2003mayjun

House author Representative Steve Smith (R)

District 33A

Senate author Senator Dallas C. Sams (DFL)

District 11

FairContractingCoalition

BillAdvances

In this issueJCAHO Patient Safety Goals

Medical Student Admissions ReportBMP Complaint Review Activities

2002 MMA Resolutions Status

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Medical Malpractice Crisis:Managing Risk After Tort Reform

Guest Speakers:Maslon Edelman Borman & Brand, LLP:

John Provo, J.D.Susan Oliphant, J.D.Laurie Kindel, J.D.

Morgan Stanley:Trey Seitz

Thursday, June 12, 2003Town & Country Club

300 Mississippi River Boulevard NorthSaint Paul, MN 55104

Wednesday, June 11, 2003The Metropolitan

5418 Wayzata BoulevardMinneapolis, MN 55416

Registration FormBy E-mail: Send e-mail to [email protected] listing all of the registration and payment information

stated below.By Fax: Complete the registration form and fax to Jessica Bennett at 612-642-8494.By Mail: Send complete registration form and payment to:

Jessica BennettMaslon Edelman Borman & Brand, LLP3300 Wells Fargo Center90 South Seventh Street

Minneapolis, MN 55402

Payment information:$100 for RMS and HMS members$150 for non-membersEnclosed is my check for $_____________(Payable to Maslon Edelman Borman & Brand, LLP)

Name___________________________________________ Business______________________________________________

Address___________________________________________________________________ Phone_____________________

Attendance date_________________________ Fax__________________ Email__________________________________

Seating is limited and reservations will be made on a first received basis.

Please check box if you prefer a vegetarian meal.

Program Schedule for All Dates:5:45 p.m.-6:00 p.m. Registration6:00 p.m.-7:00 p.m. Dinner6:15 p.m.-6:30 p.m. Laurie Kindel Part I: Effect of Reform on Insurance Coverage6:30 p.m.-7:00 p.m. Susan Oliphant Part II: Minimizing Your Exposure to Claims7:00 p.m.-7:30 p.m. John Provo Part III: Asset Protection Strategies7:30 p.m.-8:00 p.m. Trey Seitz Morgan Stanley8:00 p.m.-8:15 p.m. Q&A

All signs indicate that even the most skilled and diligent physicians will continue to face a high risk of claimsfor malpractice across the U.S. Congress soon will consider major legislative initiatives affecting such claims,including liability limits intended to address the growing crisis in the availability of medical malpractice liabilityinsurance coverage. Hear four experts discuss how Congress’ action will affect:

� Impact of reform on medical malpractice insurance coverage.� How your clinic’s business practices should change after tort reform.� Important steps you should take now if you plan to retire in ten years.� How to protect your family’s wealth for retirement and financial security.

MetroDoctors The Journal of the Hennepin and Ramsey Medical Societies May/June 2003 1

V O L U M E 5 , N O . 3 M A Y / J U N E 2 0 0 3

Physician Co-editor Y. Ralph Chu, M.D.Physician Co-editor Thomas B. Dunkel, M.D.Physician Co-editor Peter J. Dehnel, M.D.Physician Co-editor Charles G. Terzian, M.D.Managing Editor Nancy K. BauerAssistant Editor Doreen M. HinesHMS CEO Jack G. DavisRMS CEO Roger K. JohnsonProduction Manager Sheila A. HatcherAdvertising Representative Betsy PierreCover Design by Susan Reed

MetroDoctors (ISSN 1526-4262) is published bi-monthly by the Hennepin and Ramsey MedicalSocieties, 3433 Broadway Street NE, BroadwayPlace East, Suite 325, Minneapolis, MN 55413-1761. Periodical postage paid at Minneapolis,Minnesota. Postmaster: Send address changes toMetroDoctors, Hennepin and Ramsey MedicalSocieties, 3433 Broadway Street NE, BroadwayPlace East, Suite 325, Minneapolis, MN 55413-1761.

To promote their objectives and services, theHennepin and Ramsey Medical Societies printinformation in MetroDoctors regarding activitiesand interests of the societies. Responsibility is notassumed for opinions expressed or implied insigned articles, and because of the freedom givento contributors, opinions may not necessarilyreflect the official position of HMS or RMS.

Send letters and other materials for considerationto MetroDoctors, Hennepin and Ramsey MedicalSocieties, 3433 Broadway Street NE, BroadwayPlace East, Suite 325, Minneapolis, MN 55413-1761. E-mail: [email protected].

For advertising rates and space reservations,contact: Betsy Pierre2318 Eastwood CircleMonticello, MN 55362phone: (763) 295-5420fax: (763) 295-2550e-mail: [email protected].

MetroDoctors reserves the right to reject anyarticle or advertising copy not in accordance witheditorial policy.

Non-members may subscribe to MetroDoctors at acost of $15 per year or $3 per issue, if extra copiesare available. For subscription information,contact Doreen Hines at (612) 362-3705.

2 LETTERS

3 HMS, RMS, and MMA to Relocate Offices

5 How to Create a Successful Coalition

8 COLLEAGUE INTERVIEWMaureen K. Reed, M.D.

10 Classified Ad

11 JCAHO’s National Patient Safety GoalsAim to Prevent Common Errors

13 Minnesota Board of Medical PracticeComplaint Review Activities

14 U of M Admissions

16 Update on 2002 MMA Resolutions

18 PHYSICIAN’S SOAP BOXCanadian Universal Health Care

21 AMA Code of Medical Ethics

23 2003 Winter Medical Conference

RAMSEY MEDICAL SOCIETY

24 President’s Message

25 Caring Hearts for Homeless People Supply Drive

26 New Members/In Memoriam

27 RMS Pictorial Directory Corrections/Call for Resoltions

28 RMS Alliance

HENNEPIN MEDICAL SOCIETY

29 Chair’s Report

31 New Members

32 HMS Alliance On the cover: The Fair HealthPlan Contracting Coalitiondemonstrates the benefits ofworking with a broad-basedcoalition of providers to securelegislation. Article begins onpage 5.

C O N T E N T S


District 33A


District 11

FairContractingCoalition

BillAdvances




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MetroDoctorsT H E J O U R N A L O F T H E H E N N E P I N A N D R A M S E Y M E D I C A L S O C I E T I E S

Doctors

2 May/June 2003 MetroDoctors The Journal of the Hennepin and Ramsey Medical Societies

Dear Editor:

The fact that there are 42 million uninsuredpeople in the United States does not surpriseme. I see these people every day. I’m aphysician at Model Cities Health Center—afederally funded community health centerwhich offers care to anyone, regardless of theirability to pay.

My uninsured patients spend a lot oftime worrying about getting sick. When theydo fall ill, they anxiously experiment withhome remedies and hope they can recover ontheir own. By the time they come in for amedical appointment, they are very sick. It’soften a case of too little, too late. An illness wecould have easily treated in its early stages hasnow escalated into a full-blown crisis, whichwe may or may not be able to solve.

Here are just a few of their stories. I’vealtered some details to protect my patients’privacy.

Their faces fall as I suggest a CAT Scan toevaluate the abdominal mass I could easilyfeel. Eyes welling with tears, the patient’swife says, “but we don’t have healthinsurance.” My patient had lost his job ofeight years just three months ago. He andhis wife couldn’t afford Cobra coverage.They came to my clinic because they didn’twant to go to the ER.

“I thought it was just him alwaysmisbehaving…” said the father through histears. His son, my patient, never seemed tobe able to stick to one task; he seemedunpredictable, always racing around. Hehad lost 40 pounds in the last two years.Seeing his enlarged thyroid gland, I feltgood knowing that we could cure hisproblem with some simple tests andprocedures. My hopes were dashed when Irealized he doesn’t have health insurance. Iwrote a letter to the state asking for medicalassistance for him, but he was denied.

“I wouldn’t be bothering you if I had themoney” says the 66-year-old man whocomes to clinic for more samples of amedication that has totally changed his life.Medicare doesn’t pay for the expensiveprescription, but without it he has to run tothe bathroom five or six times an hour. Myheart sinks as I look at the empty spot inour clinic’s sample cabinet. I assure mypatient that we’ll call the pharmaceuticalrepresentative for more samples. I’ll alsohave my staff help him fill out anapplication to get free pills from themedication manufacturer. Unfortunately,he may have to wait three or four weeks.

The 50ish woman on the exam tablestrained to retain her composure as I toldher she has diabetes. She had worked all herlife, supported her children and husband.And now here she was with a low payingjob with no benefits and mounting medicalbills. Her application for medical assistancewas turned down because she isn’t poorenough and she doesn’t have enoughunpaid medical bills. I wondered just howmuch unpaid medical debt puts someonein the running for medical assistance. Iasked a county welfare worker who told methe figure was $6,000. So all my patienthad to do was to stop paying any medicalbills, make a few more ER visits to rack upa medical debt of at least $6,000 and thenshe might qualify to get Medical Assistance.And she’d better do it fast if she wantedmedication and supplies to take care of herdiabetes.

Each of the patients described areAmerican citizens trying to do what oursociety requires: work full-time, provide forthemselves and their families, and follow thelaw. Though they are doing what they aresupposed to, they cannot care for their ownhealth—it’s just too expensive.

So many of my patients are not poorenough to qualify for government programs.

They are people from all walks of life. Whilesome of them are knocked down by illness orjob-loss, most work full-time. They just havejobs with no affordable health insurancebenefits. Either they work for businesses thatdo not offer health benefits or they simplycannot afford the benefits that are offered.These hard-working Americans have lesshealth care available to them than peopleliving in Canada or Cuba. For many of them,the costs of insurance and medical care areweighed against equally essential needs likefood, utilities and rent.

We are the richest country in the world.Not one of our people should lack basichealth care services. No diabetic should haveto space out blood sugar testing to once aweek because she can’t afford testing supplies.No person should have to live with anuntreated overactive thyroid. No one shouldhave to deal with the nuisance andembarrassment of running to the bathroomsix times an hour, when one pill could solvethe problem. No one should have to waituntil it’s too late to have his or her cancertreated.

The statistics are sobering. Uninsuredmen are nearly twice as likely to be diagnosedat a late stage of colon cancer as men withinsurance. Women with breast cancer aretwice as likely to die if they are uninsured.And children without insurance are 70percent more likely than insured children notto receive medical care for commonchildhood conditions like ear infections.

It will take each one of us, people bothinside and outside the medical profession, towork together to make high-quality basichealth care accessible for everyone. ✦

Sincerely,Jeevan Paul, M.D.

The Uninsured: Rx Needed Now

L E T T E R S


May/JuneIndex to Advertisers

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I

HMS, RMS, and MMAto Relocate Offices

IN NOVEMBER the joint offices of HMS,RMS, and the MMA will move from Broad-way Place East at 3433 Broadway St. NE inMinneapolis one block west to Broadway PlaceWest at 1300 Godward St. NE.

This move is necessary as the lease expireson the current space on the third floor of Broad-way Place East in November and, more impor-tantly, the space needs of all three organizationshave declined.

After the move to the second floor ofBroadway Place West, the three organizations

will realize a significant savings in rent costs.Conference rooms and other meeting space willcontinue to be available to allow for physicianmembers to meet at the joint offices with freeparking.

In addition to the ability to downsize thespace, the favorable lease terms, along with costguarantees beyond the lease, were importantfactors in the decision. ✦

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O

How to Create a Successful CoalitionThe Saga of the Minnesota Health Plan Contract Act

ON A WARM, JULY AFTERNOON in thesummer of 2000, a group of representatives ofprovider organizations met at the Nicollet Is-land Inn to talk about the need for legislationthat would begin to restore a semblance of fair-ness to the contractual relationship betweenhealth plans and providers. Organized by theHennepin Medical Society and the RamseyMedical Society, the initial meeting included theAdvocates for Marketplace Options forMainstreet (AMOM), the Minnesota MedicalAssociation (MMA), the Minnesota Chiroprac-tic Association, the Minnesota Chapter Ameri-can Physical Therapy Association, theMinnesota Dental Association, the Minnesota

Medical Group Management Association, andthe Minnesota Nurses Association. Over thecourse of the following year the original groupdecided that the Minnesota Fair Health PlanContracting Coalition (MFHCC) should be or-ganized and that additional organizations shouldbe contacted, meetings should be organized, anda goal should be established of developing legis-lation for the 2002 Session.

During the months of 2000 and 2001,meetings of the MFHCC continued to be heldand additional organizations such as the Min-nesota Podiatric Medical Association, the Min-nesota Physician Patient Alliance, the MinnesotaPsychiatric Society, the Minnesota Rural HealthCooperative, and the Northwestern Health Sci-ences University became active members of theCoalition. Although the MMA participated insome meetings, the MMA did not officially jointhe Coalition.

As the sound of the opening gavel of the2002 Session of the Minnesota Legislature camecloser, the members of the Coalition rolled uptheir collective sleeves and began to craft a bill.Meetings were held with greater frequency andintensity. Each provider group brought theirparticular perspective on health plan contract-

ing issues to the table. Coalition Chair PhilRiveness proved to be an excellent choice to chairthe initial efforts of the Coalition as he servedin the State Senate and works as a clinic admin-istrator at the Noran Clinic in Minneapolis.

