COMPREHENSIVE CARE FOR INFANTS, CHILDREN AND YOUNG …bchphysicians.org/.../CWPW-Newsletter-Summer2013.pdf · leading a multi-center, federally funded trial, using parents as stem

ADOLESCENTMEDICINE AND GYNECOLOGY

CARDIOLOGY

CRITICAL CARE

DEVELOPMENTAL PEDIATRICS

ENDOCRINOLOGY

GASTROENTEROLOGY

GENERAL PEDIATRICSAND HOSPITALISTMEDICINE

HEMATOLOGY/ONCOLOGY

INFECTIOUS DISEASE & IMMUNOLOGY

MEDICAL GENETICS

NEONATOLOGY

NEPHROLOGY

NEUROLOGY

OBSTETRICS/GYNECOLOGY

PSYCHOLOGY

PULMONOLOGY, ALLERGY & SLEEPMEDICINE

RESEARCH

RHEUMATOLOGY

SURGERY

GASTROENTEROLOGY

NEPHROLOGY

OBSTETRICS/GYNECOLOGY

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SUMMER 2013, VOL. 4, NO. 1COMPREHENSIVE CARE FOR INFANTS, CHILDREN AND YOUNG ADULTS

PEDIATRIC SPECIALTIES

There is a not-so-well-kept secret in pediatricmedicine circles and among parents and those

whose business it is to follow infant health care thatthere is quite a revolution taking place inneonatology in the Hudson Valley, thanks, in part, tothe dedicated efforts of Edmund F. LaGamma, MD,and his team of 30 neonatologists, nursepractitioners and physicians-in-training.

Dr. LaGamma, CWPW’s Chief of the Division ofNewborn Medicine, and Maria Fareri Children’s Hospital Director of theNeonatal-Perinatal Fellowship Program and Professor of Pediatrics,Biochemistry & Molecular Biology at New York Medical College (NYMC),leads a cadre of dedicated professionals who care for the most vulnerablepatients — premature babies who frequently can weigh no more than 500grams (less than one pound) and whose life hangs in the balance.

Using state of the art technology and the latest diagnostic tools, as wellas advancing the field with research contributions, public healthinitiatives, high-risk follow-up programs and educational symposia, Dr.LaGamma and his team have established the Regional Neonatal IntensiveCare Unit (RNICU) at Maria Fareri Children’s Hospital of WestchesterMedical Center to be among the premier neonatal groups in the nation. AsDr. LaGamma proudly points out, his group is recognized nationally andinternationally in terms of innovation and patient outcomes. Members ofhis team like Lance A. Parton, MD, FAAP, Sergio Golombek, MD, MPH,FAAP, and Heather Brumberg, MD, MPH, FAAP, hold positions inprofessional organizations at the national level including the AmericanAcademy of Pediatrics and the Eastern Society for Pediatric Research. Keymembers like Praveen Ballabh, MD, FAAP and Dr. LaGamma serve onNIH study sections and receive funds for research.

“We have achieved remarkable outcomes, thanks to the level ofexcellence of our neonatologists and the nursing staff of Maria FareriChildren’s Hospital,” Dr. LaGamma says. “These are the most difficult,most challenging, hard-to-succeed patients. Some are no larger than aBarbie doll; that’s how small they are.” Yet the physicians and staff arecalled upon to utilize their experience and medical expertise to ensuresurvival of their tiny patients.

In addition to Dr. LaGamma and colleagues in neonatal medicine, theMaternal Fetal Medicine team includes: Howard Blanchette, MD, FACOG,Director of the Westchester Medical Center’s Department of Obstetrics andGynecology; Andrew Elimian, MD, FACOG, the hospital’s Chief ofPerinatal Medicine; and obstetricians Desmond White, MD, FACOG;Jennifer Wong, MD, FACOG; and Geetha Rajendran, MD, FACOG. AnnMarie Bentsi-Addison, RN, CNM, MSN, Perinatal Clinical NurseSpecialist/Outreach Coordinator, rounds out the team.

PERINATAL NEWS: Edmund LaGamma, MD, and His NICUTeam Set New Standards of Excellence in Infant Care

Edmund LaGamma,MD, FAAP

PERINATAL NEWS l PEDIATRIC HEMATOLOGY/ONCOLOGY l CWPW & NORTHERN WESTCHESTER HOSPITAL l APPOINTMENTS l NEW LEADERSHIP

The largest group of pediatr ic special ists o f i ts kind in the region.

The Division of Pediatric Hematology/Oncologyat CWPW has seen broad expansion in the last

two years under the leadership and vision of ChiefMitchell Cairo, MD. Since coming aboard in 2011,Dr. Cairo has spearheaded a division that has notonly increased in size, but forged true progress inbone-marrow transplantation, neuro-oncology,pediatric leukemia and lymphomas, as well ascellular therapy.

During his tenure at CWPW, Dr. Cairo’s division staff has tripled insize: today there are 55 staff members, compared with just 17 two yearsago. And, he has introduced new areas of treatment and research,including a Child and Adolescent Cancer and Blood Disease Center.“It’s a multi-disciplinary, multi-institutional approach to treatingchildren and adolescents with cancer and blood disorders,” Dr. Cairoexplains. The initiative involves CWPW as well as Maria FareriChildren’s Hospital and New York Medical College. “All the work isinteractive to optimize diagnoses and state of the art treatment.”

