11-14 BULLETIN :9-09 BULLETIN · 2014. 11. 6. · Beverley Townsend, Commissioner, West Georgia Department of Public Health, Columbus, GA Statement from the Georgia Commissioner on

THE BULLETIN

A PUBLICATION OF THE MUSCOGEE COUNTY MEDICAL SOCIETY

ERUDIRE ET DELECTARE

V O L U M E 5 9 • N U M B E R 1 1

NOVEMBER 2014

See Inside: “An Anniversary to Remember” by Vincent Naman, MD

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THE BULLETINSociety Office: 2300 Manchester Expressway, Suite F-7 • Columbus, GA 31904

706-322-1254 • FAX 706-327-7480 • www.muscogeemedical.org

C o n t e n t sPresident’s Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Hospital News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8, 16

Editor: David H. Levine, M.D. • Associate Editor: Casey Geringer, D.O.Managing Editor: Lisa Venable

Officers 2014:

President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . James D. Majors, M.D.

President-Elect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .W. Frank Willett, III, M.D.

Past President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Glenn E. Fussell, M.D.

Secretary-Treasurer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Glenn E. Fussell, M.D.

Director to MAG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fred Flandry, M.D.

Alternate Director to MAG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W. Frank Willett, III, M.D.

Executive Committee: James D. Majors, M.D., W. Frank Willett, M.D., Glenn E. Fussell, M.D.,Fred Flandry, M.D., Michael Borkat, M.D., Ryan Geringer, D.O., Kurt Jacobson, M.D., David H. Levine,M.D., Ken Smith, M.D., Karen Stuart, M.D.

Delegates: Michael Borkat, M.D., Benjamin Cheek, M.D., Fred Flandry, M.D., Glenn E. Fussell, M.D.,Ryan Geringer, D.O., James D. Majors, M.D., Folarin Olubowale, M.D., Karen Stuart, M.D., W. FrankWillett, III, M.D., Joseph Zanga, M.D.

Alternate Delegates: Larry Brightwell, M.D., Casey Geringer, D.O., James Hagler, M.D., KendallHandy, M.D., A. J. Jain, M.D., David Levine, M.D., Henry Ngo, M.D., Kenneth Smith, M.D., TimothyVillegas, M.D., John D. Watson, M.D.

Ad position is at the sole discretion of the Editorial Board.

Members are urged to submit articles for publication in The Bulletin. Deadline for copy is the 11th of the month preceding date of issue.The Bulletin of the Muscogee County Medical Society is the official monthly publication of the Muscogee County Medical Society, 2300Manchester Expressway, Suite F-7, Columbus, GA 31904. All material for publication should be sent to the Managing Editor not laterthan the 11th of the month. Advertising requirements and rates upon request. Opinions expressed in The Bulletin, including editorials,are those of the individual authors and do not necessarily reflect policies of the Society unless stated. Advertisements in this magazinedo not necessarily represent endorsement or support by the Muscogee County Medical Society.

On July 25-26, the Medical Association of Georgia hosted aLegislative Update at the Jekyll Island Hotel. Twenty-four Georgiastate senators and state house representatives were inattendance. Senator Josh McKoon (R-29, Columbus), Rep.Carolyn Hugley (D-136, Columbus) and Rep. Richard Smith (R-134, Columbus) were invited speakers. All of the legislatorswere quite supportive of physicians and it was a successfulweekend. The topics covered will need legislative support in the2015 State Assembly.

The Georgia State Legislature is in session for only 60 days each year over 3 months,mid January to mid March. The legislators have other jobs, but are paid $16,000 peryear for the 60 legislative days. Most do not have a secretary or instead share asecretary with 4 other legislators while in session. I found all the legislators to bequite interested in representing the needs of Georgia physicians.

The first topic covered was Worker’s Compensation. There is a new ASC (ambulatorysurgery center) fee schedule as of April, 2014. Unfortunately, Worker’s Comp. hasnot paid a single ASC facility fee since the new reduced ASC facility fee schedule waspublished. It seems the cost savings in the fee schedule were not deep enough forthe Worker’s Compensation Board. Surprisingly, there were Worker’s Comp.representatives involved in the drafting of the new fee schedule. MAG is seekinginput from legislators to resolve this impasse.

The next topic discussed was malpractice reform. The main topic was the “PatientInjury Act” or the “Patient Compensation Act.” This bill has the misguided support ofa cadre of Family Practice physicians in the ultra-liberal Atlanta Medical Society. Thisbill would replace Georgia’s current medical malpractice system with anadministrative compensation system. It would create independent medical reviewpanels in Georgia to evaluate patient injury claims as well as a board to oversee them.The system would be funded by health care providers in the state (a new $600 taxon physicians and $2500 tax on physician groups.) MAG opposes this bill as there isNO REQUIREMENT of PROOF of NEGLIGENCE. An unhappy patient can seekfinancial payment for any reason, such as a keloid or unpleasant scar. Fortunately,100% of the legislators in attendance oppose this bill with vehemence. The bill willbe introduced again in 2015 and has been also introduced in Tennessee andFlorida. MAG has spent over a year evaluating this Patient Compensation Systemmodel and the MAG Board unanimously voted to oppose this bill. It has no proventrack record. (Only Sweden and Iran have a similar model.) Senator Josh McKoonpresented a precise condemnation of this bill that is opposed by MAG and theGeorgia State Trial Lawyers Association.

The last topic covered was Scope of Practice. Advanced Practice Registered Nurses

P R E S I D E N T ’ S M E S S A G EJames D. Majors, M.D.

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and Physician Assistants continue to lobby our state legislators for independentpractice. They argue that they can work in underserved areas of the state.Unfortunately, the truth is that most work in metro Atlanta and these demographicswere provided for the legislators in attendance. No legislator present at this meetingsupports the independent practice of APRN’s or PA’s in Georgia. MAG supportsthese professions as physician extenders only.