A bill was drafted and Senator Dallas Samsfrom Staples and Representative LindaBoudreau from Faribault agreed to be chief au-thors in the Senate and in the House. Housefile 2925 and Senate file 2532 were titled theMinnesota Fair Healthplan Contracting Act.The MMA decided that the bill could not besupported because of the consumer disclosureand health plan liability provisions in the bill.Representative Boudreau successfully steered thebill through its initial hearing in the HouseHealth and Human Service Policy Committee.The opponents of the bill, the Council of HealthPlans and the Minnesota Chamber of Com-merce, testified that the provider groups in theCoalition were a fringe group and that no legis-lation was needed.

Passage of the bill out of the first HouseCommittee was viewed as an achievement thatgot the attention of those who said the bill wouldnever receive serious consideration. That suc-cess was followed by the bill clearing the HouseCommerce, Jobs, and Economic DevelopmentPolicy Committee. All the members of the Coa-lition then focused on working together to passthe Minnesota Fair Healthplan Contracting Actin the Senate as the bill moved to the SenateHealth and Family Security Committee. Thebill continued to face stiff opposition from theCouncil of Health Plans and the MinnesotaChamber of Commerce. The increasing opti-mism that members of the Coalition felt afterthe bill moved out of the Senate Health andFamily Security Committee soon turned into

B Y R O G E R K . J O H N S O N , C A EC E O o f t h e R a m s e y M e d i c a l S o c i e t y (Continued on page 6)

Senator Dallas Sams

Editor’s Note: The photos on the cover ofthis issue of MetroDoctors depict some of themembers of the Fair Health Plan Contract-ing Coalition.

In the upper photo (from left) are:David Kunz, Minnesota Chiropractic Asso-ciation; Kathi Micheletti, lobbyist for Min-nesota Medical Group ManagementAssociation; Jack Davis, Hennepin MedicalSociety; Senator Dallas C. Sams (DFL); DaveRenner, Minnesota Medical Association;Dominic J. Sposeto, lobbyist for MinnesotaPsychiatric Society and Minnesota Dental As-sociation; Roger Johnson, Ramsey MedicalSociety; and Michelle M. Barrette, J.D., Min-nesota Podiatric Medical Association.

In the lower photo: 5th person from theleft is Representative Steve Smith (R) picturedwith the members of the Fair Health PlanContracting Coalition listed above.


frustration when Senator Linda Scheid, chairof the Senate Commerce and Utilities Commit-tee refused to give the bill a hearing. As a result,the Minnesota Fair Healthplan Contracting Actdied in the 2002 Session when all the Commit-tee deadlines could not be met due to SenatorScheid’s decision not to hear the bill.

The Coalition did achieve one major ac-complishment in the 2002 Session by blockingthe attempt to move the coverage of care of in-jured victims of auto accidents into managedcare networks. Coalition backed Senate File1226, which was adopted by the Legislature,prevents health plans from forcing physiciansunder contract into networks to care for injuredpersons covered by no-fault auto insurance. Thatlegislation supported by the auto carriers work-ing with the major health plans would have ef-fectively reduced reimbursements to physiciansby 40 percent.

The members of the Minnesota FairHealthplan Contracting Coalition vowed tostick together, continue working through the

summer and fall of 2002, and go back into the2003 Session with a new bill. Phil Rivenessstepped down as chairperson and the memberselected Jack Davis, HMS CEO, to take over thehelm for the 2003 Session.

In an effort to refine the message of theCoalition it was decided that the Coalitionwould develop the guiding principles for faircontracting between providers and health plans.After weeks of meetings and discussions, theMinnesota Fair Healthplan Principles of Con-tracting were approved. The Principles included

policy statements on disclosure of contractterms; the advance notice of profiling of pro-viders; the accountability of health plans formedical decisions; the prohibiting of shadowcontracting; the prohibiting of the use of uni-lateral terms in contracts; the requirement ofan explanation of recoupment; the timely pay-ment of claims; the advance notification to pro-viders of coding changes; and the ability tocomplete efficient prior notification on a 24/7basis.

The Principles became the basis for meet-ings that were held with the health plans in-cluding Blue Cross and Blue Shield, Medica,and HealthPartners to discuss the principles tobe included in contracts and to make an effortto agree on the components of fair contracting.The discussions did provide for a better under-standing of the principles by the health plansand a greater understanding of the health plans’approach to contracting by members of theCoalition. The health plans sought to persuadethe members of the Coalition that legislationwas not needed.

Coalition members determined that theMinnesota Fair Healthplan Contracting Actshould be revised and that the members wouldwork to have it introduced in the 2003 Session.Refinements were made to several sections ofthe bill and members confidently looked for-ward to the renewed effort in 2003.

The Coalition was strengthened with theaddition of the Minnesota Pharmacists Asso-ciation and the Minnesota Occupational Thera-pists Association bringing the total to 15provider organizations working together to im-prove the ability of providers to agree to a faircontract with the health plans.

House File 606 and Senate File 394, theMinnesota Fair Health Plan Contracting Act,was introduced in the 2003 Session by Repre-sentative Steve Smith of Richfield in the Houseand again by Senator Dallas Sams of Staples inthe Senate. Not surprisingly, the bills were op-posed by the Council of Health Plans, the Min-nesota Chamber of Commerce, and theMinnesota Business Partnership. The Chamberand the Business Partnership asserted that re-quiring that the health plans must inform theproviders of their reimbursements would in-crease health care costs. The health plans con-tinued to argue that legislation was not neededas they were working to improve their contracts.

Minnesota Fair Healthplan Contracting Coalition

(Continued from page 5)

Representative Steve Smith

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As the 2003 Session of the Minnesota Leg-islature moved along it was dominated by con-cerns over the deficit that exceeded $4 billion.As a result all legislation that carried a fiscal notefor state spending also became a red flag for leg-islators. While the Fair Healthplan Contract-ing Act did not have state spending implications,the opponents such as the Chamber of Com-merce continued to assert that it would increasehealth care costs since providers who were fullyinformed about their health plan contracts couldnot be trusted to use health care resources wisely.

Members of the Coalition continued toconsider options as the Session moved intoMarch and the first Committee deadline ofApril 4 needed to be met. In an effort to reachout to the MMA and to seek MMA support forthe bill, the Coalition decided to delete the con-sumer disclosure section and to amend thehealth plan liability section of the bill by substi-tuting regulatory review for civil liability. TheMMA Committee on Legislation met and afterreviewing the bill, the Committee recom-mended that the MMA Board of Trustees sup-port the Contract Coalition bill and the promptpay bill the MMA had negotiated with thehealth plans. The MMA Board considered theCommittee’s recommendation on March 22 andvoted to approve the recommendation.

The combination of RepresentativeBoudreau scheduling the bill for a hearing inher Health and Human Services Policy Com-mittee on March 26 and the new support fromthe MMA served as the catalyst for the Councilof Health Plans to begin to negotiate with theCoalition on specific language in the bill. Theresult of those negotiating sessions produced anextensive amendment that was introduced byRepresentative Smith in the House HealthPolicy Committee on March 26. At that hear-ing, the amended bill included much of the newlanguage, however, the bill was opposed by theMinnesota Chamber of Commerce, the Min-nesota Business Partnership, and Blue Cross andBlue Shield, as well as HealthPartners. The Com-mittee voted overwhelmingly to pass the bill andthe bill moved to the House Commerce, Jobsand Economic Development Policy Commit-tee chaired by Representative Gregory Davidsof Preston. The House Commerce Committeesent the bill to the House floor on April 3.

As this issue of MetroDoctors goes to press,negotiations on the sections of the bill that ad-

dress coding changes, the profiling of provid-ers, and regulatory review were successfully com-pleted with the Council of Health Plans toincrease the likelihood of passage of the bill.Members of the Coalition moved over to theSenate where Senator Ellen Anderson’s Com-merce Committee heard the bill and moved itto the Senate floor on April 4. Both H.F. 606and S.F. 394 await votes in the House and Sen-

ate. It appears at press time that this precedent-setting legislation will be adopted and becomepart of Minnesota statutes. For the first time,the basic rights of physicians who contract withhealth plans will be established in statute. Thebenefits of working with a broad-based coali-tion of providers to secure legislation are alsovery evident and bode well for future legislativeactions. ✦


AQ

Maureen K. Reed, M.D.

How does your role as a health plan medical directorpromote your calling to medicine?

A career in medicine is, among other things, a career in self-discovery. Iconfess that I cannot precisely remember how I viewed my calling to medi-cine 25 years ago. But after reading the second Institute of Medicine re-port Crossing the Quality Chasm two years ago, I specifically rememberthinking, “Finally! This is it. This is exactly what health care should be:safe, effective, efficient, timely, patient-centered and equitable.” The re-port is as energizing as it is daunting. The concept that health care mustachieve all of these six aims challenges me as much in my administrativework as in my clinical or my policy work. One can’t divorce the effective-ness of a particular intervention from its timely delivery. One can’t sepa-rate the efficiency of a set of services from their equitable delivery. Andone surely can’t remove patient-centeredness from safety. As a health planmedical director, I find that simultaneously advancing these six aims re-quires tremendous concentration and attention. The fact that health carecurrently falls far short of each of these aims means that committed phy-sicians must remain steadfastly committed to their calling or the qualitychasm will not be crossed.

In your role as a health plan medical director, how do youassure access and quality without denying recommended care?

The solution must be to rely on the evidence that supports best care. Thestruggles of a medical director often revolve around issues of overuse,underuse and misuse. My time is divided between creating and imple-menting programs that will, for example, reduce the use of viral antibiot-

ics for viral illness, increase the rates of lipid, hypertension and glycemiccontrol in members with diabetes, and reduce unnecessary hospitaliza-tions for members whose conditions could be treated in other ways. Anyand all of these changes require that “best care” is known and is promul-gated among clinicians, patients, and health plan medical directors alike.

How do you assure treatment for underserved patients,such as the mentally ill?

This question goes to the heart of the “equitable” aim of health care. Fromthe standpoint of HealthPartners behavioral health, expansion of the pro-vider network is a good example of addressing this concern. Also, patientswith serious behavioral health diagnoses often need additional help infinding the providers best suited to caring for them. For this reasonHealthPartners created the Personal Assistance Line a few months ago,thus making information about care and providers much more readilyavailable to members with behavioral health questions and needs. So far,members and providers have been very pleased with this service. Addi-tionally, HealthPartners has taken action to decrease the social stigma andpromote better identification and treatment of mental health conditions.

In a wider societal sense, the issue of adequately serving theunderserved remains a distant goal. In my internal medicine practice atFremont Community Clinic, the plight of uninsured and under-insuredpatients, new Americans and marginalized fellow human beings is pain-fully visible. Only a strong societal commitment to reducing the formi-dable barriers of health care financing, geographic mismatch betweenproviders and patients, workforce education, workforce mix, and so on willresult in solutions to the problems of unequal access and disparities of care.

Editor’s Note: Maureen K. Reed, M.D., is a medical director and vicepresident at HealthPartners. She provides health plan leadership formedical policy, care management, quality improvement, and physicianrelationships for medical groups affiliated with HealthPartners. In ad-dition, Dr. Reed also practices internal medicine at Fremont Commu-nity Clinic on a part-time basis. She serves as a diplomate in internalmedicine with the American Board of Internal Medicine. She is also afellow of the American College of Physicians. In 1997, Dr. Reed waselected as a regent of the University of Minnesota and is currently serv-ing as Chair of the Board of Regents. She is a national speaker on healthcare quality, service, cost, and safety.

Dr. Reed received her undergraduate and medical degrees from theUniversity of Minnesota, where she also completed her residency.

C O L L E A G U E I N T E R V I E W


(Continued on page 10)

MMA and the MN Psychiatric Society support legislationto integrate mental health and medical/surgical benefitsand administration. This anti-carveout bill will permitfamily doctors and internists to see such patients and bepaid for this. HealthPartners has advertised more choiceand access to mental health professionals. Presently,however, many psychologists are paid a flat case rate of$335/case for their HealthPartners clients. AreHealthPartners enrollees seeking mental health treatmentaware of these stringent care rate limitations?

For years, HealthPartners has reimbursed primary care physicians for treat-ment of behavioral health diagnoses, in recognition of the importance ofan integrated approach to care. About two years ago, HealthPartnersdoubled the size of its behavioral health provider network and movedfrom capitation to case-rate payment for behavioral health providers. Ourmember satisfaction surveys demonstrate that members are significantlymore satisfied with behavioral health care and access now than was thecase prior to this change. Although few members seem interested in pay-ment method information, we make such information readily available toevery member upon request.

What will you do in your roles at HealthPartners and as aUniversity Regent to protect patient care in this environ-ment of severe government budget cutting?

Action by government is simply a manifestation of public will. Some-times the public will is misperceived by elected officials, in which case myrole is to help dispel the misconceptions. In other cases, elected officialsaccurately perceive the public will, but the public does not realize that theconsequences of governmental action are detrimental to the ultimate publicgood. Those cases require that the public be educated as to the true long-term consequences. The current budget dilemma represents both of thesescenarios.

