly Races

Both the Senate and Assembly races are very important. Once again there are candidates who have vowed to help access to medical care in Nevada. We want to encourage their success in November. In the Assembly, we are especially appreciative of the fine work of our fellow physicians, Garn Mabey and Joe Hardy. In the Senate, we are thankful for the goodwill and efforts of Sandra Tiffany, Barbara Cegavske, Joe Heck and many others. Please join the Clark County Medical Society in supporting the following candidates in their races by 1) your vote, 2) your contribution to their campaign, and 3) your solicitation of your patient population for their vote.

Assembly

Linda West Meyers, District 1

Garn Mabey, MD, District 2

Francis Allen, District 4

Valerie Weber, District 5

Chad Christensen, District 13

Joe Hardy, MD, District 20

Brian Keane, District 21

Lynn Stewart, District 22

Steve Grierson, District 23

Michael Smith, District 29

Senate

Sandra Tiffany, District 5

Barbara Cegavske, District 8

Dennis Nolan, District 9

Warren Hardy, District 12

We need candidates elected who will uphold the laws in place to provide access to medical care in Nevada. We need you to request banners and posters for the above candidates to display in your offices. Please hand out flyers to your patients. It is critical in the aftermath of Questions "3," "4," and "5" that every physician be both vigilant and committed to the fight for access to good medical care in Nevada.

As you are well aware, there is widespread voter apathy. Having traveled to many countries and seen other forms of government, I do not need to tell you how immeasurably blessed we are to live in a democracy, where we have both the privilege and the obligation to vote. As responsible citizens of the community, we should all vow to make our votes count and to encourage our patients to celebrate the freedom that is represented by a democratic system. My intention is not to be sappy about this matter; my intention is to merely impress upon you that the battle for access to medical care is far from over. Your participation is vital.

There are those who are sharpening their knives ready to slice up the progress we have made. Many of us still live on thin ice in our profession. For many it is difficult economically, psychologically and physically to keep up. We have got to make the environment better for quality medical care. That requires all of us to work hard on the political front. If we suffer reversals either in the Executive Branch, the Legislative Branch or the Judicial Branch it may well be permanent for some of us. Let us keep our resolve firm. Let us encourage our patients to vote responsibly. Thank you for getting the word out, now!

Included with this article is a handout that you can give patients. Please do so. Thank you.

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

Chad Christensen, District 13

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

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Clark County District Court Medical Malpractice Filings

Against Health Care Providers, Jan 2001 – Aug 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

Jul 19 100 114 45 66 74

Aug 54 51 76 67 33 82

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 –

September 2006

· Carl E Allen, MD - OB-Gyn, PO Box 15645, Las Vegas, NV 89114

K Leslie Avery, MD - Pediatric Critical Care, 3006 S Maryland Pkwy 505, Las Vegas, NV 89109
Tracy J Butler, MD - Pediatric Critical Care, 3006 S Maryland Pkwy 505, Las Vegas, NV 89109
L Eugene Daugherty, MD - Pediatric Critical Care, 3006 S Maryland Pkwy 505, Las Vegas, NV 89109
John H Duong-Tran, MD - Pediatric Critical Care, 3006 S Maryland Pkwy 505, Las Vegas, NV 89109
Ruchi Garg, DO – Pediatrics, 3006 S Maryland Pkwy 505, Las Vegas, NV 89109
Joseph A Gassen, MD – Pediatrics, 3006 S Maryland Pkwy 505, Las Vegas, NV 89109
Diane C Lipscomb, MD - Pediatric Critical Care, 3006 S Maryland Pkwy 505, Las Vegas, NV 89109
Eva D Littman, MD - Reproductive Endocrinology, 653 Town Center Dr 206, Las Vegas, NV 89144
Michael S Mall, MD - Family Practice, 3201 S Maryland Pkwy 220, Las Vegas, NV 89109
Porferia D Montesclaros, MD – Psychiatry, 6450 Spring Mountain Rd 8, Las Vegas, NV 89146
Michelle M Pastorello, MD – Pediatrics, 3006 S Maryland Pkwy 505, Las Vegas, NV 89109
Kevin Sinai, DO - Family Practice, 3201 S Maryland Pkwy 220, Las Vegas, NV 89109
James D Swift, MD - Pediatric Critical Care, 3006 S Maryland Pkwy 505, Las Vegas, NV 89109
Paula A Vanderford, MD – Pediatrics, 3006 S Maryland Pkwy 505, Las Vegas, NV 89109