Overall, this summer legislative conclave was successful. The legislators inattendance were lobbied successfully for continued support of Georgia physicians.If you are not a Medical Association of Georgia member, I can assure you that your$500 annual membership fee is well spent as MAG works tirelessly on behalf ofGeorgia physicians. MAG has over 7500 members, including physicians thatrepresent every specialty in every practice setting. There are 54 county medicalsocieties in Georgia, including the Muscogee County Medical Society. I stronglyrecommend membership in both MAG as well as the Muscogee CountyMedical Society.

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H E A L T H S T A T E M E N TBeverley Townsend, Commissioner, West Georgia Department of Public Health, Columbus, GA

Statement from the Georgia Commissioner on Public Health: Ebola

The CDC is continuing to monitor the outbreak of Ebola virus disease or Ebolahemorrhagic fever ("Ebola") in West Africa. Early symptomatic recognition andreporting are critical to infection control. The Georgia Department of PublicHealth (DPH) is responsible for the data collection in our state. Health careproviders should be alert for, and evaluate, any patient who has: within 3 weeks of presenting, traveled to an area where Ebola transmission isactive, including travel to, or residence in, Liberia, Guinea, Sierra Leone orNigeria; AND has a fever of greater than 101.5 degrees Fahrenheit, with additional symptomssuch as severe headache, muscle pain, vomiting, diarrhea, abdominal pain,rash, or unexplained hemorrhage; OR had contact with blood or other body fluids of a patient known to have, orsuspected to have, Ebola within 3 weeks of presenting.

Patients meeting these criteria should immediately be reported to DPH at1-866-PUB-HLTH (866-782-4584), while implementing standard, contact,and droplet precautions.

DPH will provide information about appropriate samples and sample handling, ifneeded. Since Ebola is transmitted through direct contact with the blood orbodily fluids of an infected symptomatic person, the presence of these criteriabring the following recommendations:• Isolate the patient: Patients should be isolated in a single patient room(containing a private bathroom) with the door closed.• Wear appropriate personal protective equipment (PPE): Health careproviders entering the patient's room should wear gloves, gown (fluid resistantor impermeable), eye protection (goggles or face shield), and a facemask. • Restrict visitors: Avoid all entry of visitors into the patient's room. • Avoid aerosol-generating procedures: If performing these procedures, PPEshould include respiratory protection (N95 or higher filtering face piecerespirator) and the procedure should be performed in an airborne infectionisolation room.Implement environmental infection control measures: Diligentenvironmental cleaning and disinfection and safe handling of potentiallycontaminated materials is of paramount importance, as blood, sweat, vomit,feces, urine and other body secretions represent potentially infectious materialsshould be done following Ebola infection control protocols. Furtherinformation for health care professionals from the CDC can be found athttp://www.cdc.gov/vhf/ebola/hcp/index.html.

– Brenda Fitzgerald, M.D.Commissioner, Georgia Department of Public Health

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St. Francis Receives 2014/2015 Consumer Choice AwardFor the 10th consecutive year, area consumers have chosen St. Francis Hospital asthe area’s “Consumer Hospital of Choice,” according to data compiled byNational Research Corporation (NRC). The award identifies hospitals that healthcare consumers have selected as having the highest quality, best doctors, bestnurses and best image in more than 300 markets throughout the United States.Winners are determined by consumer perceptions on multiple quality and imageratings collected in the company’s Ticker survey. The NRC study surveys morethan 250,000 consumers in the contiguous 48 states and the District of Columbiaand is the nation’s largest and most comprehensive study of its kind. The studyhas a margin of error of + or – 0.2 percent at a national level.

St. Francis Forms Partnership With Columbus State University Athletic ProgramSt. Francis became the Official Healthcare Provider of Columbus State University’s(CSU’s) Athletic Program August 1. As a result of the new partnership, St. FrancisOrthopaedic Institute (SFOI) physicians conducted annual physicals onapproximately 300 CSU athletes when classes began in August. Additionally, aSFOI physician and nurse will conduct a weekly injured athlete clinic at CSU;athletes with more severe injuries will be seen at SFOI on St. Francis’ maincampus. SFOI surgeons Dr. George McCluskey and Dr. Leland McCluskey andshoulder/elbow fellows Dr. Jason Clark and Dr. Lucas Schnell will providephysician support, including physician coverage at home sporting events.

St. Francis Women’s Hospital to Celebrate First Birthday!The St. Francis Women’s Hospital turns one this month, and you are invited to abirthday celebration from 11 a.m.-2p.m. Sunday, November 9, in the ButlerPavilion. The party will feature lunch, crafts for kids and a photo booth. Bringyour family! Tell your friends and patients. The whole community is invited. Sinceopening in October 2013, more than 1,275 babies have been born at St. Francis—more than double the number originally anticipated.

Attend Diabetes University October 31St. Francis will host a Diabetes University for clinicians Friday, October 31, in theSara Ruth Carroll Auditorium in the Butler Pavilion on St. Francis’ main campus.Registration begins at 7:30 a.m., and the conference will end at 3:15 p.m. Thisyear’s conference will focus on “Proliferating Health Care Challenges: UsingDiabetes as a Model.” This continuing education forum for health professionalswill offer the latest information on research and innovation in diabetesmanagement, patient care and diabetes education. Nationally-accreditedspeakers will discuss these topics:

Health Care Issues Represented by the Problems in Diabetes Care – Congressman Lynn Westmoreland

S T. F R A N C I S N E W S

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2300 Manchester Expressway, Woodruff Pavilion, Suite 201 | Columbus, Georgia 31904706-243-4550 | www.wecareforlife.com

Expertise inNeurology

Welcome Dr. Nojan Valadi

Nojan Valadi, MD

Dr. Valadi is now available to see patients at this location:

St. Francis Neurology is pleased to welcomeneurologist Nojan Valadi, MD. Dr. Valadi isthe medical director of the CerebrovascularDisease and Stroke Program. Dr. Valadibrings with him five years of experience as themedical director of the Stroke Program andEEG Laboratory at The Medical Center, wherehe was also chief of Neurology. He is board-certified in neurology by the American Boardof Psychiatry and Neurology. Dr. Valadi earnedhis medical degree from the Medical Collegeof Georgia (MCG). He completed an internalmedicine internship and neurology residencywith a focus on stroke at MCG, where he waschief resident from 2008-2009. Additionally,he was a member of the Alpha Omega AlphaHonor Medical Society. Dr. Valadi provides hisneurologic expertise to the care of stroke andepilepsy patients, as well as patients withother neurological illness, such as MultipleSclerosis, Dementia and Parkinson’s Disease.