In large part, it has been a massive increase in governmental spend-ing on health care that has necessitated relatively less spending on educa-tion, transportation and the like. I find this deeply troubling. Had wealready wrung the overuse, underuse, and misuse out of health care, wewould not be spending anywhere near what we are currently spending,and we would be demonstrating far greater value for the dollar spent.

But here we are, facing a massive deficit. A deficit due in part tohealth care spending and in part to changes in tax structure. Unfortu-nately, the quickest action that government is inclined to take is reducingor eliminating services to the very vulnerable. The vastly more difficultaction is to fundamentally reform government spending on health care soas to purchase only those services of high value.

I would like to believe that as a society we are not willing to allow ourless fortunate fellow Minnesotans to fall prey to the easy action. I wouldlike to believe that we are willing, instead, to undertake very serious re-form of a vastly more equitable and sustainable nature. My role as a citi-zen and a health care professional is to advocate for this type of change.

How do you balance your role as chair of the University ofMinnesota Board of Regents with a full time job atHealthPartners?

Sometimes not easily! It is a great privilege to serve the University in thesechallenging times, and it is a labor of love. I fully expected that chairingthe Board of Regents would be time-consuming. What I did not antici-pate was the resignation of Pres. Yudof and the presidential search thatensued. Had it not been for the extraordinary support that I receivedfrom colleagues at HealthPartners, it is likely that the search would nothave gone as smoothly or as quickly as it did. The selection of Pres.Bruininks, widely heralded as both pragmatic and visionary, will serve theUniversity and our state exceptionally well. The University is facing un-precedented funding challenges, which have spurred very serious contin-ued discussion about the role and value of the University to Minnesotans.While the forward momentum of the University will continue, the insti-tution will emerge from this era as a changed entity. It is the Board’s roleto guide that change for the benefit of our citizens.

How can organized medicine best support the AcademicHealth Center at the University of Minnesota?

Three years ago the AHC developed a very ambitious strategic plan thatdepends on the involvement of physicians across Minnesota. Organizedmedicine should engage and encourage the AHC in the achievement of thisplan. Furthermore, it should establish the expectation that the AHC put itsresearch, education and service missions toward the explicit realization ofsafe, effective, efficient, timely, patient-centered, and equitable health care.

How should organized medicine exercise physicianleadership in the creation of a better health care system?Are there initiatives that organized medicine and healthplans can work on together to achieve goals that benefitenrollees and patients?

I can think of no higher leadership role for organized medicine than tofully embrace and vigorously champion the six aims called for by the In-stitute of Medicine. These are aims that have the powerful potential tounite and inspire physicians. These are aims that melt away divisions.These are aims that take us back to the reasons we chose medicine in thefirst place.

Although Crossing the Quality Chasm articulates the aims and setsforth some general approaches for achieving those aims, it is not a “howto” handbook. The “how to” remains in the hands of those inside andoutside of health care who care enough to work together on somethingvery, very tough.


Colleague Interview


Are health plans moving toward areimbursement methodology based onphysician quality and outcomes data?

Reimbursement for outcomes is an essential fea-ture of achieving best outcomes. Long beforethe Institute of Medicine promoted outcomespayment, HealthPartners was starting down thisvery path. HealthPartners is currently advanc-ing outcomes payment on multiple fronts: hos-pital care, primary care, and specialty care. Whenoutcomes payment becomes truly widespread,patients and physicians will be the prime ben-eficiaries.

Medical education is a very expensiveprocess. Could you comment on howyou think medical education will befunded 20 years from now?

I am no expert on the funding of medical edu-cation. However, even the casual observer canclearly see that for both undergraduate andgraduate education, the current funding formu-lae and mechanisms do not adequately addresstoday’s circumstances. It is hard to imagine howmedical education can flourish absent nationalreforms that more clearly specify and separatethe roles and responsibilities of private, federaland state funders. ✦

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Chair: Dana Barr, MDEarle Brown Continuing Education Center,St. Paul17.0 Credit Hours

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E


JCAHO’s National Patient SafetyGoals Aim to Prevent Common Errors

ERRORS OCCUR EVERY DAY. But whenmistakes happen in health care, it becomes amatter of life or death.

Advances in medical knowledge, relianceon technology, increasingly multi-faceted healthcare organizations and changes in the way careis delivered all contribute to a complex atmo-sphere that leads to errors. These errors are trag-edies for victims, their families, and the healthcare professionals involved. Yet, many of thesame errors are repeated over and over again athealth care organizations across the country.

Last year, the Joint Commission on Ac-creditation of Healthcare Organizations(JCAHO) called together a distinguished groupof physicians, along with other health care ex-perts, to determine whether consensus could bereached on current patient safety priorities andsolutions. The resulting National Patient SafetyGoals are designed to give focus to evidence-based or expert consensus-based, well-defined,practical and cost-effective actions that havepotential for significant improvement in thesafety of individuals receiving care.

2003 National PatientSafety GoalsSince Jan. 1, 2003, all JCAHO accredited healthcare organizations are being surveyed for imple-mentation of the following recommendations— or acceptable alternatives — as appropriateto the services the organization provides. Alter-natives must be at least as effective as the pub-lished recommendations in achieving the goals.Failure by an organization to implement any ofthe applicable recommendations (or an accept-able alternative) will result in a special Type Irecommendation.

1. Improve the accuracy of patientidentification.

a. Use at least two patient identifiers (neitherto be the patient’s room number) whenevertaking blood samples or administering medi-cations or blood products.

b. Prior to the start of any surgical or invasiveprocedure, conduct a final verification pro-cess, such as a “time out,” to confirm the cor-rect patient, procedure and site, usingactive—not passive—communication tech-niques.

2. Improve the effectiveness of communica-tion among caregivers.

a. Implement a process for taking verbal or tele-phone orders that require a verification “read-back” of the complete order by the personreceiving the order.

b. Standardize the abbreviations, acronyms andsymbols used throughout the organization,including a list of abbreviations, acronymsand symbols not to use.

3. Improve the safety of using high-alertmedications.

a. Remove concentrated electrolytes (including,but not limited to, potassium chloride, po-

tassium phosphate, sodium chloride >0.9%)from patient care units.

b. Standardize and limit the number of drugconcentrations available in the organization.

4. Eliminate wrong-site, wrong-patient,wrong-procedure surgery.

a. Create and use a preoperative verification pro-cess, such as a checklist, to confirm that ap-propriate documents (e.g., medical records,imaging studies) are available.

b. Implement a process to mark the surgical siteand involve the patient in the marking pro-cess.

5. Improve the safety of using infusionpumps.

a. Ensure free-flow protection on all general-useand PCA (patient controlled analgesia) in-travenous infusion pumps used in the orga-nization.

6. Improve the effectiveness of clinicalalarm systems.

a. Implement regular preventive maintenanceand testing of alarm systems.

b. Assure that alarms are activated with appro-priate settings and are sufficiently audible withrespect to distances and competing noisewithin the unit.

Physician involvementin safety goalsAccreditation is at its core a risk reduction ac-tivity, an issue that greatly affects physicians. Notonly do physicians provide care themselves, butthey also affect so much of what others withinthe organization will do clinically. Physicians’profound influence on the processes of care in

B Y W I L L I A M E . J A C O T T, M . D .S p e c i a l a d v i s o r f o r p r o f e s s i o n a lr e l a t i o n s , J C A H O


health care organizations requires that they bepart of the leadership team.

JCAHO believes that physicians play a keyrole on a multidisciplinary health care team, pro-viding clinical leadership and advocating for thequality and safety of patient care. For that rea-son, involving physicians in the accreditationprocess, with its focus on helping health careorganizations improve the safety and quality ofcare, is imperative to the successful collabora-tion between a health care organization andJCAHO. This includes all organization effortsto comply with the National Patient Safety Goals.

Simply put, physicians must be at the verycenter of all team efforts to improve patient care.

Derivation of the safety goalsIn February 2002, the Sentinel Event Alert Ad-visory Group was formed to advise JCAHO inthe development of the goals by assessing theevidence for and face validity of all previouslyissued Sentinel Event Alert recommendations,

as well as the practicality and cost-effectivenessof implementing the recommendations. Namedfor JCAHO’s widely read patient safety advi-sory, the Sentinel Event Alert Advisory Groupis charged with conducting a thorough reviewof all Alert recommendations and identifyingthose that are candidates for inclusion in theannual National Patient Safety Goals.

These candidates are placed in a pool ofrecommendations identified by the AdvisoryGroup as evidence- or consensus-based, cost-effective and practical. Surveyors may discussany of the recommendations in the pool withthe organization as suggestions for improve-ment, but implementation of those recommen-dations that are not related to the NationalPatient Safety Goals will not be assessed andscored.

Each year, new recommendations fromSentinel Event Alert newsletters published in theprevious year will be added to the pool. It isanticipated that the National Patient SafetyGoals established in future years would also belimited to six goals and no more than 12 recom-mendations. Each year, the Advisory Group will

re-evaluate the goals and recommendations, andwill recommend modifications, additions ordeletions to the goals and recommendations forthe next year. The Advisory Group’s recommen-dations for annual National Patient Safety Goalsand associated recommendations are forwardedto JCAHO’s Board of Commissioners for ap-proval. New goals and recommendations areannounced in July and become effective onJanuary 1 of the following year. ✦

Dr. Jacott was appointed a special advisor for pro-fessional relations to JCAHO in January 2002.As special advisor for professional relations, Dr.Jacott serves as JCAHO’s liaison to the AmericanMedical Association Organized Medical Staff Sec-tion, and the American Academy of Family Physi-cians. He also reaches out to state and specialtyphysician societies, hospital medical staffs and otherprofessional organizations such as the AmericanMedical Group Association. Dr. Jacott focuses ontalking with physicians and other health care pro-fessionals in these organizations about priorities andstrategies for improving the quality and safety of care.

JCAHO National Patient Safety Goals


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PDESERVE THE EXPERTISE

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of aroven Professional


TTHE FUNCTION OF THE BOARD of Medi-cal Practice is to protect the public. It does soby ensuring that no practitioner is allowed toenter practice without first demonstrating thathe or she meets the minimum requirements forpractice established by law, and by reviewing allcomplaints regarding the practice of any practi-tioner, and taking appropriate action to ensurethat the practitioner is able to practice with rea-sonable skill and safety.

The complaint review process is, by far,the greatest consumer of resources, in terms ofBoard Member and staff time, and financial re-sources of any activity of the Board.

Broad categories of complaint subjects in-clude: prescribing issues; illness and impairment;and sexual misconduct.

Throughout the years, the Board has en-gaged in a number of educational outreach ac-tivities intended to assist in lowering the incidenceof complaints in these, and other areas. Theseactivities include: conducting continuing medi-cal education seminars throughout the state;offering home-study continuing medical edu-cation courses; and the publication of educa-tional articles in the Board’s newsletter, Update.

Another activity of the Board, intended toreduce complaint volume, is its work in estab-lishing and supporting the Health ProfessionalsServices Program (HPSP). HPSP is Minnesota’sdiversion program for impaired health care pro-fessionals, suffering from mental, physical, orchemical impairments. It is available to all cre-dentialed health care professionals, and is fundedby the health credentialing boards and the Min-

nesota Department of Health. It offers impairedprofessionals an opportunity to address andremediate an impairment outside the traditionalcomplaint review, and disciplinary process, byproviding recovery and practice monitoring ser-vices, which ensure that the professional prac-tices with reasonable skill and safety.

In 1989, the Board offered seminars onPrescribing and Related Documentation in sixcommunities. In 1993, seminars on Boundariesand Communications in the Practice of Medi-cine were offered in six communities. In 1994,this seminar was offered as a home-study course.In 1995, seminars on Cancer Pain Managementwere offered in seven communities. In 1997,seminars on Physician Wellness were offered infour communities. In 2001, seminars on ChronicPain Management: Critical Issues and New Di-rections were offered in 10 communities.

During this time, Update has containedarticles related to these seminars, and specificarticles on numerous other topics of interest tothe practice communities of Minnesota, de-signed to increase professional awareness andincrease practitioner knowledge.

Annual complaint volume rose steadilyduring the early 1980s, and then dramaticallyduring the latter half of that decade. The peakwas reached in the mid 1990s, at just under 1,300complaints per year. The number stabilized forseveral years, then slowly began to decline, withthe current low reached in 2001, at 775.

Several factors account for this trend incomplaint volume, but the Board has reason tobelieve that its efforts to reduce complaints havebeen among them. Specifically, prescribing is-sues, and illness and impairment were both lead-ing subjects of complaints, and causes for Boardorders. Current complaint, and Board order sta-

Minnesota Board of Medical PracticeComplaint Review Activities

tistics show both of these to represent a signifi-cantly smaller proportion of total complaintvolume than previously.

Readers wanting further information aboutthe Board of Medical Practice can call (612) 617-2130. Information on HPSP, and the services itoffers, can be obtained from (651) 643-2120. ✦

Richard L. Auld, Ph.D., is assistant executive di-rector for the Minnesota Board of Medical Practice.

B Y R I C H A R D L . A U L D , P h . D .


