Many LV patients have no patience

When former Gov. Bob Miller needed a cancerous prostate gland removed, he went to Cedars Sinai Hospital in Los Angeles.

Mayor Jan Laverty Jones chose to have a lump removed from her breast at St. John's Hospital in Los Angeles.

In March front-running Las Vegas mayoral candidate Jay Bingham said he pulled out of the race on his doctor's orders when a "dormant heart condition" recurred. He also went out of state for treatment.

They are reluctant to discuss their reasons.

Cathy Hanson, a spokeswoman for the mayor, said Jones declined to comment. Terry Murphy, Bingham's campaign manager, said Bingham didn't want to talk about his decision. Miller did not return phone calls on the subject.

But the choice by high-profile Southern Nevadans to leave the state poses a question: Are they sending the wrong message to people considering treatment here?

Medical professionals on the whole don't think so, but they understand why people choose to leave for certain procedures. And some tout health care here as being state-of-the-art while others think there is need for improvement.

Impressive credentials

Clark County has nine acute-care hospitals staffed by specialists capable of performing everything from routine gall bladder operations to complicated coronary bypass surgery. The only procedures not performed here are the big-ticket items -- heart and liver transplants.

Cardiologist Dr. Keith Boman said that when people are facing life-threatening surgery, it's human nature to want to go to a hospital that's world-renowned for certain procedures.

"There's an entire clinic at UCLA that's devoted to just treating heart failure," Boman said. "M.D. Anderson Cancer Center in Houston is known for the most sophisticated cancer research."

Boman understands the choice professionally as well. Any time patients face a heart operation that may pose serious complications -- such as replacing an entire aorta -- they're best advised to go to a facility that specializes in it.

But more often, especially with high-profile patients, the reasons are private.

In 1996 Clark County Commissioner Yvonne Atkinson Gates was diagnosed with a softball-sized tumor in her left leg. Her physician, Dr. William Zamboni, chief of plastic surgery at the University of Nevada School of Medicine, said she could have had the tumor removed in Las Vegas, but because of her celebrity status locally, she chose to go to M.D. Anderson Cancer Center, where she would not be so readily recognized.

"We can do anything they can do, but for personal reasons she went somewhere else," Zamboni said. "I think the more high-profile the person, the more privacy they want."

Dr. Elias Ghanem, Miller's personal physician, said he believed the former governor chose to go to Cedars Sinai for similar reasons, and because he liked the out-of-town physician who did the operation.

"The governor's operation could have been done here," Ghanem said. "It was all a personal thing. He did choose to have his gall bladder out here. Some people just like more privacy."

Such decisions, however, feed the impression longtime residents have that they need to go out of town for quality care, even though care has improved here, said Ghanem, who himself is a Las Vegas resident of 28 years. Newer residents, he said, have confidence in the level of care here.

"The very high-profile hospitals receive a lot of name recognition," said Bill Hale, chief executive officer of University Medical Center. "But the medical community here in Las Vegas is just as good. I would tell people to talk to their primary care physicians before thinking of leaving Las Vegas."

UMC's trauma center is the ninth busiest in the country and serves four states -- Nevada, northern Arizona, eastern California and southern Utah.

UMC was chosen as one of the nation's top 100 hospitals in 1997, according to HCIA Inc., a leading health-care information company.

Zamboni started the limb reattachment program at University Medical Center in 1994. Besides himself, the center has two surgeons and a specialty staff of nurses. They do an average of 30 reattachments -- arms, fingers, hands -- a year.

Last month Sunrise Hospital and Medical Center was chosen as one of the top 100 cardiovascular hospitals by HCIA.

Executives at Sunrise compare the hospital to such noted centers as Johns Hopkins and Loma Linda. The hospital points out it is doing sentinel lymph node biopsies for breast cancer just like Johns Hopkins.

And Sunrise compares its pediatric heart surgery program to Loma Linda, stating that it performs the same types of high-risk procedures.

"My goal is to make the community realize that Sunrise Hospital and Children's Hospital meet their needs," said Jerald Mitchell, president and chief executive officer of Sunrise Hospital. "We have 1,300 physicians on staff, 1,000 nurses and 2,000 other health professionals who have all graduated from top schools. This community has it all."

One of the reasons Jones went to the Joyce Eisenberg Keefer Breast Cancer Center at St. John's Hospital in January 1998, according to Las Vegas oncologist Dr. Heather Allen, is that at the time sentinel lymph node biopsies weren't being done in Las Vegas. It is cutting-edge medicine in which a radioisotope or dye is injected into an average of five lymph nodes.

The procedure requires great skill, Allen said, and no one here was doing it nine months ago. In breast cancer, she said, it's important to identify any lymph nodes that are cancerous and with as many as 30 located under one arm, it is important to be very accurate.