Congratulations and Welcome to the Clark County Medical Society

New Student Member - September 2006:

Patrick A Thompson - Touro University

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

Atoya B Adams, MD - Internal Medicine
Wilbert Cain, MD - Family Practice
Shanker N Dixit, MD - Neurology
Timothy J Eichenlaub, DO - Family Practice
Donna M Miller - OB-Gyn
Charmaine G Yap, MD – Endocrinology

Reinstated Members:

Stuart Hoffman, MD - General Surgery
Carlos Araujo, MD - Hematology/Oncology

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

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2006-2007 CCMS Committees

Bylaws, Policies and Procedures Staff person - Jamie Alberti

1. Warren Evins, MD - Chair

2. Max Doubrava, MD

3. Chandra Narala, MD

4. Joram Seggev, MD

Building Committee Staff person - Jamie Alberti

1. John Nowins, MD - Chair

2. Jay Coates, MD

3. Ron Kline, MD

CME Committee Staff person - Jamie Alberti

1. Michael Gross, MD - Chair

2. Daniel Fabito, MD

3. Louis Fink, MD

4. Mitchell Forman, DO

5. Michael Lee, MD

Community Health/Relations Staff person - Marlaina Burns

1. Jerry Jones, MD - Chair

2. Farooq Abdulla, MD

3. George Alexander, MD

4. Daniel Batlan, MD

5. Jonathan Bernstein, MD

6. Susan Boyd, MD

7. Vasana Cheanvechai, MD

8. Lesley Dickson, MD

9. Florence Jameson, MD

10. Ron Kline, MD

11. Beata Kwiatkowska, MD

12. Chandra Narala, MD

13. Marietta Nelson, MD

14. Lausanne Orendain, UNR Student

15. Mel Pohl, MD

16. Hamidreza Sanatinia, MD

17. Joram Seggev, MD

18. Irwin Simon, MD

Credentials Committee Staff person - Marlaina Burns

1. Carol Vanderharten, MD, MD - Chair

2. Joseph Adashek, MD

3. Howard Baron, MD

4. Mitchell Forman, DO

5. Parker Kurlinski, MD

6. Nafees Nagy, MD

NSMA Government Affairs Staff person - Dot Freel

1. Max Doubrava, MD - Chair

2. Daniel Batlan, MD

3. Keith Brill, MD

4. Raj Chanderraj, MD

5. Jay Coates, MD

6. Lesley Dickson, MD

7. Michael Lee, MD

8. Sanjay Malhotra, MD

9. Nafees Nagy, MD

10. Rhonda Robbins, MD

11. Carol Vanderharten, MD

Membership Committee Staff person - Marlaina Burns

1. Noel Harrison, MD - Chair

2. Chandra Narala, MD

3. Archie Perry, Jr., MD

NSMA Delegate Committee Staff person - Jamie Alberti

1. Annette Teijeiro, MD - Chair

2. Jonathan Bernstein, MD

3. Max Doubrava, MD

4. Warren Evins, MD

5. Parker Kurlinski, MD

6. Donald Kwalick, MD

7. Michael Lee, MD

8. Peter Mansky, MD

9. Anita Pomerantz, MD

10. David Pomerantz, MD

11. Rhonda Robbins, MD

12. Himansu Shah, MD

13. Ronald Slaughter, MD

14. James Tate, MD

15. Carla Turner, MD

16. Carol Vanderharten, MD

17. Jonathan Zucker, MD

Nominating Committee Staff person - Marlaina Burns

1. Michael Verni, MD - Chair

2. Michael Colletti, MD

3. Warren Evins, MD

4. Ron Kline, MD

5. Frank Nemec, MD

6. Ronald Slaughter, MD

7. Carol Vanderharten, MD

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Southern Nevada Health District Report

Improving low immunization rates in Clark County

By Donald S. Kwalick, MD, MPH, Chief Health Officer, Southern Nevada Health District

The Centers for Disease Control and Prevention released the results of the 2005 National Immunization Survey (NIS) on September 14, 2006. The NIS provides vaccination coverage estimates among children 19-35 months for each of the 50 states and selected urban areas. Of the 27 areas separately sampled Clark County was identified as having the lowest immunization rates for the age group and series of vaccines surveyed.