T

U of M Admissions

Editor’s Note: The following is a report onthe University of Minnesota Medical SchoolAdmissions Committee, submitted by RogerBecklund, M.D., serving as a representative ofthe Hennepin Medical Society. Dr. Becklund’sterm on this Committee expires this year. Con-tact Jack Davis at the Hennepin Medical Soci-ety if you are interested in serving on thisCommittee (612-623-2899).

THE WORK OF THE 2001-2002 Universityof Minnesota Medical School Admissions Com-mittee was completed with the matriculationof the Class of 2006 this past September.

A total of 1,645 applicants were received,of which 504 were Minnesota residents, and an

802/843 female/male ratio. The mean age was25 with the range from 18 to 51 years old.Matriculants were 166, of which 129 were Min-nesota residents (10 more than last year), 37non-residents, and a 92/74 female/male ratio.The mean age was 24 years with the age rangefrom 20 years to 34 years. The 129 residents ofMinnesota represent 26 counties. There are 18Minnesota colleges and Universities of Minne-sota represented of which six are public universi-ties. Thirty multicultural students were admittedas compared to 37 last year.

There were nine fewer applicants than lastyear. The number of Minnesota residents ma-triculated increased from 119 last year to 129this year. The number of Minnesota applicants

fell by 63 this year, giving us a significantlysmaller pool from which to pick. The reasonsfor this are not known, but the trend seems tohave been reversed for the class of 2007. MCATscores for those admitted were about the samewhile the GPA rose from 3.63 to 3.67 overall.The downward trend seems to have been re-versed this current year with a total of about1,990 applicants compared with 1,645 for thisreport.

The complete statistics are available fromthe University of Minnesota Medical School Ad-missions staff for any who are interested. ✦

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University of Minnesota Medical School-MinneapolisAdmissions Statistics, 2002 Entering Class

MATRICULANTS N=l66 TOTAL APPLICANTS 1645MN Residents 129 MN Residents 504Non-residents 37 Non-residents 1141

MD/PhD 5 MD/PhD 107Multicultural 30 Multicultural 477

GenderFemale 92 Female 802Male 74 Male 843

Mean Age 24 y/o (20 – 34 y/o) 25 y/o (18 - 51 y/o)

Interviewed 556MD/PhD 46

Mean Scores U of MN U of MN National Pool National PoolApplicants Accepts Applicants* Accepts*

MCAT

Verbal Reasoning 9.0 10.0 8.7 9.5

Physical Sciences 9.3 10.3 9.0 10.1

*Writing O P — —

Biological Sciences 9.5 10.5 9.3 10.3

GPA

Overall 3.48 3.67 3.46 3.61

GeographicTotal Minnesotans enrolled 129Counties within Minnesota represented 26/87States represented 19+ 2 countries

Academic AffiliationTotal U.S. colleges and universities represented 70Minnesota colleges and universities represented 18

Minnesota Public Universities 6Minnesota private colleges 12

Total number of majors represented 33

* National statistics as of 9-9-02.* The Writing Sample section of the MCAT is reported on a scale of J-T (T is the highest possible score).

U OF MN STATISTICSYear 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002No. of Applicants 1016 919 786 1045 1409 1988 2732 2847 3015 3203 2917 2330 2078 1945 1874 1696 1654 1645Number Enrolled 204 193 196 185 179 180 180 185 184 185 185 175 165 165 166 165 165 166

NATIONAL STATISTICSYear 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002*No. of Applicants 32,983 30,840 27,997 26,666 26,915 29,243 33,301 37,410 42,808 45,365 46,547 46,968 43,020 40,886 38,372 37,136 34,785 31,594Number Enrolled 16,268 15,670 15,614 15,828 15,867 15,998 16,211 16,289 16,307 16,287 16,260 16,200 16,165 16,706 15,872 16,301 16,263

GENERAL

ACADEMICS

ENTERING CLASS DEMOGRAPHICS


SSEVERAL MONTHS have passed since theMMA Annual Meeting in September and theresulting implementation of HMS and RMSresolutions. Below is the status of the resolu-tions as of late March 2003.

#106 by HMS “AMA National AdvisoryCouncil on Violence and Abuse”

RESOLVED, that the Minnesota Medical As-sociation delegation submit a resolution to theAmerican Medical Association (AMA) askingthe AMA to: support the continued functionof the AMA National Advisory Council on Vio-lence and Abuse; reaffirm the role the AMANational Advisory Council on Violence andAbuse in bringing together medical experts fromFederation and other key stakeholder organiza-tions to identify and promote the role of healthcare in identifying, responding to, and prevent-ing violence and abuse; promote, through thisAdvisory Council, the education and trainingof physicians in the recognition and treatmentof the health consequences of violence andabuse; reiterate the AMA position that physi-cians have the responsibility to assess and treatpatients who experience violence and abuse;direct that the National Advisory Council onViolence and Abuse help coordinate violenceand abuse activities of the AMA. The AdvisoryCouncil will submit a report each year to theAMA Board of Trustees summarizing violenceand abuse prevention and intervention activi-ties; and direct that the National Advisory Coun-cil on Violence and Abuse advise and assist theAMA and provide advocacy in promoting andencouraging public health initiatives that im-prove the health and safety of all Americans re-garding violence and abuse issues.

Status: MMA Board of Trustees adopted recom-mendation to provide reimbursement for Dr.McCollum’s travel expenses for up to two meetingsof the AMA National Advisory Council on Vio-lence and Abuse.

#207 by HMS “Legislation to ProhibitBehavioral/Mental Health Carveouts inHealth Plans”

RESOLVED, that the Minnesota Medical As-sociation develop legislation prohibiting men-tal health carveouts, taking into considerationthe forthcoming American Medical Associationmodel legislation.

Status: Bill has been drafted and introduced.

#208 by RMS/HMS “Opposition toPsychologist Prescribing”

RESOLVED, that, to protect the health andsafety of Minnesota patients, the MinnesotaMedical Association, using assistance from theAmerican Medical Association, if necessary,strongly oppose any effort to permit prescrib-ing privileges for psychologists in Minnesota,and be it furtherRESOLVED, that the Minnesota Medical As-sociation actively publicize its opposition tolegislative efforts by psychologists to gain prescrip-tion privileges in Minnesota as a threat to pa-tient safety.

Status: Ongoing (psychologist prescribing bill hasyet to be introduced).

#307 by HMS “The Importance of PhysicalActivity for the Health Maintenance ofMinnesotans”

RESOLVED, that the Minnesota Medical As-sociation urge its physician membership to en-courage and prescribe physical activity for theirpatients to prevent chronic disease states, andbe it furtherRESOLVED, that the Minnesota Medical As-sociation encourage its physician membershipto increase their own daily physical activity, andbe it furtherRESOLVED, that the Minnesota Medical As-sociation, in cooperation with other physicianorganizations, develop a plan to increase aware-ness among physicians and Minnesotans of theimportance of physical activity, and be it fur-therRESOLVED, that the Minnesota Medical As-sociation promote physical activity among Min-nesota youth by encouraging physical educationclasses in grades K-12.

Status: Article scheduled for publication in Mayissue of Minnesota Medicine.

#308 by HMS “Consumer Cost Sharingand Payment Information Disclosure”

RESOLVED, that the Minnesota Medical As-sociation recognize that changes in the healthcare marketplace are increasing patients’ out-of-pocket costs, and be it further RESOLVED, thatthe Minnesota Medical Association supportpatients’ ability to use cost and quality infor-mation in making appropriate health care deci-sions, and be it further RESOLVED, that theMinnesota Medical Association support physi-cians’ ability to use cost and quality informa-tion in making appropriate health carerecommendations.

Status: Implement as policy statement. Complete.

Update on 2002 MMA Resolutions


#309 by HMS “Road Rage”

RESOLVED, that the Minnesota Medical As-sociation encourage the State of Minnesota tocollect data on driver behaviors and highwayinfrastructure issues that most often lead to an-gry or violent responses, and use the data toimplement public education programs to im-prove drivers’ awareness of offensive drivingbehaviors to thereby reduce road rage incidents.

Status: MMA to send letter to MN Dept. of Pub-lic Safety urging incorporation of data collectioneffort as part of current road rage campaign.

#400 by RMS “Tort Reform Legislationfor 2003 Session”

RESOLVED, that the Minnesota Medical As-sociation strongly support the American Medi-cal Association’s top priority of passing MedicalInjury Compensation Reform Act (MICRA)type tort reform at the federal level, and be itfurtherRESOLVED, that the Minnesota Medical As-sociation introduce for the 2003 MinnesotaLegislature a tort reform bill that will includethe following provisions: 1) a $250,000 limiton awards for non-economic damages; 2) a limiton attorneys’ fees; 3) an increase in the standardof proof to “clear and convincing evidence”; and,4) mandatory jury instruction that awards arenot taxable.

Status: 1st: HR 5 introduced in US House.2nd: Bill introduced in Minnesota (caps on non-economic damages); more comprehensive bill closeto being introduced.

#401 by RMS/HMS “Access to PsychiatricServices in Minnesota”

RESOLVED, that the Minnesota Medical As-sociation in collaboration with the MinnesotaPsychiatric Society request that the MinnesotaDepartment of Health and Department ofHuman Services convene a study group to in-clude all interested parties, with a charge to:1) examine in a coordinated manner all aspectsof the shortage of psychiatric services (beds andpersonnel) and barriers to psychiatric care inMinnesota; and 2) develop recommendations,including possible legislation, for providergroups, health plans, state departments, and the

legislature to remedy this shortage of services,and be it furtherRESOLVED, that, if the Minnesota Depart-ment of Health and Department of HumanServices are unable to establish the study groupas outlined above, the Minnesota Medical As-sociation petition the next Minnesota governorto order such a study by the departments or byan independent “Blue Ribbon” commission.

Status: Task force roster development is completed.First meeting held January 15, 2003.

#403 by HMS “Health Plan Accountabilityfor Eligibility and Coverage Decisions”

RESOLVED, that the Minnesota Medical As-sociation develop and lobby for legislation:

1) prohibiting health plan/clinic contracts thatplace legal liability onto clinics for health planeligibility (coverage) decisions; 2) defining de-nial decisions by health plans on covered ser-vices as “medical practice”; and 3) holdingmakers of denial decisions accountable to thesame regulatory and liability standards as theproviders of services.

Status: MMA is supporting legislation that hasalready been introduced on this topic.

The Hennepin and Ramsey Medical Soci-eties Leadership have scheduled their respectiveCaucuses as listed below. If you have an issueyou would like to bring forward to your col-leagues, by all means do so by submitting a reso-lution and participating in the MMA House ofDelegates as a Delegate for RMS or HMS. ✦

A Call for DelegatesIf you are interested in serving as a Delegate,please contact us at your earliest convenience.

Kathy Dittmer Roger JohnsonExecutive Assistant Chief Executive OfficerHennepin Medical Society Ramsey Medical Society612-623-2885 [email protected] [email protected]

If you have any questions contact:

MMA Annual MeetingWednesday-Friday, September 17-19, 2003

Kahler Hotel, Rochester, MN

HMS Caucus RMS CaucusThursday, May 15, 2003 7:00 a.m.7:00 – 8:30 a.m. Thursday, May 29, 2003 –Broadway Ridge Building Children’s Hospital Auditorium3001 Broadway Street, NE Thursday, June 5, 2003Minneapolis, MN 55413 St. Joseph’s Hospital –Lower Level Conference Room St. Joseph’s Room

Caucuses Will Be Held

Hennepin Medical Society Ramsey Medical SocietyNo later than Friday, May 9 No later than Friday, May 13

A Call for ResolutionsResolutions are due at the


P H Y S I C I A N ' S S O A P B O X

I

Canadian Universal Health Care –A Model for the U.S. to Follow?

B Y L E E K U R I S K O , M . D .

“The ‘common good’…was the claim and justification of every tyrannyever established over men.” Ayn Rand “The Fountainhead”

IMAGINE HAVING A CRITICAL narrowing diagnosed within one ofthe main blood vessels to your brain and then having to wait threemonths for the surgery; just enough time for it to block off completely.Imagine waiting months for your MRI only to find out that your backpain was caused by a huge tumor or rampant infection rather than adisc problem. Imagine waiting weeks or months for your CT scan tohave your tumor diagnosed and then waiting weeks again for adiagnostic biopsy, while the tumor continues to grow and spread.

Are these examples of medical care in Zaire? No, they are not.These are actual cases of medical care that I have been involved with asmedical director of Diagnostic Imaging in Thunder Bay, Canada. Suchare the horrors of medical care delivered under Canadian universalhealth care.

The current Canadian health care system began simply as a “one-party payer” system which many have simplistically proposed as a curefor the ails of health care in the U.S. Such a proposal evades the factthat as payer for the system, the government will have a vested interestin controlling the system with an attendant loss of individual liberty forboth patients and the providers of care.

At the time of the American Revolution, liberty meant freedomfrom the coercion of others; especially government and mob rule. Themeaning of liberty has been insidiously corrupted over the last centuryto mean “freedom from want” implying freedom from our owneconomic concerns. It is in the nature of reality that we cannot be freefrom the coercion of others and also be free from our own economicconcerns. You literally cannot have your cake and eat it too.

