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Washoe County Medical Society

Getting Back to Wellness is Essential

PSA- get back to wellness campaign

Jay K. Morgan WCMS PresidentEditor’s Note: Watch this opinion piece in Sunday’s Reno Gazette-Journal.

Fear has been driving many decisions by our patients about obtaining or not obtaining medical care. Today, we have established precautionary tools and processes in place to help our patients remain safe during appointments.

We are encouraging our families, friends and neighbors to get back to wellness. Our PSA, “Let’s Get Back to Wellness,” aims to assure our community that it is safe to resume your routine medical care. Don’t suffer through painful conditions, neglect blood pressure checks, cholesterol tests, immunizations, or any routine medical care that keeps you pain free and healthy.

As COVID-19 continues, we realize that there is an additional health concern that is separate from but related to the novel coronavirus. We have learned that many individuals are afraid to schedule a doctor’s appointment or go to the emergency department because they fear contracting the coronavirus. It was an eye-opener for me when an emergency room colleague recently asked, “Why is no one having a stroke?” He wasn’t wishing for a medical calamity, but he wasn’t seeing the normal rate of patients presenting with stroke symptoms.

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Let's Get Back to Wellness

Sierra Neurosurgery Group and the Washoe County Medical Society partnered to create a public service announcement (PSA) encouraging individuals to take care of their routine health issues.

 

“DOCTORS ARE EVIL”

Stop Coronavirus

A letter from Pamela E. Netuschil, M.D. to the Washoe County Medical Society.

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Stethoscope on health insurance form

Group Health Insurance is Back at WCMS!

If you are in a group with 2-50 full-time employees, your clinic is eligible for an association health plan when all the physicians in your group are members of WCMS. To join individually, go here. If you wish a group invoice, contact Wendy Hernandez, wendy@wcmsnv.org or 775-825-0278, who will help you enroll and process multiple membership applications.

Washoe County Medical Society (WCMS) members now have access to health insurance benefits through Prominence Health Plan that includes several different medical plan options offered with a composite rating structure. Open enrollment begins June 1 with benefits effective July 1 and Aug. 1. New members to WCMS may enroll their groups as soon as their membership applications are approved and payment is received.

Programs available will include Go365, a wellness program that encourages a healthy lifestyle, as well as the Teladoc Program, 24/7 member care via telephone or video from physicians and behavior health specialists. Additionally, dental care, vision plans, and life insurance will be available through Kansas City Life.

For more information about association plans, please contact your local insurance broker or reach out directly to Prominence Health Plan, send your quotes to:  PHP-GroupQuotes@uhsinc.com or reach out the Prominence account manager at Kathy.Wells@uhsinc.com.

 

 

 

 

COVID19

Changing the Practice of Medicine

COVID-19 illustration

Jay K. Morgan WCMS PresidentCOVID19 has changed the way we practice medicine. We face the dual challenges of embracing procedures that provide optimum protection against the spread of the disease while also reassuring our patients and their families that with the proper precautions, there is no immediate cause for alarm or panic.

This is a tough situation since the protective measures appear to be dramatic causing greater concern by the very appearance of parking lot screenings, restricting visitors at our medical centers and clinics, masks and segregated waiting rooms to isolate those suspected of being affected by the virus.

Many of our family members and friends either will be working from home or temporarily laid off. Non-essential businesses are closed. Parents are helping their children adapt to online learning. Key events statewide have been canceled, including Match Day, at the medical schools. While we help our patients cope, we also need to help our families and friends manage with a minimum of stress. Being kind and patient has never been more important.

Our staff began working remotely March 18 for the next 30 days but remain accessible to you through emails and the office phone—825-0278. Mary Ann tells me you are welcome to reach her by cell: 952-292-8130. Our meetings have gone virtual. The business of WCMS continues, just not quite “business as usual.”

Daily, WCMS and NSMA are evaluating the new information being issued by the Washoe County Health District, the CDC, AMA and other expert health sources. Members of WCMS’ Allied Public Health Commission and NSMA’s Public Health Commission are working closely with the health district to interpret recommendations from all the COVID-19 sources to help our members make informed decisions about how they manage patients at their facilities. The information is being shared through emails and posted to the NSMA Coronavirus Resource Center. (https://nvdoctors.org/coronavirus-resource-center/).
One of the leaders in this effort is Kevin Murphy, MD, an infectious disease specialist with Saint Mary’s Regional Medical Center, and chair of our Allied Public Health Commission. Dr. Murphy is continually monitoring and synthesizing the vast amount of data coming from multiple resources. His regular updates provide us with guidelines for managing patients and protecting staffs. His updates and recommendations are being distributed frequently with other critical information. They also can be found at https://nvdoctors.org/public-health-advisory-on-covid-19/.

With the situation changing daily, we are committed to ongoing assessment of the data available and providing prompt access to updated recommendations and support resources. We are striving to be a highly reliable clearinghouse of the current information that will guide your practice procedures until the virus had ceased to be community health concern.