The Clark County vaccination coverage rate for children aged 19-35 months is 58.8 percent. The overall rate for Nevada is 63.2 percent and the rate for the rest of the state (not including Clark County) is 75.8 percent.

This survey marks the first time Clark County was assessed separately from the rest of the state. Clark County was selected to be surveyed as a separate urban area due to the unique challenges that result from the tremendous growth of the county and the 24-hour nature of the community.

When the health district was asked to participate as an urban area in the survey process they immediately agreed. Staff knew the rates for Clark County were much lower than what had been portrayed in the past when it was included with the rest of the state. The 2005 rates released in the survey demonstrate the need to concentrate more immunization resources in Clark County in order to keep children in Southern Nevada healthy and appropriately immunized.

The Southern Nevada Health District provides more than 300,000 immunizations each year to children and adults. The district tracks vaccine coverage rates for its clientele that correspond to those released in the NIS. Health district client coverage rates for the corresponding vaccines range from more than 70 percent to 86 percent.

A recent study conducted by the American Journal of Public Health evaluated the direct impact of the CDC's Immunization Grants program on vaccination coverage rates. The results showed that increases in funding were significantly associated with higher rates of vaccination coverage.

We have worked closely with the CDC to evaluate our program and have continually received feedback confirming that the health district is utilizing all resources available and has developed an effective immunization program. We now need to secure additional resources that will enable the health district to expand its programs and work with community partners and health care providers to ensure they have the resources they need to appropriately immunize the children they serve as well as have access to an integrated system for tracking coverage rates.

The results of the survey were not a surprise to the staff at the health district. We participated in this program knowing it would be an opportunity to demonstrate the need for increased programs and funding in order to improve immunization services for children in Clark County. Physicians that participate in the state's Vaccines for Children (VFC) program can have a significant impact on Clark County rates by ensuring they accurately track the vaccinations they administer and implementing a recall system for alerting patients when vaccinations are due.

The recommended vaccine series detailed in the survey includes: four doses of diphtheria and tetanus toxoids and pertussis vaccines, diphtheria and tetanus toxoids vaccine, or diphtheria and tetanus toxoids vaccine and any acellular pertussis vaccine (DTP/DT/DTaP); three doses of poliovirus vaccine; one dose of measles, mumps, rubella (MMR) vaccine; three doses of Haemophilus influenzae tybe b vaccine; three doses of hepatitis B vaccine; and one dose of varicella (chicken pox) vaccine. The survey included children born during February 2002 -

July 2004.

More information about the Southern Nevada Health District immunization program is available at: http://www.southernnevadahealthdistrict.org/nursing/immunizations.htm or by calling 759-0850.

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Alliance Message

By Pauline Lee & Andrea Yu, 2006-07 CCMS Alliance Co-Presidents

For nearly 40 years, the Alliance has had a tradition of hosting fundraising events benefiting various local charities and community projects. This year, the Executive Board of the Alliance has selected the American Stroke Association and the American Heart Association as the beneficiaries of the Alliance's year long fundraising efforts. The decision to support the American Stroke Association (ASA) and the American Heart Association (AHA) was an easy one as the ASA and AHA sponsor specific local programs directed towards stroke victims in Clark County.

For example, the Stroke Peer Visitor Program involves the participation of stroke survivors and caregivers whose mission is to provide information and support to hospital patients, who have recently had a stroke, and their caregivers. The Stroke Visitor Program trains survivors and caregivers to become outreach volunteers to those newly affected by stroke. The training focuses on stroke education and information, basic counseling skills and sharing of community resources. Once a volunteer is trained as a Stroke Peer Visitor, the volunteer then visits stroke patients in hospitals, nursing homes and rehabilitation centers to help them begin the recovery process. Currently, seven support groups meet regularly in Las Vegas at participating hospitals, community centers and faith-based organizations.