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Prescribing for Diabetes in the New Health Care Environment – Dr. Peter Hoffman, Medical Director, Express Scripts

How Health Insurance Influences Diabetes Care – Mr. Morgan Kendrick, President, GA Blue Cross

PhRMA Approach to the Treatment of Diabetes – Ms. Courtney Keplinger, Director, Public Policy, NovoNordisk Corporation

Treating Diabetes in the New Environment – Dr. Dawn Smiley, Director, Clinical Care for Diabetes, Grady Hospital

Diabetes Devices and Treatment – Dr. Damon Tanton, Medical Director, Florida Hospital System, Orlando

Achieving Clinical Goals With the New Health Care Environment – Dr. Steven Leichter, Senior Physician, The Center for Diabetes and Metabolism, Columbus, Ga.

St. Francis Hospital is accredited by the Medical Association of Georgia to providecontinuing medical education for physicians. St. Francis Hospital designates thislive activity for a maximum number of 5 AMA PRA Category 1 Credit(s)™.Physicians should claim only the credit commensurate with the extent oftheir participation in the activity. For more information, visitwww.wecareforlife.com/diabetesuniversity

Tell Your Patients: Diabetes University for the Community November 1St. Francis will host a Diabetes University for the community Saturday, November 1, inthe Sara Ruth Carroll Auditorium in the Butler Pavilion on St. Francis’ main campus.Registration begins at 8 a.m., and the conference will be held from 9 a.m.-noon. Theevent is free and will focus on news and innovative ways to manage diabetes.

St. Francis to Host Annual Medical Staff Meeting November 10St. Francis will host its annual medical staff meeting from 6-9 p.m. on Monday,November 10, in St. Francis’ Sara Ruth Carroll Auditorium in the Butler Pavilion.All medical staff members are invited. Dinner will be served. Please RSVP to JoryMedical Staff Services at 706-660-6095 or email [email protected].

Save the Date!Dr. Rajinder Chhokar to Receive the Butler Service and Leadership Award January 27Pulitzer Prize Winning Humorist Dave Barry will entertain guests.Rajinder Chhokar, MD, will receive Dr. Clarence C. Butler Service and LeadershipAward on Tuesday, February 4, at the Columbus Convention and Trade Center.Known for her leadership, compassion and excellence in patient care, Dr. Chhokarwill be the 11th recipient of the esteemed award. As Columbus’ first femalecardiologist, Dr. Chhokar has pioneered numerous advancements in cardiologyduring her 32 years of practice in Columbus. She, along with Dr. Gordon Miller,

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brought angioplasty to the community and were the first two physicians inColumbus to perform the procedure. Over the years, Dr. Chhokar became aspokesperson and an advocate for bringing many more advancements incardiology to St. Francis and the region. Those advancements includeinterventional cardiology, including stent procedures and treatment forperipheral vascular disease, plus electrophysiology. Dr. Chhokar’s passion forexcellence has driven her to improve patient care protocols. She wasinstrumental in helping to reduce the door-to-balloon time for heart attackpatients coming to St. Francis’ Emergency Room to under 90 minutes.

The dinner will feature humorist Dave Barry, who for many years wrote a syndicatednewspaper column that appeared in more than 500 newspapers. In 1988, Barry wonthe Pulitzer Prize for commentary. He has written more than 30 books, including thenovels Big Trouble, Lunatics, Tricky Business and, most recently, Insane City. He hasalso written a number of books with titles like I'll Mature When I'm Dead. Two ofBarry's books were the basis for the CBS sitcom Dave's World.

The Dr. Clarence C. Butler Service and Leadership Award was established in 2004to honor highly respected physicians, whose qualities of leadership, vision andinspiration, as exemplified by Dr. Butler, have left an enduring mark on ourcommunity’s health care. For individual or table reservations to this black tieevent, call the St. Francis Foundation at 706-653-9375 or visitwww.wecareforlife.com.

Mark Your Calendar!Medical Staff Holiday Party Coming December 12The St. Francis Hospital Board of Trustees and hospital administrators invite theSt. Francis Medical Staff to a Physician Holiday Party at 6 p.m. on Friday, December12, in the Sara Ruth Carroll Auditorium in the Butler Pavilion. Please RSVP toMedical Staff Services at 706-660-6095 or e-mail Jory Prather [email protected].

November CME OpportunitiesSt. Francis will offer these CME opportunities in November:Cancer Conference: Wednesday, November 12, 12:30 p.m., Lecture Hall in theButler Pavilion. Lunch will be provided. A reservation is not required. For moreinformation, contact Ruby Gladney at 706-660-6096 or [email protected] Cancer Conference: Friday, November 14, 7-8 a.m., Lecture Hall in theButler Pavilion. Breakfast will be provided. A reservation is not required. Formore information, contact Ruby Gladney at 706-660-6096 [email protected] Conference: Tuesday, November 18, 6 p.m., Lecture Hall in the ButlerPavilion. Dinner will be provided. For more information or reservations, contactTeresa Loney at 706-596-4181 or [email protected].