One Student’s Journey

Navigating Medical School in Uncertain Times


 

coronavirus covid-19 infected patient

 

Anita-savell-medical-student

By the time this article is published there will have been many updates and changes to the circumstances surrounding COVID-19 and the medical school experience, but today I’ll offer you a perspective from a moment in time as a 3rd year medical student navigating the spread of the novel coronavirus.

By mid-March all inpatient rotations were canceled for medical students. All clinical rotations for 3rd and 4th year students--inpatient and outpatient---were canceled until at least March 31 in a nationwide decision by the AAMC and LCME.

The impacts of the spread of this virus on medical education began slowly percolating. I remember first learning about the virus during my inpatient pediatric rotation when it was primarily in China. The floor was full of RSV patients and the whole team would put on their masks, gowns, and gloves and speak to the patients as we rounded. My colleagues on that same rotation now more than a month later have a very different experience. Medical students are barred from seeing patients on droplet precautions in order to preserve the hospital’s supply of PPE.

Hospitals in the region have completely restricted student access. And a source of anxiety for myself and my classmates is if we will be able to complete our clinical rotations and maintain our current timeline for graduation. At the same time that we are applying to 4th year away rotations in our desired specialties, we are getting notified of away rotation cancellations across the country.

There are different impacts felt at every level of medical school.

Our MS1s are trying to complete their anatomy requirements in an online capacity as UNR has made the decision all classes--graduate and undergraduate--will be online for the foreseeable future.

Our MS2s are in their dedicated study period, which is traditionally completed off campus, but they too are impacted as they wonder if the testing sites will be postponing Step 1 exams as they have Step 2 CS exams.

Our MS4s completed their rotations and interviews before travel restrictions and rotation cancellations began, but the culmination of medical school will look very different for their class than those who came before them. There wasn’t the traditional match day celebration. Many students feel uncertain of whether they will have a graduation ceremony.

Medical students have a unique position in this pandemic. While we want to be a resource in a potentially overwhelmed healthcare system and learn for future pandemics when we will be providers, we also recognize that we could become a burden to the system.

Students and providers alike--thank you to all those working to care for our community during this uncertain time.
By Monday night all inpatient rotations were canceled for medical students. By Tuesday all clinical rotations for 3rd and 4th year students--inpatient and outpatient---were canceled until at least March 31st in a nationwide decision by the AAMC and LCME.


 

Nevada Physician Wellness Coalition logo

 

Help During These Challenging Times…

Our community’s physicians and healthcare workers are navigating the challenges of the COVID-19 outbreak with courage and compassion. They are facing unprecedented circumstances in their work & home environments and are being tasked with exceptional demands.

Founded by local physicians, the Nevada Physician Wellness Coalition (NPWC) works to provide resources to physicians & their families to address burnout and to prevent suicide. We want to remind you that our resources are in full force to support those who are working so hard during this difficult time.

NPWC’s Physician & Family Resource Line provides free and confidential information and links to resources for physicians, medical students, and their families.

The Physician & Family Resource Line...

  • Operated by licensed psychologists with expertise in physician stress
  • Monday through Friday, 9 am - 5 pm
  • Calls returned within 24 hours

775-404-3307

The Physician & Family Resource Line serves non-urgent, non-crisis calls. If you or someone you know is in crisis, please call:

Crisis Call Number: 1-800-273-8255

NV Suicide Hotline: 1-800-992-5757

ABOUT NPWC

NPWC is volunteer physician led non-profit organization. It is operated independent of any health system, physician employer, licensing body, or organized medicine body. NPWC offers a range of programs including community and workplace education programs, seminars, and the Physician & Family Resource Line.

For more information, contact: info@nevadaphysicianwellnesscoalition.com, or visit: www.nevadaphysicianwellnesscoalition.com.

 

Observations from the Legal Trenches

The thorny issue of discharging a patient from a practice

Lyn Beggs

One the most common questions asked by physicians is how to properly discharge a patient from a practice. Sadly, there is little direct guidance regarding this issue.

AMA Ethics Opinion 1.1.5 states in part that when contemplating whether to terminate a physician-patient relationship a physician must:

  1. Notify the patient (or authorized decision maker) long enough in advance to permit the patient to secure another physician.
  2. Facilitate transfer of care when appropriate.

Similarly, NRS 630.304(7) states that a physician (MD) is subject to disciplinary action for “terminating the medical care of a patient without adequate notice or without making other arrangements for the continued care of the patient.” NRS 633.511(1)(n), applicable to DOs, reads almost identically.

These statements lack any definition of what defines “adequate notice.” There is a general notion that thirty days is appropriate, but this is not set forth in state law. Thirty days is typically considered adequate notice and is the notice period most practices follow. However, if you practice in an underserved specialty or care for patients in remote areas of the state, thirty days may not be sufficient; try to give as much notice as reasonably possible in these circumstances. In some cases you may be able to help the patient transfer to a new provider, if not, encourage them to contact their insurance carrier as quickly as possible for a referral. Regardless of the amount of notice, if the patient requires on-going medications, ensure that the patient has the necessary refills to last until they are able to see a new provider. In some cases, such as prescriptions for schedule II-controlled substances, this may not be feasible so early notice is crucial.