In Canada, to combat the economic impossibility of paying forsuch a system, the extent of government control over health care hasincreased relentlessly. When I moved from Canada 16 months ago, inthe province of Ontario, 44 cents of every provincial tax dollar wasearmarked for health care and continuing to increase. There is alsomassive federal assistance on top of this. To control costs, services suchas CT and MRI scans are only available in government run hospitals(private hospitals are disallowed). This is despite the fact that waiting

lists for imaging may be as long as 19 months. In the name of“universality,” doctors are disallowed from working outside of thesystem and patients are disallowed from spending their own money forbetter service. In essence, the system is communist in that both patientsand doctors are treated as property of the state.

Government has also had a vested interest in controlling the numberof doctors. In Canada, physicians are seen as cost centers, not because oftheir earnings, but because of the much larger costs of admittingpatients to the hospital and ordering tests. Despite an aging population,the number of doctors allowed to be trained was decreased and thegovernment has turned a blind eye to disgusted doctors like myselfleaving for the U.S. I know specialists with two-year waiting lists. Fortypercent of the population in my former home of Thunder Bay cannotaccess primary care because of insufficient doctors. I have seen patientsfirst assessed for high blood pressure once they have had a massivestroke. No doctor was available to treat them prior to this catastrophe.

In the province of Quebec, government has offered buy-outs toolder physicians to NOT work despite physician shortages. There isnow a desperate shortage of physicians in Quebec with some emergencyrooms being unstaffed at times. To solve this problem, ER physicianshave been presented with bailiff delivered subpoenas commanding themto work on notice as short as 12 hours and possibly at a hospitalhundreds of miles away. Failure to comply may result in a five thousanddollar fine. Given that the government is the paymaster, it is impossibleto not comply. Imagine seeing a doctor that had to be “arrested” toprovide you with care. Would you want your doctor working undersuch duress?

Shortly before leaving Canada, the Ontario Ministry of Health gaveme a going-away present. It was a bill for three thousand dollars. In orderto recoup costs, the government had unilaterally decreed that radiologistscould no longer charge for the interpretation of coronary angiograms.This ruling was instituted retroactively. I have hired a lawyer and requesteda hearing to dispute this edict. The government has yet to even grant adate for such a hearing. The request was made 18 months ago. Undersimilar circumstances, a former colleague from the ER is resigned tohaving to pay back 100,000 dollars. When government assumes the roleof benefactor, count on the fact that they will be your ruler.

Universal health care is a socialist paradigm. Socialism is thepolitical system in which the state is both the provider and employer. Itis predicated upon the collectivist notion that all citizens become one


another’s slave and master. Such a system is immoral because it isintrinsically based upon coercion. Someone must provide the serviceand someone must pay for it. Coercion is in the very fabric of socialism.The human rights violations in the Soviet Union were predictable justas escalated loss of liberty is occurring in Canadian health care.

Morality and practicality go hand-in-hand. Witness the abysmalfailure of socialist programs such as food production in the formerSoviet Union or present day North Korea, the ongoing angst of publiceducation or the financial catastrophe of American Social Security. Justas the Soviet Union had long line-ups for bread, Canadians have longline-ups for health care. If you can’t put a loaf of bread on the table withsocialism, how can you expect to get your heart valve replaced?

Just as socialized food production leads to starvation, Canadiansare starving for decent medicalcare. What then is the solution forthe perceived deficiencies of theAmerican health system where aportion of the population lackshealth insurance (although notnecessarily health care)? Thesolution to the problems in boththe U.S. and Canada is opposite tothe cause of the problems. Ratherthan having government intervenefurther and further, there should bea return to a free market. There isno shortage of food, tennis racketsand CD players in either countrybecause they are delivered under afree market capitalist paradigm. Infree markets, commodities tend to become cheaper with ever improvingquality and variety. To paraphrase economist Milton Friedman, in freemarkets, people tend to get what they want. In government runsystems, people get what bureaucrats allow them to have.

Just as Canadian physicians are paralyzed by governmentbureaucracy, U.S. physicians can hardly be considered “free” whereevery patient is a potential adversary and litigant. Physicians areeffectively disallowed from exercising reasonable discretion for fear ofthe government in the form of the courts unless every problem is over-investigated and excessively treated. A fall from a barstool may promptthousands of dollars of imaging when a “wait and see” approach wouldbe perfectly reasonable if American physicians had the liberty to exerciserational judgment. Such elaborate intervention drives costs increasingthe ranks of the uninsured.

There are three practical reasons why Canadian universal healthcare is a failure. Firstly, neither physicians nor patients have anyaccountability for costs. The average citizen perceives health care as“free” which distorts supply and demand. If the price of apples were tobe halved, demand would increase. If the price doubles, demand drops.If a commodity has no direct cost attached to it, the demand becomesinfinite. Hence the bankruptcy of the Canadian system.

Secondly, rather than being an economy-stimulating,employment-generating, resource-creating business, health care is agovernment run monopoly which is parasitic on the Canadian economyand whose primary purpose is to save money while maintaining thefaçade of providing care. Karl Marx and Frederick Engels mistakenlyadvocated the incorrect concept of “The Zero Sum Game.” Theybelieve that the amount of wealth in the world is finite and fixed.Therefore, they argued, wealth needed to be divided up evenly just asthe Canadian government attempts to divide up health care resourcesevenly while severely limiting private investment.

As Henry Hazlitt pointed out in his 1947 book, “Economics inOne Lesson,” wealth creation is the result of the surplus between thecosts of raw material for a product or service and its subsequent value in

a free market. For example, the rawmaterials of computer technologyare very cheap. The computer erauntil recently invoked the mostprosperous era in all of humanhistory. There was more wealth inthe world than at any other time inhistory. The Zero Sum Game hasbeen proven wrong. The funds forCanadian health care are siphonedfrom the wealth that Canadians docreate thereby removing capitalthat could further expand theeconomy. Health care funding isderived from a finite pool of tax-derived funds. Socialized healthcare therefore creates the Zero Sum

Game, the very thing that socialism attempts to combat.Thirdly, health care is a major segment of the economy which

government attempts to centrally plan just as the Soviet economy wascentrally planned with disastrous consequences. Imagine if thegovernment declared itself the sole provider of bread. The governmentalone would determine how much wheat would be grown, how manybakeries there would be, how many loaves of bread could be baked,where and when the bread could be sold. The number of loaves of breadbaked would be far below public demand. People would be squabblingover those few loaves of bread. Chaos would reign. Such is the state ofCanadian health care just as it was for food production in the SovietUnion. It will eventually be the same in the U.S. if universal health careis enacted. If both the Soviet Union and Canada have failed withsocialism, why would the United States be successful? ✦

Lee Kurisko M.D. is former medical director of Diagnostic Imaging atThunder Bay Regional Hospital in Thunder Bay, Canada. He now worksfor Consulting Radiologists, Ltd. in Minneapolis.

The solution to the problemsin both the U.S. and Canada

is opposite to the cause of theproblems. Rather than havinggovernment intervene furtherand further, there should bea return to a free market.


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Highlights of the Code of Medical Ethicsof the American Medical Association

B Y S A R A T A U B ,A M Y M . B O V I , M A , A N DL E O N A R D J . M O R S E , M . D .

Section E-9.00: Opinions onProfessional Rights andResponsibilities

The very notion of professionalism lies at thecore of this section of the American MedicalAssociation’s Code of Medical Ethics. Profession-als, as beholders of expert knowledge, are en-trusted to provide a service that is highly valuedby society with limited external oversight so longas they self-regulate by establishing and enforc-ing their own standards. While many physiciansmay believe that this ideal of professional au-tonomy disappeared from medicine with theintrusion of public and private third party pay-ers, it continues to inspire patient trust. There-fore, the guidance offered in this section, whichcounter-balances physicians’ individual freedomto choose whom to serve, remains crucial whenfostering trust in medicine.

In particular, three broad topics will be ex-amined: physicians’ autonomy and freedom tochoose whom to serve and their obligations totreat patients in a just manner; means to ad-dress misconduct; and professional responsibili-ties regarding medical knowledge andinnovation.

Choice and FairnessThe AMA has long supported physicians’ pro-fessional autonomy in terms of their individualfreedom to choose with whom to enter into arelationship, whether it is a therapeutic relation-ship or a professional one. In 1957, Section 5of the Principles stated: “A physician is free tochoose whom he will serve,” whereas Section 6

stated: “A physician should not dispose of hisservices under conditions that make it impos-sible to render adequate service to his pa-tients….”

Today’s Principle VI combines those twonotions, stating: “A physician shall, in the pro-vision of appropriate patient care, except inemergencies, be free to choose whom to serve,with whom to associate, and the environmentin which to provide medical care.” Opinion9.06,“Free Choice,” expands on this freedom,making it reciprocal, such that patients also canchoose their physicians. The Opinion does ac-knowledge certain practical limitations, such asemergencies. Interestingly, the 1847 Code, whichdirected physicians to “be ever ready to obeythe calls of the sick,” considered obligation totreat as more of an absolute than a matter ofchoice.

While the Code recognizes the importanceof free choice in medicine, the obligation to pro-vide care to the less fortunate is discussed inOpinion 9.065 “Caring for the Poor,” whichstresses that charity care should be a regular partof individual physicians’ practice. Whether phy-sicians offer care at no cost in their offices orvolunteer their services at free clinics, they arerequired to help improve access to health carefor those in the community who are impover-ished.

In exercising their right to choose whomto serve, physicians are cautioned that certainconduct could constitute discrimination. Forexample, Opinion 9.12, “Patient-Physician Re-lationship: Respect for Law and Human Rights,”warns that “… Physicians who offer their ser-vices to the public may not decline to acceptpatients because of race, color, religion, nationalorigin, sexual orientation, or any other basis thatwould constitute invidious discrimination.”Since the onset of the AIDS epidemic, non-dis-

crimination has been expanded to protect HIVpatients in Opinion 9.13 “HIV-Infected Patientsand Physicians.” The Code’s concern for fairnessis also captured in Opinions 9.121 “Racial Dis-parities in Health Care” and 9.122 “GenderDisparities in Health Care,” which remind phy-sicians not to let their medical judgment beunduly influenced by patient characteristics suchas race or gender.

The Code also recognizes that discrimina-tion may exist among colleagues in the medicalprofession. Opinion 9.03 “Civil Rights and Pro-fessional Responsibility” maintains that physi-cians should not be denied professionalopportunities because of personal characteris-tics and Opinion 9.035 “Gender Discrimina-tion in the Medical Profession” emphasizes thatmale and female physicians should be affordedequal opportunity and compensation.

Compromised Physiciansand the Requirement ofSelf-Regulation in MedicineSelf-regulation, as opposed to government orother third party oversight, may be viewed as aprivilege that is granted to a profession, but it isin fact a defining characteristic of a profession.To this end, several Opinions in Section 9 de-scribe how physicians should, consistent withPrinciple II, “report physicians deficient in char-acter or competence, or engaging in fraud ordeception.”

The notion of accountability appeared inthe original 1847 Code, albeit in a different form,emphasizing honest self-appraisal and purity ofcharacter. In 1957, when the Code underwentan important reorganization, an entire sectionwas devoted to addressing physicians’ responsi-bility to regulate the profession.



Today, Opinion 9.031 “Reporting Im-paired, Incompetent, or Unethical Colleagues”proposes a range of reporting mechanisms ac-cording to the nature of the conduct and thepotential impact on patient welfare. Opinion9.04, “Discipline and Medicine,” supplementsa physician’s individual obligation to exposeunfit colleagues with a similar obligation on thepart of medical associations. It also emphasizesthe importance of due process, which is alsoelaborated upon under Opinion 9.05, “DueProcess.” Finally, these two Opinions identifyimportant protections including immunity forreporting physicians and confidentiality of theinformation regarding physicians whose con-duct is being reviewed.

Opinion 9.10, “Peer Review,” describesanother form of self-regulation, which althoughit may be perceived as interfering with absoluteprofessional autonomy, should be recognized asnecessary and ethical, so long as it balances phy-sicians’ right to independent medical judgmentwith their obligation to uphold standards of theprofession.

With its focus on “Physicians with Dis-ruptive Behavior,” Opinion 9.045 is directedtoward less severe behavior that nonethelesscould interfere with patient care and therefore,also requires appropriate reporting and reviewmechanisms.

Finally, recognizing the unique power dif-ferentials that may exist in an educational set-ting, the Code addresses instances where amedical trainee has a complaint against a medi-cal supervisor separately. Opinion 9.055 “Dis-putes between Medical Supervisors andTrainees” also emphasizes due process, noting,“retaliatory or punitive actions against those whoraise complaints are unethical.”

Physician Responsibilitytoward Medical Innovationand ProgressMedical expertise, another fundamental char-acteristic related to professionalism in medicineis covered in this section of the Code, buildingon Principle V, which calls upon physicians toremain dedicated to life-long learning and thesharing of knowledge. The first duty is reflectedin Opinions 9.011 “Continuing Medical Edu-

cation” whereas physicians’ obligation to sharetheir innovations is discussed variably in severalother Opinions. Similar concerns with regardto the use and commercialization of innovationsarise elsewhere in the Code, as illustrated inOpinions 2.08 “Commercial Use of HumanTissue” and 2.105 “Patenting Human Genes.”Overall, Opinions in Section 9 discourage thepatenting of medical procedures and praise thesharing of knowledge, although they also rec-ognize the availability of patent protections forcertain innovations.