St. Francis Hospital is accredited by the Medical Association of Georgia to provide continuing medicaleducation for physicians. St. Francis Hospital designates this live activity for a maximum number of 1AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extentof their participation in the activity.

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call. Columbus Hospice’s staff is experienced with all the answers to questions racing through your head. The earlier you call, the sooner you will discover the advantages Columbus Hospice has to offer you. Let us provide support and comfort during your time of uncertainty. When should you call Columbus Hospice? As soon as

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Becky Abell, M.D. earned her medical degree from MedicalUniversity of South Carolina, Charleston. She completed herresidency in emergency medicine at Brooke Army MedicalCenter, San Antonio, TX. Dr. Abell is board certified by theAmerican Board of Emergency Medicine. She is a fellow ofthe Academy of Wilderness Medicine and has been aninstructor, Outworld Medical Rescue Services, Belize, CentralAmerica. She practices emergency medicine at St. FrancisHospital, Columbus, GA. Her office phone is 706-596-4121.Welcome Dr. Abell to Muscogee County Medical Society!

Juan Ayerdi, M.D. earned his medical degree from FranciscoMarroquin University and Medical School, Guatemala City,Guatemala. He completed his residency in general surgery atthe University of Massachusetts Medical Center, Worcesterand at The Guthrie Clinic and Robert Packer Hospital, Sayre,PA. Dr. Ayerdi completed an endovascular fellowship and avascular surgery clinical fellowship at Southern IllinoisUniversity School of Medicine, Springfield, IL. He was formerdirector of endovascular therapies at Wake Forest Universityand a vascular surgeon in Macon. He is the recipient ofseveral research awards and author of book chapters andpeer review articles about vascular conditions. He is aDiplomate of the American Board of Surgery and certified bythe American Board of Surgery Vascular Surgery. Dr. Ayerdipractices at St. Francis Cardiothoracic and Vascular Institute,2300 Manchester Expressway, Butler Pavilion, Suite 1009,Columbus, GA 31904. His office phone is 706-596-8200. Wewelcome Dr. Ayerdi to Muscogee County Medical Society!

Rhoda J. Donat-Flowers, D.O. earned her medical degreefrom University of Medicine and Dentistry New Jersey-Schoolof Medicine, Newark, NJ. She completed her residency infamily practice at UMDNJ-SOM. She is board certified infamily medicine by the American Osteopathic Board of FamilyPhysicians. She practices family medicine in Columbus.Welcome Dr. Donat-Flowers to the Muscogee County MedicalSociety!

W E L C O M E N E W P H Y S I C I A N M E M B E R SWe welcome our new physician members to the

Muscogee County Medical Society:

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Amanda W. Du Sablon, D.O. – resident member, earned hermedical degree from the University of Pikeville-KentuckyCollege School of Osteopathic Medicine. She in her firstyear of residency at the Midtown Medical Center FamilyResidency Program. She is sponsored by MCMS memberDr. Ferdinand Alcaide. Welcome Dr. Du Sablon to MuscogeeCounty Medical Society!

Rembert Andrew “Drew” Williams, M.D. earned hismedical degree from Louisiana State University School ofMedicine. He completed his residency in family practice atthe Medical Center, Columbus, GA. He practices emergencymedicine at St. Francis Hospital, Columbus, GA. His officephone is 706-596-4121. Welcome Dr. Williams to MuscogeeCounty Medical Society!

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Midtown Medical Center and Doctors Specialty Hospital Merge Midtown Medical Center and Doctors Specialty Hospital have merged into oneorganization, Columbus Regional Health officials announced Oct. 2. The mergedhospital will retain the name Midtown Medical Center, using a designation of“West” to indicate the former Doctors Specialty Hospital location at 616 19thStreet. “With only 500 feet separating the two facilities, they effectively have beenoperating as one for some time,” said Scott Hill, president and CEO of ColumbusRegional Health. “We have consolidated a number of services over the past fewyears because it was not efficient to operate duplicate services in adjacentfacilities,” he added. Recent examples include consolidation of emergencyservices in June 2012 and obstetrics services in October 2013, both at MidtownMedical Center on Center Street. “Merging the two under one license formalizesthis process and enhances our ability to be good stewards of our health careresources by operating as one hospital,” Mr. Hill said.

Built in 1975, Doctors Hospital was licensed as an acute-care hospital offeringgeneral medical-surgical services. In addition to inpatient and outpatient services,the facility now houses Columbus Regional Health’s MyCare Urgent Care Centerand MyCare Pharmacy. The facility also houses Columbus Specialty Hospital, along-term acute-care “hospital within a hospital.” This is a separately owned andoperated facility caring for medically complex patients after they are dischargedfrom inpatient stays at traditional acute-care hospitals. In addition, ColumbusHospice opened an inpatient unit in the facility on Oct 13.

Expansion, Renovation at Midtown Medical CenterSeveral current expansion and renovation projects on the fourth and fifth floorswill enhance services at The Children’s Hospital at Midtown Medical Center. Onthe fourth floor, three major goals have been established; namely, the upgradingand expansion of the Neonatal Intensive Care Unit to 46 private rooms, theupgrading of the Caesarean section operating room suites, and the streamliningof patient and staff flow to improve the patient and physician experience. Therenovation and expansion of the region’s only Level III Neonatal Intensive CareUnit will include a 46-bed private-room unit for added privacy and security. Theunit will be contiguous to Labor/Delivery/Recovery (LDR), C-Section operatingrooms and recovery rooms. A dedicated NICU Family Support area will be addedand improved infant abduction security systems will be incorporated. Renovationof the fifth floor, which began in April 2014, is set to open in February 2015. Thepediatric inpatient services will feature 26 all-private rooms, a 5-bed intermediatecare step-down/observation unit, a 5-bed state-of-the-art Pediatric Intensive CareUnit, a Child Life Program and a Family Resource Center.