Administrator looking at medical record

If you are discharging a patient for any reason other than you are leaving the practice, be sure to document in relative detail the patient’s chart as to why the patient is being terminated from the practice; this may protect you should the patient file a complaint with the state board or other entity regarding the discharge. Regardless of the reason you are discharging a patient, provide written notice to the patient, even if you have verbally informed the patient. In most circumstances you should notify the patient of the final day that you will be providing medical care for them but offer to provide interim care during the period between providing the notice and the final day of care.

Discharging a patient does not discharge your duties to retain the patient’s medical records. Also, the patient is entitled to a copy of the chart pursuant to NRS 629. 061; while it’s fairly standard to transfer the patient’s chart to a new provider, if the patient asks for their own copy of the chart, you may legally charge up to $.60 per page for the copy.

Finally, while it is recommended to provide as much notice as reasonably possible to a patient being discharged, neither you nor your staff should ever be placed in a situation which may result in physical harm or other danger; in those circumstances immediate termination is certainly justified. Under such circumstances be sure to document in detail the circumstances resulting in immediate termination; if appropriate, you may notify the patient that one refill has been made for their medications to avoid disruption of needed medications.

In unusual discharge situations, you may want to consult with counsel, however most physician-patient relationship termination should not require legal advice if proper notice is given and good documentation is made.

Ms. Beggs, principal of the Law Offices of Lyn E. Beggs, PLLC, focuses her practice primarily on assisting clients with administrative and professional licensing board matters in addition to representing healthcare providers on a variety of issues. Ms. Beggs may be reached at 775-432-1918 or at lyn@lbeggslaw.com. This article does not constitute legal advice and should not be considered a substitute for retaining counsel for advisement in legal matter.

Check Your Sources!


 

Check cdc.gov for the latest information on the Coronavirus Disease.


 

Check washoecounty.us/health for the latest information from Washoe County Health District on the Coronavirus Disease.


 

Check Nevada Health Response for the latest information from the Nevada Health Response on the Coronavirus Disease.


Understanding the important work of the Nevada State Public Health Laboratory

Dr. Thomas Schwenk Dean of the School of Medicine and VP of Health Science

Dr. Thomas Schwenk Dean of the School of Medicine and VP of Health Science

Most of you probably know little about the work of the Nevada State Public Health Laboratory (NSPHL). You should know more, because the lab scientists and technicians are literally working around the clock to protect you and all Nevadans from a wide range of potential infections, food-borne illness, and unsafe water, as well as providing emergency response to biological and chemical terrorism, and testing every Nevada baby for more than 30 hereditary diseases.

Established in 1909, the NSPHL serves as Nevada’s centralized lab, representing a first line of defense in the rapid detection of a public health threat. The laboratory is part of the University of Nevada, Reno School of Medicine and located on the University campus.

Here are a few facts to help you understand the important work of the NSPHL and how it serves the entire state, so well. The laboratory performs over 550,000 tests each year to help keep Nevadans safe and healthy—that’s more than 2,000 tests each day. Over 400,000 of those tests are conducted on newborn babies, with each baby being tested twice in the first 10-14 days of life for conditions ranging from cystic fibrosis to congenital hypothyroidism to sickle cell disease to severe combined immunodeficiency disease. Every day, the NSPHL is confronted with questions and challenges, ranging from the safety of water in the Truckee River to outbreaks of whooping cough in local schools to whether the West Nile virus has come to Nevada.

The NSPHL is staffed by over 30 scientists and technicians, with a budget of over $7m/year. But, the cost per Nevada resident has dropped over the years, with state funding per capita declining from $644 in 1998 to $564 in 2018 due to an increasing level of efficiency and success by the laboratory management in seeking grants and contracts from other sources.

The NSPHL also has a new Director, Mark Pandori, Ph.D. Dr. Pandori has over 15 years of high-level experience in public health laboratory leadership, most recently as Director of the Alameda County Public Health Laboratory in Oakland, California. He earned his Ph.D. from the University of California, San Diego, completed a fellowship at Harvard University, and holds several certifications in diagnostics and public health microbiology. He will serve as a faculty member in the Department of Pathology and Laboratory Medicine at UNR Med where he will teach medical students and residents, in addition to his laboratory leadership responsibilities.

Dr. Pandori will continue the outstanding tradition of public health leadership that the state has enjoyed with Dr. Trudy Larson, professor and dean of the School of Community Health Sciences, who has served as NSPHL director since July 2014.

The NSPHL is an example of community service and engagement that characterizes the core mission of UNR Med at its best, to serve the state, to improve the health and quality of life and to contribute to a Healthy Nevada. Nevada residents can be confident that their public health is in good hands with the leaders and scientists at the Nevada State Public Health Laboratory.