ConclusionSection 9, “Opinions on Professional Rights andResponsibilities,” can help physicians identifythe unique characteristics that shape medicineinto a profession. More specifically, Section 9addresses the need to balance professional au-tonomy with fairness and compassion; mecha-nisms that will help ensure self-regulation, andthe importance of disseminating medical knowl-edge through education and innovation. Whileat times this section relies on important legalconcepts, they each can be linked to more fun-damental ethical notions, echoing the relation-ship between law and ethics discussed inSection 1 of the Code. Moreover, Section 9 setsthe stage for the last section of the Code, wheremedical ethics and professionalism are exam-ined in the context of the unique characteristicsof the therapeutic alliance that joins patients andphysicians. ✦

Sara Taub is a senior research assistant, Councilon Ethical and Judicial Affairs, Amy M. Bovi,MA, is a senior research assistant, Council on Ethi-cal and Judicial Affairs, and Leonard J. Morse,M.D., is chair, Council on Ethical and JudicialAffairs.

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2003 Winter Medical Conference

THE 2003 RMS/HMS Winter Medical Con-ference attracted more than 40 participantsincluding 21 physicians to the warm and sunnybeaches at the Paradisus Playa Conchal Beach& Golf Resort, a five star all-inclusive resortin the Guanacaste region of Costa Rica.

Sixteen hours of CME jointly sponsoredwith the MMA or 16 hours of prescribed cred-its by the American Academy of Family Physi-cians were offered. Some topics included: TheDysmetabolic Syndrome; Cardiovascular Dis-ease; Abnormal Bleeding; Rhinitis; and acurbside consultation with a cardiologist andpulmonary medicine physician. The lectureswere presented in the conference room highatop a hill and provided a commanding view

The view from the Conference Center overlooking the resort was spectacular.

A river tour provided an opportunity to see many ofthe rainforest animals.

Nancy and Dr. Mark Winholtz are joined at Spicesrestaurant by Stephanie Hines to experience cookingfood on hot stones.

Physician participants paying close attention during a presentation.

Presenters for the conference are from left: A. StuartHanson, M.D.; William F. Schoenwetter, M.D.; Lyle J.Swenson, M.D.; J. Michael Gonzalez-Campoy, M.D.,Ph.D., CME chairperson; Jon S. Nielsen, M.D.; and MarkWinholtz, M.D.

of the resort, the Pacific, the Catalina Islands,surrounding beaches, and nearby mountains.A beautiful sunset was enjoyed as well.

Many members of the groupenjoyed excursions to one of the ac-tive volcanoes, the cloud forest, awalk through a rain forest, a canopytour, horseback riding, a mud bath,deep sea fishing, or a ride on the 4-wheelers up the mountainside, aswell as the opportunity to golf onthe championship golf course. Col-orful birds, monkeys, iguanas andother wildlife were easy distractions.

The perfect weather, a beauti-ful resort, informative lectures and

a location offering many interesting activitiesall contributed to a very high evaluation of the2003 Winter Medical Conference. ✦

PRESIDENT ’S MESSAGEJ . M I C H A E L G O N Z A L E Z - C A M P O Y, M . D . , P h . D .

RMS-Officers

President J. Michael Gonzalez-Campoy, M.D., Ph.D.President-Elect Peter J. Daly, M.D.Past President Peter H. Kelly, M.D.Secretary Jamie D. Santilli, M.D.Treasurer Charles E. Crutchfield III, MMB, M.D.

RMS-Board Members

Victor S. Cox, M.D., Specialty DirectorGretchen S. Crary, M.D., At-Large DirectorLaura A. Dean, M.D., At-Large DirectorJames J. Jordan, M.D., Specialty DirectorRobert V. Knowlan, M.D., At-Large DirectorBradley C. Linden, M.D., Resident PhysicianCharlene E. McEvoy, M.D., At-Large DirectorRagnvald Mjanger, M.D., Specialty DirectorRobert C. Moravec, M.D., At-Large DirectorJane C. Pederson, M.D., M.S., Specialty DirectorLon B. Peterson, M.D., At-Large DirectorThomas D. Siefferman, M.D., Specialty DirectorStephanie D. Stanton, Medical StudentLyle J. Swenson, M.D., MMA TrusteeCharles G. Terzian, M.D., Specialty Director &

MMA TrusteeDavid C. Thorson, M.D., Specialty DirectorPeter B. Wilton, M.D., At-Large Director

RMS-Ex-Officio Board Members &Council Chairs

Brent R. Asplin, M.D., AMA Young Physician SectionBlanton Bessinger, M.D., AMA Alternate DelegateJohn M. Brown, M.D., Sr. Physicians

Association PresidentKenneth W. Crabb, M.D., AMA DelegateRobert W. Geist, M.D., Ethics & Professionalism

Council Chair*J. Michael Gonzalez-Campoy, M.D., Ph.D.

Education Resource Council ChairRebecca Gonzalez-Campoy, Alliance PresidentFrank J. Indihar, M.D., AMA DelegateNeal R. Holtan, M.D., Community Health

Council ChairWilliam E. Jacott, M.D., U of MN RepresentativeMelanie Sullivan, Clinic Administrator*Lyle J. Swenson, M.D., Public Policy Council Chair

*Also elected RMS Board Member

RMS-Executive Staff

Roger K. Johnson, CAE, Chief Executive OfficerDoreen M. Hines, Membership & Web Site CoordinatorSue Schettle, Director of Marketing & Member Services


WAdvocate for Your Profession

WHAT IS IN A WORD?Up to 100 points, if you are a skilled

Scrabble® player like my wife, Becky.Allow me to reflect on the word Medicine.

Not the “pill” definition of medicine, but theother. Medicine is a profession. Profession isdefined by the Oxford Dictionary as work thatinvolves some branch of advanced learning orscience, a calling, a vocation. The word profes-sional has various adjectives attached to it as syn-onyms, including trained, practiced, veteran,experienced, qualified, licensed, competent,able, skilled, expert, and masterful. And the syn-onymous nouns include master, expert, special-ist, authority, and proficient. In the definitionof professional the dictionary has “engaged in aspecified activity as one’s main paid occupation.”

Most of us are true professionals. But whatconstitutes, or should constitute, professionalactivity varies widely. Most of us competentlytreat our patients. This is, I would say, only apart of our profession. We all seek knowledgeand keep ourselves updated with continuedmedical education. Some of us write or lectureto educate others. Some of us are administra-tors, and oversee the work environment for oth-ers. Some of us are employed by universities orpharmaceutical companies and do research.Some of us are involved with the regulation ofthe profession at a higher level, ensuring the stan-dards we set for each other are upheld. Theretruly is NOT one definition of a physician.

It pleases me to announce via this column,that the legislative efforts of the Ramsey andHennepin Medical Societies are starting to payoff. We now have the endorsement of the Min-nesota Medical Association and the Health Plansfor our Joint Contracting Coalition bill. Thiswill be a giant step to protect physician au-tonomy, and empower us to be better advocatesfor ourselves and our patients. The progress wehave made has been possible because we haveworked together, and we have allowed for posi-tive feedback from others. There is power innumbers.

Ramsey Medical Society will have a Stra-tegic Planning Session toward the end of theyear, sometime in the fall. All of us that are in-volved in organized medicine place value in aprofessional activity that is not often compen-sated in dollars and cents. We value the role ofbeing an advocate for the profession, and seetangible rewards in protecting the profession ofmedicine. This is a benefit to all, those who chooseto support our societies, and those who don’t.

The perennial question asked of us at duestime is, “What is the Ramsey Medical Societydoing for me?” At the very least, it is allowingeach of us the opportunity to be advocates forthe profession. Unless we each look beyond theconfines of our practice, and address the con-stant corrosion at the essence of medicine thatsurrounds us, those that follow in our footstepswill be significantly challenged in their role asphysicians. Indeed, it is best to ask, “What am Idoing for medicine?” not “What is medicine do-ing for me?” The least YOU can do to be anadvocate for your profession is to pay your dues,and drop us a line about what you see as chal-lenges for the profession. Beyond that, I wel-come your contributions of time and energy,and more importantly, your ideas and construc-tive criticism.

In formulating the strategic planning thisfall, I would like to have ideas from as many ofyou as possible. My e-mail is [email protected], and I look forward to hearing from eachof you. ✦

Mike


T

RMS UPDATE

2003 Supply Drive

THE ELEVENTH ANNUAL “Caring Heartsfor Homeless People,” sponsored by RamseyMedical Society, Ramsey Medical Society Alli-ance and HealthEast Care System, began onFriday, February 7, 2003 and concluded onMonday, February 24, 2003.

This year’s drive was very successful! Thir-teen medical clinics, 30 churches, HealthEastCare System, and many volunteers from theRamsey Medical Society Alliance, and manyother organizations (4-H clubs, girl scout troops,high school youth groups, elementary classgroups) pitched in to collect and sort more than$40,000 worth of hygiene and medical suppliesfor the Health Care for the Homeless clinics,Listening House, and SafeZone. In addition,more than $1,500 in cash contributions wascollected. These organizations rely heavily ondonated medications, hygiene supplies, toys,juice, and monetary donations to help meet the

physical, emotional and mental health needs oftheir clients. This drive contributes the major-ity of supplies needed for the entire year.

Carole Nimlos coordinated the activitiesof the RMS Alliance members who worked hardpicking up the supplies from the 13 participat-ing medical clinics. Thank you to the clinicmanagers, staff, and physicians of the followingclinics that participated:

• Allina Medical Clinic – Shoreview• East Metro Family Physicians, P.A. –

Maryland• Gillette Children’s Specialty Healthcare• Hamm Memorial Psychiatric Clinic• Metropolitan Urologic Specialists, P.A.• Minnesota Medical Joint Services

Organization• Partners Obstetrics and Gynecology, P.A.• Physicians Neck & Back Clinic, P.A.• Ramsey Family Physicians• St. Croix Orthopaedics, P.A.• St. Paul Eye Clinic, P.A.• University Affiliated Family Physicians –

Phalen Village Clinic• University of Minnesota Medical Students ✦

Seventh graders from St. Pascal’s Schoolhave wonderful eyes for checkingexpiration dates on medications.From left: Patrice Frankfurth-Bushinski,Katie LeTourneau, Andrea Dreis, andStephanie Hines.

Volunteers from left: Sister MarianLouwagie and Susie Andler down on theirknees sorting shampoos and conditioners.

Griffin Hayes (volunteer on left) helpingSafeZone employee Vontrell McSwain withthe sorting of collected items.

Mark your Calendars

The 2004 Caring Heartsfor Homeless PeopleSupply Drive, will be

held February 1 throughMarch 1, 2004. Please callDoreen at 612-362-3705 if youwould like to have your clinicadded to the 2004 drive. Youmay even consider beginningto collect items now. One ideawould be to focus on collect-ing one item each month (i.e.,June-sunscreen; July-bug lo-tion; August-socks; etc.) Youcould also call and we couldprovide you with a list of someof the items that are alwaysin short supply by the recipi-ent organizations.

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New MembersRMS welcomes these new members to the Society.

Schools listed indicate the institution where the

medical degree was received.

Active

Omar E. Awad, M.D.University of MinnesotaOphthalmologyLufkin Eye Clinic

James A. Brockberg, M.D.University of MinnesotaObstetrics/GynecologyAllina Medical Clinic - Parkview Ob/Gyn

Stephan G. Burgeson, M.D.University of IllinoisInternal MedicineHealthEast Woodbury Clinic

Blake A. Elmquist, M.D.University of MinnesotaAnesthesiologyAssociated Anesthesiologists, P.A.

Jonathan C. Grimes, M.D.University of MinnesotaEmergency MedicineSt. John’s Hospital

David L. Hunter, M.D.Ohio State UniversityFamily PracticeUniversity Family Physicians-Bethesda Clinic

Jay E. Kent, M.D.University of MinnesotaAnesthesiologyAssociated Anesthesiologists, P.A.

Karen L. MacKenzie, M.D.University of MinnesotaFamily PracticeNorth Suburban Family Physicians, P.A.-Shoreview

Bronagh P. Murphy, M.D.University of Dublin, IrelandOncologyMinnesota Oncology Hematology, P.A.

Darrell W. Randle, M.D.Mayo Medical SchoolAnesthesiologyAssociated Anesthesiologists, P.A.

William B. Sweeney, M.D.Hahnemann UniversityColon & Rectal SurgeryColon & Rectal Surgery Associates, Ltd.

Robert D. Thomas, M.D.University of MinnesotaInternal MedicineDaly, Corbett, Ogden, Abid & Olive

Judith L. Trudel, M.D.University Laval, Fac De Med, CanadaGeneral SurgeryColon & Rectal Surgery Associates, Ltd.

Susan M. Truman, M.D.Yale UniversityDiagnostic RadiologySt. Paul Radiology, P.A.

Jerald O. Van Beck, M.D.University of MinnesotaAnesthesiologyAssociated Anesthesiologists, P.A.