NICU QI Team Selected to Present at National QI Conference The neonatal “Brain Savers” Quality Improvement team at Midtown MedicalCenter has been chosen to present their work on “Reducing the Incidence of

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Intraventricular Hemorrhage in a Regional Neonatal Intensive Care Unit” at theAnnual Quality Congress of the Vermont Oxford Network (VON), a globalneonatal quality collaborative. Their work uses the quality improvementmethodologies of the network to implement interventions, both pre- andpostnatal, designed to reduce the incidence of intraventricular hemorrhage ininfants born before 31 weeks gestation. One of the main accomplishments in thefirst nine months of the two-year project involves markedly enhancedcollaboration between neonatal and obstetric staff to improve adoption ofantenatal interventions to improve outcome for babies at risk. Another isdeveloping family engagement and empowerment to improve standardization ofinterventions including a “Golden Hour” bundle. The team, which includesnurses, parents, and physicians, as well as respiratory, pharmacy and nutritionstaff, was chosen for both a podium presentation and to be featured in the“Guided Poster Walk.” The 2014 VON Quality Congress, “Reducing MajorMorbidities in the NICU,” will be held Oct, 30-Nov. 2 in Chicago.

Columbus Hospice Opens at Midtown Medical Center WestA Ribbon Cutting and Open House was held Oct. 8 for a 10-bed hospice inpatientunit that will open on Oct. 13 on the fifth floor of Midtown Medical Center West.The unit has nine private patient rooms and one private room for a pediatrichospice patient. The unit will allow Columbus Hospice to continue to serve theirend-of-life hospice patients who need aggressive management of their pain andpalliation of symptoms and to help them transition to end-of-life care morequickly and comfortably. The unit is available for patients from all local hospitals.When the new unit opens, Columbus Hospice patients and their families willcontinue to have the option of receiving care at the Hospice House onMoon Road.

Breast Cancer Luncheon to Help Purchase Biopsy Equipment More than 1,200 people attended the 12th Annual Breast Cancer AwarenessLuncheon on Oct. 7 at the Columbus Convention and Trade Center. Proceedsfrom the event sponsored by Columbus Regional Health Foundation will be usedtoward the purchase of biopsy equipment to enhance the detection of breastcancer and a blanket warmer to comfort patients during mammography anddiagnostic procedures at Columbus Regional Breast Care Center.

Auburn University Dance Marathon Pledges $500,000 to Pediatric ServicesStudents representing the Auburn University Dance Marathon were recognized atMidtown Medical Center on Oct. 3 for the organization’s work in raising fundsfor The Children’s Hospital at Midtown Medical Center. The organization hasalready raised more than $350,000 in three years and has pledged to raise anadditional $500,000 over the next three years. The Auburn University DanceMarathon is a yearlong fundraising event on campus that will culminate in a 12-hour dance marathon on Feb. 7, 2015. All proceeds from their efforts benefit theChildren’s Hospital at Midtown Medical Center.

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Clinical Trials Being Conducted for Patients with GoutColumbus Regional Research Institute (CRRI) is conducting research on a newtreatment for gout. The purpose of this study is to see whether an investigationalmedication can safely and effectively lower the high uric acid levels that causegout. Gout is urate crystal induced arthritis, which affects approximately 8 millionAmericans. It is caused by the build-up of uric acid in the body, which can beassociated with a broad range of health conditions. Adult patients, age 18+, witha history or presence of gout, which have experienced at least 1 gout flare in thelast year may be eligible to participate. For more information regarding trialeligibility, referring patients or all currently enrolling trials, contact Lee Starling at706-321-0495 or [email protected].

CME Opportunities Offered for PhysiciansEach of the following Continuing Medical Education (CME) opportunities forphysicians has been approved for one hour of CME credit:Pediatric Grand Rounds: Every Thursday, 8:15 a.m., Columbus RegionalConference Center at Midtown Medical Center. Open to any physician or otherhealth professional providing care for children. For more information, call LoriSitch at 706-571-1220. Cancer Conference: Every Monday, 12:30 p.m., Conference Room at the John B.Amos Cancer Center, except for first Monday which is held at Columbus RegionalConference Center at Midtown Medical Center. (Approved as a series.) For moreinformation, call 706-571-1102.Thoracic Oncology Conference: 1st and 3rd Friday, 7 a.m., Conference Roomat the John B. Amos Cancer Center. For more information, call 706-571-1102.

Midtown Medical Center is accredited by the Medical Association of Georgia toprovide continuing medical education for physicians. Midtown Medical Centerdesignates this live activity for a maximum of 1 AMA PRA Category 1 CrediT™.Physicians should claim only the credit commensurate with the extent of theirparticipation in the activity.

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M A G N E W SBy Fred Flandry, M.D., F.A.C.S.

MAG BOD Report 10/17/14

The MAG Board of Directors met on October 17 at Callaway Gardens in advanceof the House of Delegates annual session. The following is a summary of thesignificant items of discussion and action.

MAG Premier Connect: A Georgia Health Information NetworkMAG is undertaking the formation of a Health information network modeled afterthe successful Kansas network. The network offers GA providers a repository ofpatients’ personal health information including past diagnosis codes andprocedures, medications, allergies, immunizations, lab data, syndromicsurveillance, etc. all through a secure portal that can function seamlessly andacross most EHR platforms.

MAG sees formation of such networks as a trend and feels it would be best forsuch a network in Georgia to be owned and managed by physicians rather thanby a third party entity. It is not a stretch to envision that in the future, review of apatient’s health information stores on such exchanges when rendering treatmentmay become standard of care. A detailed summary of MAG’s business plan isavailable at the MCMS society office if you would like more detail.