Another worthwhile program is the Saving Strokes Golf Clinic, which is a golf fitness and training program for stroke survivors. Stroke survivors in all states of recovery are evaluated by physical therapists and then teamed with golf pros for hands-on experience proving how golf can play an important recovery in their physical and emotional recovery. This year, the clinic will be held on October 20, 2006 at the Las Vegas Municipal Golf Course and will be supported by the PGA - the National PGA has chosen disabled golf as their priority for "growth of the game."

One of the goals of the AHA is to reduce stroke and stroke risk by 25% by the year 2010. To attain this lofty goal, the ASA desires to deliver a series of comprehensive campaigns to aggressively educate and promote awareness of stroke prevention to those at highest risk. At this stage, the Power to End Stroke campaign will target African Americans to increase awareness of risk factors and stroke prevention and recruit ambassadors (spokespeople) to raise funds to support the campaign and promote activities and neighborhood based community programs.

The ASA also sponsors a Heart and Stroke Conference which is a call to action to the medical community to move stroke care to the forefront and to improve clinical outcomes. The conference concentrates on education for survivors and caregivers and provides proposals for redesigning systems for health car professionals to detect and prevent stroke and heart disease.

With your support and enthusiasm, the Alliance hopes to provide more than sufficient funding for these very worthwhile local programs this coming year. For more information, please contact us at info@ccmsa-lv.org.

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LIABILITY LIMITS OF $500,000/$1,500,000 - PRUDENT OR IMPRUDENT?

By Weldon (Don) Havins, M.D., Esq., CEO, President-Elect, & Special Counsel, Clark County Medical Society

Two months ago, the County Line published an article regarding the reduction of Professional Liability Insurance (PLI) required minimums for staff privileges at our largest Nevada hospital. The reduction of required PLI limits from $1million/$3 million to $500,000/$1,500,000 created an opportunity for PLI carriers to offer reduced PLI premiums for reduced insurance coverage to physicians. Thus far, the maximum reduction in annual premium for the reduced coverage is about 20%.

The relatively low risk of being successfully sued for medical malpractice contrasts with the potentially devastating consequences of an award or settlement over the insured's policy limits. Confusion and anxiety may result when a health care provider ponders whether the increased risk of an award or settlement exceeding reduced policy limits justifies a 20% reduction in PLI premiums. More directly, is a 20% reduction in annual premium worth reducing insurance coverage by 50%? For an OB-Gyn with an annual premium of $100,000, is a $20,000 reduction in premium worth reducing insurance by 50%? For an internist with an annual premium of $30,000, does a $6,000 reduction in premium justify one-half the prior insurance coverage?

During the recent medical malpractice insurance crisis, the Nevada Trial Lawyers Association researched medical malpractice trials in Clark County from 1996-2001. The information they provided in public forms revealed that of the 58 trials in Clark County District Court, 25 (43%) resulted in a verdict and award for the Plaintiff. The Defendant health care provider(s) prevailed in 57% of the trials. An edited chart of those verdicts is hereby appended as Exhibit A. Of the Plaintiff verdicts rendered from 1996 -2001, 60% were for greater than $500,000.

In October 2002, the A.B. 1 medical tort reform of the Legislative special session became effective. A.B. 1 eliminated the Medical Dental Screening Panel and did not provide for a firm $350,000 cap on non-economic damages. While A.B. 1 contained a few beneficial provisions, it was a disaster in addressing the continuing medical malpractice insurance crisis. The number of medical malpractice claims filed in Clark County District Court exploded, and half the insurance companies in Clark County stopped writing PLI insurance to physicians or left Nevada altogether. Those insurers remaining increased their premiums at unprecedented double digit rates annually. On November 24, 2004, the medical tort reform provisions of Ballot Question 3 (aka, the KODIN Initiative), voted into law by the people of Nevada, became effective. Ballot Question 3 medical tort reforms have stabilized the PLI insurance market, albeit at a record high level. Since November 2004, none of the five remaining PLI insurers (seven if one counts the national Anesthesiology and Ophthalmology insurance programs selling insurance to those Nevada specialists) has left Nevada or ceased selling PLI insurance. For the first time in many years, two new PLI insurers have begun selling insurance in Clark County. Virtually all insurance policies have been for the $1 million/$3 million minimum policy limits. The medical tort reforms implemented in November 2004 have facilitated the reduction of policy limits. Objective data to assist physicians in their decision to hold at the present PLI

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