1st Year Practice

Shalabh Bobra, M.D.University of MinnesotaRadiologySt. Paul Radiology, P.A.

Nicole K. Groves, M.D.University of MinnesotaPediatricsStillwater Medical Group, P.A.

Karen L. Mecklenburg, M.D.University of MinnesotaAnesthesiologyAssociated Anesthesiologists, P.A.

Joseph J. Shaffer, M.D.University of LondonDermatologyDermatology Consultants, P.A.

Peter B. Wold, M.D.University of MinnesotaDiagnostic RadiologySt. Paul Radiology, P.A.

Residents

Michelle A. Bayne, M.D.University of MinnesotaFamily PracticeFamily Medicine Clinic

Thomas R. Frerichs, M.D.University of MinnesotaDiagnostic RadiologySuburban Radiologic Consultants, Ltd.

Mark R. Menge, M.D.University of MinnesotaInternal Medicine/Hematology/OncologyUniversity of Minnesota

Carolyn D. Sparks, M.D.Southern Illinois School of MedicineFamily PracticeRamsey Family Physicians ✦

In Memoriam

FRANK M. GAERTNER, JR., M.D. diedFebruary 19 at the age of 71. He graduatedfrom Marquette University School ofMedicine and interned at the old MillerHospital in St. Paul. Dr. Gaertner joined theArcade Clinic, practicing the kind of“old time” family medicine that allowed himto take time for patients and make housecalls for 37 years before retiring in 1996. Hejoined RMS in 1961.

FRANCES P. OLSON, M.D. died at theage of 94 on May 28, 2002. Dr. Olsongraduated from the University of OklahomaSchool of Medicine and completed aninternship at the University of Minnesota inPsychiatry. She joined RMS in 1963, movedto Fergus Falls in 1965 and then returned toRMS in 1988. ✦


Page 15The paragraph stating there are five sectionshas an incorrect reference to an emeritusmember. An Emeritus Member is not aphysician 65 or over who is in active practice.Second sentence should read: The EmeritusMember section includes all physicians 65 orover who are retired, and also includes retiredphysicians who are under age 65.

Page 16Harvey C. Aaron, M.D. address is incorrect:Address should be 7300 France Ave. S., #200,Edina, MN 55435

Page 41Christina M. Juhl, M.D. clinic is incorrect:Clinic should be Allina Medical Clinic-Woodbury (not the Eye Clinic)

Page 42Kristine M. King, M.D.Updated photo

Page 45Thomas A. Lange, M.D. phone and fax isincorrect: Correct phone is (651) 254-1514.Fax is (651) 254-1519

Robert B. Lasser, M.D.photo is incorrect.Photo shown is Irving J.Lerner, M.D.Here is the correct photo.

Page 46Irving J. Lerner, M.D.photo is incorrect.Photo shown is Robert B.Lasser, M.D.Here is the correct photo.

Page 50Sherief A. Mikhail, M.D. specialty, clinicname, address, phone and fax are incorrect.Correct information is: Specialty isOccupational Medicine, Clinic is MinnesotaSpine Rehab., Inc., 360 Sherman St., #240,St. Paul, MN 55102; (651) 209-6520.

Page 70Photo is incorrect ofGregory M. Vercellotti, M.D.Photo shown is Michael C.Vespasiano, M.D.Here is the correct photo.

Page 76Harold T. Arneson, M.D., InternalMedicine, University of Rochester, NY ’68,3081 Chatsworth N., Roseville, MN 55113,(651) 484-7728 was omitted.

Page 81John F. Alden, M.D. is now deceased.

Page 85Thomas F. Mulrooney, M.D. should be listedin the Active Section on page 52.

Page 86Frances Palmer Olson, M.D. is now deceased.

Page 87Lyle A. Tongen, M.D. is now deceased.

Page 91In the Allergy & Immunology section, pleaseinclude Anthony C. Orecchia, M.D.

The following names should be included in theCardiology & Cardiovascular Diseases section.

Alan J. Bank, M.D.Steven L. Benton, M.D.Thomas A. Biggs, M.D.Charles M. Cliffe, M.D.Michael D. Garr, M.D.Dennis W. Halbe, M.D.Priscilla A. Hedberg, M.D.Thomas H. Johnson, M.D.Nazifa Sajady, M.D.Thomas A. Wiberg, M.D. ✦

RMS Pictorial Directory

Additions and Corrections

A Call for ResolutionsResolutions are due by May 13, 2003.

A Call for Alternate DelegatesIf you are interested in serving as anAlternate Delegate, please contact RMS.

RMS Caucus7:00 a.m.Thursday, May 29, 2003 –

Children’s Hospital AuditoriumThursday, June 5, 2003 –

St. Joseph’s Hospital – St. Joseph’s Room

MMA Annual MeetingWed.-Fri., September 17-19, 2003Kahler Hotel, Rochester, MN

Please cut this section out and insert it in yourdirectory booklet.

Please help us to assure that your interests areaccurately conveyed by contacting RMS staffto submit resolutions: phone 612-362-3799;

fax 612-623-2888; or [email protected]

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RMS ALLIANCE NEWSR E B E C C A G O N Z A L E Z - C A M P O Y

Carrying Out Our Mission

I AM VISITING FAMILY in the Philadelphiaarea. While war rages in Iraq, I’m traveling fromone Revolutionary War monument to the next.While bombs fall on Baghdad, I hike throughValley Forge National Park. I take advantage ofthe last opportunity to take a picture by the Lib-erty Bell (it soon will be encased in glass). I walkwhere our Founding Fathers walked when theyconvened the Continental Congress.

Our core value was – and still is – free-dom. The notion of who gets to enjoy this rightand how, has evolved over time. Yet, the basicpremise remains constant.

The basic premise of the Ramsey MedicalSociety Alliance – service to the community andto medical families – also remains constant. And,here again, the notion of who carries on thismission and how, continues to evolve.

We’re at a crossroads. Many of our mem-bers are “empty nesters” or are heading towardretirement. Their kids are in college, or gradu-ate school, or on their own. Some members arepursuing their own education. Others are wellestablished in their careers or are re-enteringthe work force. A few of us have young kids athome and are balancing the whole medical fam-ily routine.

Here’s our dilemma. Who will lead ourorganization and where will we go with it? And

perhaps more pressing, from where will our re-sources come? I addressed the question “Is theAlliance relevant?” last fall. However, the ques-tion continues to arise in conversations I havewith folks in our organization as we try to comeup with a leadership slate for next year.

First of all, the answer still is a resoundingYES! What we do is still necessary to the com-munity and to each other. More on that in abit. Let me address this leadership vacuum first.We’re poised to modify our “constitution”– orbylaws – to address our changing needs muchlike we Americans have done over the course ofhistory. The current leadership of the Alliancewill present an updated set of bylaws to themembership for review and approval at our an-nual meeting this month.

These amendments to our bylaws will al-low for a more inclusive membership base andwill create a new leadership structure. The ideais to get more people into the tent and be sensi-tive to most people’s aversion to being respon-sible for what they perceive to be monumentaltasks. The membership changes are really justan effort to put us in line with what the Alli-ance is doing on State and National levels –physicians and divorced spouses can be mem-bers, for example. As for leadership, we wouldcreate a Leadership Council of up to five mem-

bers that, between them, woulddo what the President, President-Elect and Vice Presidents donow. This not only allows mem-bers to take on the work they dobest, it invites more new mem-bers to take part with little riskof being overwhelmed. And forthe record, several other Alli-ances around Minnesota aremoving in this direction for thesame reasons we are.

Why bother? Because nowmore than ever the work we dofor our communities and eachother is in great demand. Thanksto state and federal economic

policy and budget cuts, making sure everyonehas proper health care and knows how to livehealthy lives falls to groups like ours. Taking careof each other, our families, and the medical pro-fession becomes more critical with each newrestriction and further invasion into the patient-physician relationship.

How we carry out our mission is up to eachone of us. I will share my motto here: Those atthe table get to eat. In other words, if you don’tlike how an organization operates, get in thereand share your ideas. It’s not going to change ifyou walk away or hover at the sidelines. An or-ganization reflects who takes part.

It’s time to renew our annual membership.The Alliance needs people who want to improvethe health of the community through work and/or simple – generous – contributions. You canbe an active member and/or a supporting mem-ber. There’s room for everyone, regardless of yourstage in life.

A special note to physicians: There aremany more members of the Ramsey MedicalSociety than there are of the Alliance. Please talkwith your spouse about joining the Alliance. Sheor he is bound to have qualities that will en-hance our organization. And we provide ameans to strengthen medical families and thepractice of medicine. That need not be just yourresponsibility. For more information, pleasecontact Doreen Hines at 612-362-3705, [email protected].

And finally, about the picture I’ve includedwith this column. It obviously has nothing todo with our Founding Fathers or changing by-laws. It does, however, have to do with mem-bership. If a picture truly is worth 1,000 wordsthen make no mistake when you look at thisone: Members of RMS and RMS Alliance alsojust want to have fun! ✦Dr. Mike and Becky Gonzalez-Campoy enjoying a

mud spa in Costa Rica during the RMS/HMS 2003Winter Medical Conference.


THMS-Officers

Chair T. Michael Tedford, M.D.

President Michael B. Ainslie, M.D.

President-elect Michael B. Belzer, M.D.

Secretary James F. Peters, M.D.

Treasurer Paul A. Kettler, M.D.

Acting Past Chair Virginia R. Lupo, M.D.

HMS-Board Members

Eric G. Christianson, M.D.

Peter J. Dehnel, M.D.

Drew Dietz, Medical StudentDonald M. Jacobs, M.D.

Jan Musich, Alliance PresidentRonald D. Osborn, D.O.

James A. Rohde, M.D.

Edwin H. Ryan, M.D.

David F. Ruebeck, M.D.

Richard D. Schmidt, M.D.

Michael G. Thurmes, M.D.

D. Clark Tungseth, M.D.

Michael J. Walker, M.D.

HMS-Ex-Officio Board Members

Roger W. Becklund, M.D., Senior Physicians AssociationLee H. Beecher, M.D., MMA-TrusteeCarl E. Burkland, M.D., Member-at-LargeKaren K. Dickson, M.D., MMA-TrusteeDavid L. Estrin, M.D., MMA-TrusteeJohn W. Larsen, M.D., MMA-TrusteeHenry T. Smith, M.D., MMA-TrusteeDavid W. Allen, Jr., MMGMA Rep.

HMS-Executive Staff

Jack G. Davis, Chief Executive OfficerKathy R. Dittmer, Executive AssistantSue Schettle, Director, Marketing & Member Services

CHAIR ’S REPORTT . M I C H A E L T E D F O R D , M . D .

Advocacy is HMS Priority

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THE HENNEPIN MEDICAL Society boardand staff, along with the Ramsey Medical Soci-ety and the MMA, continue to advocate for phy-sicians at the legislature and in the community.Recently, our greatest success has been partici-pating with a provider coalition advancing theFair Contracting Bill through the Minnesotalegislature. Scope of practice legislation is an-other concern, with a bill moving through thelegislature that would allow optometrists to pre-scribe all legend drugs. We have recruited grassroots response to the chief author of that bill inthe senate from the 200 HMS members wholive in his district. Meanwhile, the board hascompleted strategic planning and has created awork plan for implementation.

Key points in the FairContracting Bill include:• Health plans must provide prompt access to

prior authorization systems – 24 hours a day,seven days a week.

• Medical decisions by utilization review or-ganizations or health plans are subject to thesame regulatory review as a health care pro-vider. In other words, concerns about utili-zation review decisions will be investigatedby the Board of Medical Practice.

• Amendments or changes to contracts, in-cluding reimbursement adjustments, mustbe disclosed at least 90 days prior to the ef-fective date of the change.

• Shadow contracting, the requirement to par-ticipate in all the contracts a health plan of-fers, are outlawed.

• Health plans may not change CPT or DRGcodes properly submitted by our members.

• Unilateral recoupment, the adjustment of aprevious reimbursement through a currentaccount reimbursement without proper no-tification and opportunity for appeal, is out-lawed.

• Plans may not terminate our members’ con-tracts unless the company has given writtennotice specifying the reason for the termina-tion or nonrenewal 120 days before the ef-fective date.

• Health plans must pay clean claims within30 days. If the claim is not paid or denied in30 days, the plan must pay interest (1.5 per-cent per month) automatically with the origi-nal claim. The provider shall not be requiredto bill the health plan.

HMS Strategic Work PlanHMS will continue to advocate for our mem-bers at the legislature, with the health plans andthrough other public venues with guidance fromthe strategic work plan developed at our Marchboard meeting. Here is a brief summary of thatplan.

Strategic Outcome One:Strong Voice at the LegislatureHMS engages physicians and patients in orga-nizing efforts that result in needed changes inpublic policy.

• Establish a metro-wide HMS/RMS JointAdvocacy Committee. This committee is al-ready active and is comprised of the jointexecutive committees of HMS and RMSwith the county society representatives sit-ting on the MMA Legislative and Practiceand Policy Committees.

• Linkage to MMA Legislative Committee, so-lidify our complimentary actions and forgea strong relationship with MMA.

• Develop a process to identify and determinekey policy issues.