Treasurer’s ReportMAG is projecting a surplus of $180,000.00 for this fiscal year. Though the surpluswas 10% below projected, the mortgage on the MAG headquarters was paid off,the prepayment penalty resulting in the shortfall over projected, but the savingsfor prepaying the mortgage will save $400,000.00 over the next 12 years. As aconsequence of the 5 year strategic plan instituted in 2009 when we were upsidedown, MAG is now profitable annually with $400,000.00 in operating reservesand $675,000.00 in long term invested funds.

As a reminder, MAG has a 401K plan in which member practices that do not havetheir own plan may participate.

Legislative agenda for the 2015 Georgia General AssemblyA summary of MAG’s advocacy efforts in the 2014 Georgia General assembly havebeen summarized and are available through the MCMS office.

MAG has established the following priorities for the upcoming session:• Preserving physician autonomy including transparency and physician decisionsas prevailing.• Third party payment: Prohibiting “All-products clauses” in contracts. Reducingadministrative burdens and delays in credentialing.• Tort reform: Preventing phantom damages.• Increasing access to care in Georgia.

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• Monitoring credentialing by CMO’s.• Promoting medical education, recruitment, and retention in Georgia.• Medical cannabis: Supporting the limited use of cannabinoid oil for medicaldisorder under strict physician supervision. Opposing recreational use ofcannabis.

Executive Director ReportMr. Palmissano offered the following action items for the coming year:

• Continue dissemination information on how ACA and other federal and statelaws will impact our practice of medicine.• Identify how Georgia will implement ACA and work to insure that anyimplementation is favorable to physicians ability to provide optimal medical careto their patients.• Partner and increase consensus with specialty societies.• Refine the process that MAG uses to establish legislative priorities.• Be an indispensible resource for members on how to handle items related toMedicaid, Medicare, and commercial insurance.• Develop a long-range financial plan that includes setting aside reserves equal to6% of annual expenses per year beginning FY 2013.

Blue Cross Blue Shield is sending out “amendments” to Georgia contracts thatare, in essence, new contracts. The Commissioner of Insurance has not approvedthis new contract, and MAG believes it is in contradiction to the many existinglaws. MAG is working through the Commissioner of Insurance and may considerlegal action if necessary. Should you receive such an “amendment” you are urgedto study it carefully and contact MAG’s Executive Director’s office with anyconcerns.

2013 House of DelegatesA final report on the status of all action items coming out of the 2013 House ofDelegates is available through the MCMS office.

Physician Foundation SurveyA survey conducted by the Physician’s Foundation yielded the following:• 46% of physicians give ACA a grade D or F, only 25% give it an A or B• 81% (up from 75%) physicians describe themselves as overextendedonly 19% physicians say they have time to see more patients• 39% physicians plan to accelerate retirement due to new healthcare laws• 17% (down from 25%) physicians are in solo practice• 72% physicians believe there is a physician shortage• 35% (down from 49% 2012 and 62% 2008) are independent practice owners• 7% physicians now practice direct pay / concierge medicine, 13% currently planto transition to this model, and 17% physicians under age 45 plan to transition tothis model.

It is my ongoing pleasure to represent MCMS to the MAG Board. I am happy toindividually discuss any board proceedings and actions with you at any time.

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A R T I C L E O F I N T E R E S TBy Woodrow McWilliams, M.D.

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Obesity Is a Major Risk Factor for Cancer

The prevalence of obesity has increased at an alarming rate over the past threedecades in the U.S. and abroad. Greater than one third of adults (over 72million) and 17% of children and adolescents are listed as obese in the U.S. TheAmerican Medical Association now recognizes it as a disease state. There remainsdebate on the true definition of obesity; however, the WHO classifies overweightas BMI between 25-29.9 kg/m2 while obesity is classified as BMI greater than orequal to 30 kg/m2. It plays a known role in several major illnesses includingdiabetes mellitus, cardiovascular disease and malignancy, in terms of both riskand mortality. It is estimated that as many as 84,000 cancer diagnoses can beattributed to obesity annually.

Obesity is a major under-recognized factor in our national cancer toll. It isquickly overtaking tobacco as the leading preventable cause of cancer. It isimplicated in 15-20% of total cancer-related mortality. For example, breast andprostate cancer are both the second leading cause of cancer mortality in womenand men, respectively. A recent meta-analysis of more than 200,000 breast cancerpatients over 82 studies showed a 75% increased mortality in premenopausalwomen and a 34% increased mortality in postmenopausal women who wereobese at diagnosis compared to women with normal BMI. Interestingly, menwith BMI over 30 kg/m2 appear to be at increased risk of developing biologicallyaggressive prostate cancer and more likely to be diagnosed with advanced diseaseat presentation. Given the excellent disease-specific prognoses for thesemalignancies, it is suggested that the link between obesity and cancer recurrencemay have a significant impact on survivorship.

Thus, the American Society of Clinical Oncology (ASCO) recently released anofficial statement on its commitment to reducing the impact of obesity on canceroutcomes. It announced its strategic priorities to address the obesity-cancer link.

It plans to increase education and awareness of the evidence linking obesity andcancer risk. A recent report showed that most Americans are unaware of theincreased risk of cancer with obesity. There are some populations that are atparticular risk related to ethnicity (i.e., African Americans and Latinos) andsocioeconomic level. The oncology care team has a unique opportunity toeducate about healthier lifestyle choices. The beginning of treatment is a criticaltime to establish rapport with patients. As providers, we must create arelationship based upon partnership without paternalism so that patients will bereceptive to our recommendations. ASCO plans to integrate weight managementinto the oncology training curriculum and foster relationships with otherorganizations having a common goal.