However, Dr. Ann Wierman, an oncologist at the Nevada Cancer Center, said sentinel lymph node biopsies have been performed by select surgeons in Southern Nevada for the past two years. It's just that many primary care physicians didn't know about them, she said.

Need for recognition

"If you have a unique tumor that we see once or twice a year and a place that sees and treats them 30 times a year, which place would you want to go to?" Wierman said. "To have a center that does one thing, you need a population of at least 5 million people to support it."

Besides having a population base to support a specialty center, Wierman said, a community has to have a facility where its physicians publish original research, bringingnational recognition.

People within the medical community blame the University of Nevada School of Medicine for the area's lack of original research. They say the school, founded 30 years ago, is mainly interested in producing primary care physicians and does not stress research conducted by nationally recognized health professionals.

Dr. David Schapira, senior associate dean of the school, admits the school is not fully developed in every area. But he said the school is doing original research in lung cancer screening and genetics.

The university is also participating in research in fields including Alzheimer's disease, plastic and reconstructive surgery, trauma and neuromuscular disorders, he said.

The University of Nevada is planning to do the first liver transplant in the state by the end of the year, he said, which will go a long way toward improving the medical school's national reputation.

Shapira said he also plans to apply for a grant from the National Cancer Institute to fund a comprehensive cancer center.

If he's successful, the University of Nevada School of Medicine's cancer center would be one of only 26 in the nation. Schapira is confident he can build the center, because he did the same thing at Louisiana State University in Baton Rouge.

Schapira said he was able to recruit researchers from Harvard and Princeton to LSU, and within two years the university became nationally recognized.

It was a formula followed at the University of Alabama at Birmingham, and it turned that medical school into one of the finest in the country.

Dr. S. Richardson Hill, who became the second president of the medical school in 1962, was involved in building the academic reputation of the Birmingham campus, founded in 1945.

"You have to identify the people who are the leaders in research. They'll be the ones who will get the grants," Hill, now retired, said.

Hill said he first went after the head of the surgery department at the Mayo Clinic. That was Dr. John W. Kirklin, the cardiovascular surgeon who developed the heart bypass machine used to keep blood flowing during open-heart surgery.

Hill invited Kirklin to the Alabama campus to get his advice, and once the surgeon was there, he asked him to stay.

Realizing that the big schools, such as Harvard and Johns Hopkins, were also wooing Kirklin, Hill pitched the Birmingham school as having less red tape and promised that the surgeon would be personally recognized for his published studies rather than having credit going to the medical school.

The school's interdisciplinary department approach -- where physicians from different research centers cross over to help other researchers -- also proved to be very appealing. Hill said he was thus able to avoid turf wars that are common at larger academic research centers.

With big-name researchers, Hill said, grants from the National Institutes of Health flowed to Birmingham. Today, he said, the medical school is ranked 16th in the nation for securing federal dollars. It averages $200 million a year in grants.

A nationally recognized research center, health care professionals agree, goes a long way toward improving a community's reputation.

"It's chic to say my doctor is at Mayo Clinic," said Ernie Libman, chief executive officer at Lake Mead Hospital Medical Center. "People leave here because they can afford it. And with cancer, you reach for anything you can."

Specialists will come

Libman said Las Vegas is a young community and it is taking time for the specialties to grow. More and more specialists will come to Southern Nevada, he said, as the population grows to support them.

Another draw for Las Vegans to go out of town for medical treatment, Libman said, has less to do with medical care than marketing. Hospitals such as Cottage Hospital in Santa Barbara and Scripps in La Jolla, Calif., market themselves to executives for complete physicals.

Libman said an executive or other individual with a lot of money will fly to one of these clinics in the morning and have a battery of tests done. Blood workups, treadmill test and chest X-rays all take place under one roof in a relaxed setting. The cost runs about $1,500.

One group of local physicians starting to tap into this high-profile, luxury checkup market is Internal Medicine Specialists. The center does executive physicals, which run on average $1,200 for a three-hour examination.

"When I started here five years ago, people wanted a second opinion at UCLA," said Dr. Dale Albright, an internal medicine physician at Internal Medicine Specialists. "Now this only happens about once a year.

"I don't think community medicine can ever compete with UCLA or Stanford (University). Their ideals are toward research. But people are starting to realize that the specialists are here in town and are well trained. Today it's rare that people leave to get medical care."

Maintaining that level of confidence is an ongoing challenge, health care professionals say, due to Southern Nevada's transient population. The lack of a stable community makes it hard for any hospital or clinic to maintain name recognition.

"We have to work all the time on this," Mitchell said. "It's important that there be an ongoing advertising campaign. The average age of people in Las Vegas is 34 years old. These people aren't thinking of health care."

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