Strategic Outcome Two:Increased Organizational VisibilityHMS increases its visibility through pro-activemarketing and public relations efforts.

• On-going presence in metro area physician-read publications describing HMS activities

(e.g. medical staff newsletters, e-mail list-serve, inserts in medical staff newsletters).

• Establish a Communications Committee tocoordinate all visibility and communicationsactivities, including MetroDoctors editorialboard.

• Contract with a marketing expert to pack-age HMS message.

Strategic Outcome Three:Increased Physician InteractionHMS uses technology and other tools to en-gage physicians in discussion, debate and ac-tion on relevant issues that impact them, theirrelationships with patients, and the healthcareindustry.

• Monthly e-mail and broadcast fax to mem-bers and non-members of HMS activitiesand updates.

• Identify non-members through medical staffrosters.

• Leverage opportunities to meet a variety ofphysician needs by gatherings that servemultiple functions (topic related programs,public policy agenda development and net-working and support).

Strategic Outcome Four:Establish Leadership RoleHMS is recognized as the pre-eminent voice onmedical issues and a leader in the areas of col-laboration, public policy and physician support.

• Describe leadership role in bio-terrorism,nurses’ strike, etc., as well as resource formedical and public policy issues.

• Re-establish physician’s responsibility forpatient welfare; establish principles such asuniversal coverage.

• Provide education on how to be a leader.

Your HMS leadership is proud of our cur-rent accomplishments and enthusiastic aboutour direction for the future. Personally, I lookforward to seeing our society exercise leadershipcreating a better healthcare system, maybe fol-lowing the aims described by the Institute ofMedicine. A health care system for the 21st cen-tury will provide care that is safe, effective, pa-tient centered, timely, efficient and equitable.As always, we welcome your input. Please callor e-mail with your comments or ideas. ✦

Michael Tedford, M.D.; [email protected]

Chair’s Report


SHARING A SINGLE FOCUS

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New MembersHMS welcomes these new members to the Soci-

ety. Schools listed indicate the institution where

the medical degree was received.

ActiveBridget B. Ahles, M.D.Eastern Virginia Medical SchoolObstetrics & GynecologyPark Nicollet Clinic - Maple Grove

Kent D. Bergh, M.D.University of Minnesota Medical SchoolFamily PracticeUniversity Family Physicians - North Memorial

Amy M. Brown, M.D.Washington University School of MedicineObstetrics & GynecologyObstetrics, Gynecology, & Infertility, P.A.

Durand E. Burns, M.D.University of Minnesota Medical SchoolCardiovascular DiseasesMinneapolis Cardiology Assoc. MinneapolisHeart Institute

Marion L. Collins, M.D.Albert Einstein College of Medicine-YeshivaUniversityPediatricsPartners in Pediatrics, Ltd.

Robert J. Couser, M.D.University of North Dakota School of MedicinePediatricsNeonatology, P.A.

Ruth E. Deitz, M.D.Cornell University Medical CollegeFamily PracticeFairview Uptown Clinic

Angela I. Dhruvan, M.D.Mayo Medical SchoolFamily PracticeFairview Hiawatha Clinic

Stephen J. Frey, M.D.University of Colorado School of MedicineFamily PracticeFairview Cedar Ridge Clinic

Emanuel P. Gaziano, M.D.West Virginia University School of MedicineMaternal & Fetal MedicineMinnesota Perinatal Physicians

Timothy P. Gibbs, M.D.University of Minnesota Medical SchoolPsychiatryAbbott Northwestern Hospital

Richard C. Glaze, M.D.University of Kansas School of MedicineOtolaryngologyAnesthesiology, P.A.

Butch M. Huston, M.D.University of Iowa College of MedicineForensic PathologyMidwest Forensic Pathology, P.A.

Thomas Knickelbine, M.D.University of Wisconsin Medical SchoolCardiovascular DiseasesMinneapolis Cardiology Assoc. MinneapolisHeart Institute

Loie Anne Lenarz, M.D.University of Minnesota Medical SchoolFamily PracticePresident and Senior Medical Director, FairviewClinics

Benjamin P. Levine, M.D.University of Vermont College of MedicineOrthopaedic SurgeryPark Nicollet Clinic - Meadowbrook

William Russell Lundberg, M.D.Medical College of WisconsinOrthopaedic SurgeryNorthwest Orthopedic Surgeons

Larry A. Mathison, M.D.University of Colorado School of MedicineFamily PracticeRidgeview Mound Clinic

Adrienne J. Nguyen, M.D.University of Missouri School of MedicineUnspecified SpecialtyNorth Clinic, P.A.

Anthonia A. Olajide-Kuku, M.D.Orvosi Fakultas Tudomanyegyetem, BudapestPediatricsBlaine Medical Center Multicare Assoc. of the T.C.

Lorinda F. Parks, M.D.University of Minnesota Medical SchoolFamily PracticeUniversity Family Physicians - North Memorial

Nathaniel R. Payne, M.D.Emory University School of MedicineNeonatal-Perinatal MedicineNeonatology, P.A.

Pamela M. Persak, M.D.Chicago Medical SchoolPediatricsWayzata Children’s Clinic, P.A.

Maren E. Peterson, M.D.Mayo Medical SchoolInternal MedicinePark Nicollet Clinic - Plymouth

Michael Ellis Pinchback, M.D.University of Arkansas School of MedicineFamily PracticeNorth Memorial Clinic–Northeast FamilyPhysicians

Norman B. Ratliff III, M.D.University of Minnesota Medical SchoolCardiologyMinneapolis Cardiology Assoc. MinneapolisHeart Institute

Roger W. Rhodes, M.D.University of Minnesota Medical SchoolObstetrics & GynecologyPark Nicollet Clinic - Carlson Parkway

Khaled Jamal Saleh, M.D.University of Western Ontario Faculty ofMedicineOrthopaedic SurgeryUniversity of Minnesota Physicians

Meskath Uddin, M.D.Chittagong Medical CollegeInternal MedicineHealthPartners - Riverside

Michael R. Wootten, M.D.Vanderbilt University School of MedicineFamily PracticeUniversity Family Physicians - North Memorial

Daniel M. Zapzalka, M.D.University of Iowa College of MedicineUrology/Urological SurgeryPark Nicollet Clinic - St. Louis Park

Resident Transfer to HMS

Dimitri M. Drekonja, M.D.University of Minnesota Medical SchoolInternal Medicine ✦

HMS NEWS

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HMS ALLIANCE NEWS

Peggy JohnsonCo-President

Diane GayesCo-President

HMSA Body Works – 20th AnniversaryApril 21-25, 2003

Body Works motto: Doctors Can Help: Par-ents Can Too; But a Healthy Body is up to You!

HENNEPIN MEDICAL SOCIETY Alliance(HMSA) volunteers remain dedicated to their“signature” program, Body Works. Since 1983:more than 30,000 hours have been committedto Body Works by HMSA volunteers; more than40,000 Minneapolis Public School third-grad-ers have attended Body Works; Thrivent Finan-cial (formerly Lutheran Brotherhood),Hennepin Medical Society, Hennepin MedicalFoundation, The Minneapolis Heart InstituteFoundation, local hospitals and clinics, medi-cal companies, and individual physicians con-tinue to support and co-sponsor Body Works. Thetotal cost of time and materials donated to BodyWorks has surpassed $200,000 ($10,000/year).

In the early 1980s, the HMS Alliance re-alized a need for a community health servicebenefiting young children. After a year of con-siderable research and meeting with the schoolsystems under the leadership of HMSA mem-ber, Gen Lindemann, the first Body Works pro-gram was held in April of 1983. Third-grade,

considered the ideal level for raising children’shealth awareness, remains the target audience.At this age, they are responsive, cooperative andreceptive (minds like sponges) to the preventa-tive health education presented at Body Works.Approximately 160 students will attend each ofthe three, one and one-half hour sessions heldeach of the five days. In total, the 2003 BodyWorks will educate approximately 2,400 Min-neapolis Public School third-graders at theThrivent Financial auditorium, downtown Min-neapolis, April 21-25 from 9:00 a.m. to 1:20p.m. daily. Visitors are welcome to come andobserve.

The students will rotate through eight ar-eas of education: Hospital Room; Stop America’sViolence Everywhere (SAVE); Bones; Exercise/Nutrition; Heart; Lungs; Disability; and VeryImportant Kid (VIK).

Highlights of 2003 Body Works:• For the First Year - Food Label Detective: Each

student will receive an interactive workbookthat was designed by an Alliance member tohelp kids be savvier about what they eat andlearn to make healthy food choices. This is inaddition to an activity book that reinforcesthe Body Works’ health education.)

• For the Third Year - HiTECH HEART: TheMinneapolis Heart Institute Foundation staffthe Heart Area and will educate the childrenusing this dynamic heart model designed toprovide an interactive learning experience.The students will have a ‘hands on’ opportu-nity to pump the heart and see how it works.

• For the Seventh Year - PEACE RAINBOW:The students will bring signed pledges againstviolence: “I pledge to SAVE today andSTOP AMERICA’S VIOLENCE EVERY-WHERE.” Over one thousand of the pledgeshave been laminated to form a PEACERAINBOW at Body Works.

HMSA Annual Meeting andLuncheonThe HMSA invites members and non-mem-bers to their 2002/2003 annual meeting andluncheon to be held at the Edina Country Club,May 2. The day begins with a 9:30 a.m. boardmeeting. The social hour, 10:30 a.m., will be fol-lowed by the annual luncheon and installationof the 2003/2004 HMS Board of Directors.

The guest speaker will be Janis Amatuzio,M.D., forensic pathologist for Anoka Countyand author of Forever Ours: a forensic pathologist’sperspective on immortality and living – a col-lection of real-life stories. Dr. Amatuzio’s pre-sentation, Lessons in Living From a CountyCoroner, will draw on her vast experience as acounty coroner, and will explore death as thegreat fear, great mystery, and the great teacher.

RSVP to Kathy Dittmer at 612-623-2885by April 28. Cost $23.00.

AppreciationOn behalf of the HMSA members, Diane Gayesand Peggy Johnson express their sincere appre-ciation for the remarkable support the medicalalliance continues to receive from the HennepinMedical Society (HMS), the Hennepin Medi-cal Foundation, Jack Davis, CEO, HMS, andKathy Dittmer, Executive Assistant, HMS. Inaddition, Diane and Peggy thank the HMS Al-liance members for their continued supportthroughout 2002/2003. The articles in theHMSA spring newsletter, Pulsations, reflect thededication, hard work and passion that HMSAmembers have to make a difference in the livesof people who live in our community, our state,and our country, in addition to those individu-als who live beyond our country’s borders. ✦

Dianne Fenyk talking to third graders abouthealthy bones.

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Family Practice Review:

Update 2003

May 5-9 • Radisson Hotel

Metrodome • Mpls.

32nd Annual Clinical

Hypnosis Workshops

May 29-31 • Earle Brown CE

Center • St. Paul

67th Annual Surgery Course:

Advances in Breast, Endocrine

and Cancer Surgery

June 11-13 •Hyatt Regency • Mpls.

Topics & Advances in

Pediatrics

June 12-13 • Radisson Hotel

Metrodome • Mpls.

North Central Neonatology

Issues Conference (NCNIC)

June 13-15 • Grand Geneva

Resort • Lake Geneva, WI

Pelvic Floor Workshop

Sept. 2 • Hyatt Regency • Mpls.

Endorectal Ultasonography

Sept. 3 • Hyatt Regency • Mpls.

Principles of Colon and

Rectal Surgery

Sept. 4-6 • Hyatt Regency • Mpls.

34th Annual Seminar:

Obstetrics and Gynecology

Sept. 8-9 • Radisson Hotel

Metrodome • Mpls.

4th Annual Upper Midwest

Brain Tumor Symposium

Sept. 12 • Radisson Hotel

Metrodome • Mpls.

Novel Therapies in Thoracic

Oncology

Sept. 12 • Hilton Airport

Bloomington • Bloomington

Partial 2003 CME Calendar“Current 2003 calendar information is available online at www.med.umn.edu/cme”

Heart Failure Society of

America: 7th Annual

Meeting

Sept. 21-24 • Mandalay Bay

Resort & Casino • Las Vegas, NV

Evidence-Based Healthcare

Workshop: Learning to

Teaching

Sept. 24-28

Hyatt Regency • Mpls.

Fourth Annual Psychiatry

Review: Anxiety Disorders

Sept. 29-30 • Radisson Hotel

Metrodome • Mpls.

Transplant Immunosuppres-

sion 2003: The Continuing

Challenges

October 1-4 • Radisson Hotel

Metrodome • Mpls.

Sixth Annual Twin CitiesMarathon Sports MedicineConferenceOctober 3-4

Four Points Sheraton • Mpls.

Internal Medicine ReviewOctober 8-10 • Radisson HotelMetrodome • Mpls.

9th Annual VascularDiseases: A Primary CarePerspectiveOctober 24-25 • Radisson Hotel

Metrodome • Mpls.

7th Annual AnticoagulationClinicsNovember 6 • Radisson Hotel

Metrodome • Mpls.

28th E.T. Bell Fall PathologySymposiumNovember 7 • Radisson HotelMetrodome • Mpls.

2003mayjun

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