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It will provide tools and resources to aid practicing clinicians in addressingobesity with their patients. This will include the development of practicalrecommendations and guidelines as a part of clinical practice. Data has shownthat the most effective interventions for weight loss combine nutrition education,diet/exercise counseling, and behavior strategies to help patients struggling withtheir weight to successfully implement lifestyle modifications. The importance ofthis intervention has also been recognized locally. The John B. Amos CancerCenter has launched a weight control intervention program with our NutritionServices specifically targeting survivors of breast cancer.

ASCO is promoting a robust research agenda to better understand the impact ofbehavior modification on cancer outcomes. This will include standardization ofbest practices for helping survivors make effective changes after diagnosis. Asummit is planned for a transdisciplinary consortium of investigators to planfuture endeavors in this area of research. This also will include advocacy toincrease funding for investigation in key gap areas.

Obesity is a multifaceted, societal problem with many entrenched, contributingfactors. As with other US public health challenges, ASCO recognizes that policyis necessary to create an environment for social change in this arena. Thisinitiative will require promoting healthy communities and workplaces, obesityscreening/treatment, and access to effective therapies. ASCO has beenadvocating to CMS to add obesity to the list of diseases eligible for the proposedcomplex chronic care service payments. It has also encouraged the Departmentof Health and Human Services to clearly define access to obesity-specifictherapies in the new state health care exchange plans. As more evidencebecomes available, ASCO will advocate for more coverage of proveninterventions in the cancer population.

Traditionally, we as oncologists have not been involved in implementing weightloss programs for our patients. As survivorship for certain malignancies hasimproved, we increasingly recognize our responsibility to play a role in weightmanagement for our patients. The John B. Amos Cancer Center has recentlyimplemented a survivorship clinic to assist with long-term patient care. Weightcontrol is part of the initiative in overall health maintenance for survivors. ASCOalso acknowledges the importance of the members of the oncology care teamleading by personal example.

Thus, as evidence continues to mount linking obesity to cancer risk andoutcomes, ASCO recognizes the need for concerted action to convert thisknowledge into meaningful action. As the organization representing the nation’scancer physicians, it has formally made a commitment to promoting education,research, and policy changes to reduce the impact of weight on public health andon cancer risk and prognosis.

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Ebola Update

Ebola news is constantly changing and we are unable to keep up with the pace ofthe information being made available. According to the CDC, there have been morethan 4000 deaths from Ebola. According to WHO, approximately 400 healthcareworkers have contracted Ebola and more than half have died. On September 30,2014 the first laboratory confirmed case of Ebola was diagnosed in the UnitedStates. The patient had travelled to Dallas, Texas from West Africa. He wasasymptomatic when leaving Africa, but developed symptoms approximately fourdays after arriving in USA. Two healthcare workers who provided care to the patienthave now tested positive for Ebola, with the second worker now being treatedat Emory.

The U.S. has already opened a state of the art Ebola Treatment Unit (ETU) in WestAfrica and plans to open approximately 18 more ETUs. These workers need to betrained. The CDC has launched a training program at a former army base inAnniston, Alabama. CDC instructors will lead students through three days ofpracticing triage. Students will be instructed on how to remove masks, goggles,aprons, suits, gloves and boots without letting any potentially contaminatedsurfaces touch their skin. The CDC says a “buddy system” is essential for health-careworkers to ensure the proper removal of protective gear. At this time there are noplans to offer the training to medical workers here in U.S. facilities.

In the United States, we have started screening travelers from West Africa arriving atfive of the country's largest airports. The screenings will be at New York's John F.Kennedy International Airport, Newark Liberty in New Jersey, Washington Dulles,Chicago O'Hare and Hartsfield-Jackson Atlanta. According to the CDC, theseairports receive more than 94 percent of travelers from the countries hardest hit byEbola, with JFK accounting for nearly half of them.

Despite all the negative news, there have been no new Ebola cases in Nigeria orSenegal since 9/5/14 and 8/29/14 respectively. Hospitals and healthcare workersmust prepare themselves and follow the CDC recommendations of:

(1) Increased vigilance in inquiring about a history of travel to West Africa in the 21days before illness onset for any patient presenting with fever or other symptomsconsistent with Ebola;(2)Isolate patients who report a travel history to an Ebola-affected country(currently Liberia, Sierra Leone, and Guinea) and who are exhibiting Ebolasymptoms in a private room with a private bathroom and implement standard,contact, and droplet precautions (gowns, facemask, eye protection, and gloves); (3) Immediately notify the local/state health department.

A R T I C L E O F I N T E R E S Tby Saeed A. Baloch, M.D.

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According to the CDC website, a dedicated CDC Response Team can be on theground within a few hours at any hospital that receives a confirmed patient withEbola. The CDC Response Team would provide in-person, expert support andtraining on infection control, healthcare safety, medical treatment, contact tracing,waste and decontamination, public education and other issues. The CDCResponse Team would help ensure that clinicians, and state and local publichealth practitioners, consistently follow strict standards of protocol to ensuresafety of the patient and healthcare workers.

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NOVEMBER 2014

Thank you!

2014 MCMS Delegates to MAG

October 18th and 19th

W. Frank Willett, III, M.D., Chair

Michael J. Borkat, M.D.

Benjamin H. Cheek, M.D.

Frederick C. Flandry, M.D.

Glenn E. Fussell, M.D.

James R. Hagler, M.D.

James D. Majors, M.D.

Folarin A. Olubowale, M.D.

Karen A. Stuart, M.D.

Joseph R. Zanga, M.D.

Alternate Delegates:

Larry Brightwell, M.D.

Henry Ngo, M.D.

Kenneth L. Smith, M.D.

Timothy P. Villegas, M.D.

John Watson, M.D.

2015 Muscogee County Medical Society Dues have been mailed

and invoiced. Please call if you did not receive an invoice

706-322-1254

If you would like to write an article for “The Bulletin”

Contact Dr. David Levine or Dr. Casey Geringer

Please send all practice changes of phone, retirement or address to:

706-322-1254 phone or [email protected]

M C M S U P C O M I N G E V E N T S

A R T I C L E O F I N T E R E S Tby Vincent Naman, MD

An Anniversary to Remember

For most of the past 10 years, I have been traveling to Mexico for a week of missionwork with the Christian organization, International Medical Assistance or IMA. By2010, I felt ready to bring my whole family with me to share in the joy of servingothers in a Christian setting. My wife, Dian, is a nurse and my 4 children rangedin ages from 15 to 23. It seemed to be the perfect time to have a ‘mission vacation’.What follows is an account of that trip to Valladolid, Mexico.

IMA has set weeks where plastic surgery is offered, including 2 weeks in June. Tocoordinate with everyone’s schedule, the week we chose to travel was also theweek of our wedding anniversary. And not just any anniversary, our 25thanniversary! It was probably not the way we would have envisioned spending sucha special day if you asked us years earlier, but my loving wife was willing to goalong with the plan. My son invited one of his buddies, so all in all, there were 7of us leaving Columbus together on that Saturday morning.

The flight from Atlanta to Cancun was relatively short. Going through customsthough can sometimes be as long as the flight. Years earlier I had the silly idea topack my medical supplies in containers that would look nothing like luggage. Iquickly learned that such a package attracted the attention of customs. I’ve spentover an hour answering questions about the items I was bringing into theircountry. They wanted to know if I was selling it and if so, what the value was sothat I could pay the appropriate tax. After showing letters of invitation from themayor of Valladolid, the tax collectors would not be satisfied until money was leftbehind – some negotiated amount of US Dollars. By 2010 I knew better. Comingwith my whole family, dressed like I am about to spend a week in Cancun, andcarrying all my medical supplies in typical suitcases, we cruise through customslike a tourist!

Next, we gather all our bags and head to the outdoor meeting place – tables andchairs that serve as overflow seating to an adjacent restaurant. This is where wemeet Maria, the coordinator for the volunteers, and all the others who are arrivingfor the coming week of work. We will stay at the airport until all the volunteershave arrived so that we can leave together. This can take hours, but it is a greattime to meet and get to know the other volunteers. There are many teenagers thatcome in June, so my kids quickly make friends and have them all playing cardgames to pass the time. Meanwhile, I get to meet up with old friends I’ve beenworking with for years and prove to them that I really do have a family.

Once all the volunteers are present (about 30 of us) we are placed on a large, air-conditioned comfortable tour bus. The newbies imagined a comfortable 90minute ride all the way to Valladolid, but I had already warned my family that this

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was only the bus that takes us from the airport to the Sam’s club parking lot 5miles away where our vintage school bus would be waiting to carry us for theremainder of the trip. Turns out that the Cancun airport will not allow that businto the bus-stop area where beautiful new charters take waiting vacationers totheir luxurious hotels in Cancun, Playa de Carmen or Cozumel. The bouncyschool bus with all the windows down and lots of chatter amongst the newlymade friends makes this trip seem more like we were off to summer camp.

Once in the beautiful ancient city of Valladolid, we get our room assignments atthe hotel located in the city center. The rooms are comfortable and clean, butmarkedly simple. We are told to meet back downstairs to be transported (byschool bus) to supper at the clinic. After giving God thanks for allowing our safetravel and providing the food, we enjoy the first of the delicious and healthymeals that we will be enjoying throughout the week. Already, my wife iscomfortable with the fact that her family will be well fed without her having tocook! The ground rules are discussed and we break for the evening, ready to startSunday morning. Sunday we are to organize the supplies that we take to thevillages – medications, reading glasses, etc. Those working in the surgery centerwill organize their ORs, gather instruments and supplies, assign scrub techs,nurses for recovery and circulators. We also have an all day clinic where we selectthose patients who will be having surgery over the next 5 days. Sunday night isa treat as there is always a live band and dancing in the street along with manyvendors. This takes place in the central park right outside our hotel.

Monday starts the real work. Half of my kids head off to the villages, while theother half help in the OR. Dian works in the Recovery Room. It seems a lot likeworking at home but with several distinct differences. First, our day starts with agroup breakfast. Then we have a brief bible study/devotion and singing of praisesongs. While this delays the start of our day, we all start out with great attitude.Second, the atmosphere is much friendlier and familiar. We all work on a firstname basis. We share all meals together and we have a lot of patience since mostof us are working outside of our traditional roles. Third, everything isdocumented in Spanish. Most of the volunteers speak English, but thecommunications with the patients are in Spanish (or a Mayan dialect) and thenotes in the chart are written in Spanish. I challenge myself to do this withminimal help, but there are plenty of translators available. Lastly, the medicalproblems are somewhat unique such as a teenager with a cleft palate that hadnever received any surgical care until our visit. This is something you may neversee in the U.S.

The volunteers who went to the villages (self named ‘the village people’) got tosee the real living conditions of the people we were serving. They listened totheir complaints, distributed medications, gave away reading glasses (critical tothe older population who make money selling handmade crafts) played with thechildren and shared the love of God.

Our anniversary fell on a Wednesday. That morning they presented us with a cake

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and a small Teddy Bear with a ‘25’ tag around its neck. Our kids were all there tohelp us celebrate. It was really special.

Friday comes before you know it. The people we met the previous Saturday feellike old friends. We plan a half-day so people can make a trip to the ancientpyramids of Chichen Itza or enjoy a swim in one of the Cenotes (natural sinkholesinto groundwater). Saturday is for good-byes to our new friends from Valladolidand IMA. Our family tacks on a couple of extra days to enjoy the sun, sand andsurf of Playa de Carmen before heading back to Georgia. Awesome! While not atraditional way to spend a 25th anniversary, I’m sure Dian would agree that it wasperfect in many ways. We have gone back together 3 more years since that trip.

Learn more about IMA at www.chosenima.org and we’ll try to post photos on theMCMS website.

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