Dr. Cairo’s group has also launched a program in pediatrichematological malignancies since he came aboard. “The message wefocus on here is developing a personalized medical approach where wehave a better understanding of the genetic and immunological bases ofthe diseases,” Dr. Cairo says. “From that, we tailor the therapy to focuson the patient’s specific disease. This has served as a catalyst forlaunching targeted therapies using antibodies to target certain cancerproteins in leukemia and lymphoma cells,” he adds.

The division is also ramping up its efforts in the area of neuro-oncology. “Here again, we have launched a multidisciplinary programthat includes skilled pediatric neuro-oncologists and pediatricneurosurgeons,” Dr. Cairo states. He recruited noted pediatric neuro-oncology expert Paul Jubinsky, MD, PhD, from Yale-New HavenHospital to lead this effort.

This has all been achieved in collaboration with Maria FareriChildren’s Hospital’s outstanding programs in pediatric neurosurgery,radiation oncology, neuro-pathology, radiology, and neuro-psychology,” Dr. Cairo says. The neuro-oncology team is looking touse small molecule inhibitors and cellular vaccines to target and treatbrain tumors.

In the area of stem cell transplantation, Dr. Cairo’s group is makingstrides in several areas. “We are using reduced or lower-intensityconditioning prior to stem cell transplantation to reduce acute toxicitiesand long-term late effects,” he reports. “We’ve been very successful inthis regard.”

PEDIATRIC HEMATOLOGY/ONCOLOGY: Under the Leadership of Mitchell Cairo, MD,Division Expands to Provide Extensive Services to Children and Families

Mitchell Cairo, MD

ADULT SPECIALTIES

Continued on page 3 Continued on page 2

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A MESSAGE FROM The President

Anothersummer is

upon us, andwith it come thejoys of days atthe beach,weekends withfamily in thebackyard, andhopefully some time to kickback and soak up the season. Alot has transpired in the last fewmonths at CWPW, and we’rehappy to report that wecontinue to grow and provideexemplary medicine to ourpatients from some of the finestand dedicated doctors.

Two such physicians arefeatured on the front of thisnewsletter. Edmund LaGamma,MD, FAAP, and his team of 30neonatologists, RNs and supportstaff, have established theRegional Neonatal IntensiveCare Unit at Maria FareriChildren’s Hospital in Valhalla,NY to treat the tiniest patientsand ensure the healthiestoutcomes possible. At the sametime, Mitchell Cairo, MD, aleading expert in pediatriccancer and blood disorders, hasspearheaded a major expansionin the division. The group hastripled in size since 2011 and isforging new ground in thecritical areas of pediatric bone-marrow transplantation,neuro-oncology, pediatricleukemia and lymphomas, andcellular therapy.

CWPW is expanding again,this time entering into anagreement with NorthernWestchester Hospital to providepediatric surgical services at thehospital in Mount Kisco, NY.Surgical services will includeinpatient, emergencydepartment, and neonatalintensive care.

Children suffering from cysticfibrosis, a debilitating lung anddigestive disorder, have greaterhope than ever, thanks to theefforts of an innovativeinitiative established to improvepatient care and medicaloutcomes. Diana Lowenthal,MD, attending physician inpediatric pulmonology atCWPW and an expert in cysticfibrosis in children, is deeplyinvolved here with CWPW andin the Armond V. Mascia Cystic

2

continued on page 3

Leonard Newman, MD

Children’s and Women’s Physicians of Westchester, LLP(CWPW) and Northern Westchester Hospital recently

announced that they have entered into an agreement to providepediatric surgical services for patients at Northern WestchesterHospital in Mount Kisco, New York.

“Under our agreement,” states Leonard Newman, MD,President of CWPW, “CWPW surgeons will providecomprehensive general surgical coverage and services to pediatricpatients at NWH’s inpatient unit, emergency department, andlevel-three neonatal intensive care unit.”

CWPW surgeons will participate in Northern WestchesterHospital's ongoing surgical quality assurance programs andassist in the ongoing education and training of nurses at NWH.These programs have been implemented to continuously enhancethe surgical care provided to NWHpatients.

“We at Children’s & Women’sPhysicians of Westchester arevery pleased to partner withNorthern WestchesterHospital,” says GerardVillucci, FACHE, Chief

Executive Officer. “Our pediatric surgeons are world leaders in thesurgical treatment of complex pediatric illnesses and we areproud in bringing state of the art, advanced care to the childrenwe are committed to serve. CWPW is one of the largest medicalpractices in the region dedicated to providing comprehensiveinpatient and outpatient care to infants, children and adolescentsthroughout the greater New York Metropolitan area, extendingfrom New York City, throughout the Hudson Valley, and into partsof Connecticut.”

“Northern Westchester Hospital provides high-qualitypediatric care for our community and this agreement enables usto ensure that surgical services are continuously available to ouryoungest patients. Our mutual goal through this partnership is toprovide an excellent level of integrated pediatric surgical care

available to Northern Westchester Hospital pediatric patients,”states Marla Koroly, MD, Senior Vice President for Medical

Affairs and Chief MedicalOfficer at Northern

WestchesterHospital.CWPW

Children’s and Women’s Physicians of Westchester, LLP and Northern Westchester Hospital Partner to Provide Pediatric Surgical Care

Dr. Cairo Continued from page 1

Dr. Cairo’s group operates a state-of-the-art comprehensive sicklecell disease program as well. “We’re the only group in the countryleading a multi-center, federally funded trial, using parents as stemcell donors for children with poor-risk cell disease,” Dr. Cairoexplains, pointing out that “poor-risk” equates to children with nosibling match as a stem cell donor. “It’s a high-risk situation —taking the mother’s good cells, and depleting bad cells,” he notes.The effort is part of a multinational clinical trial.

A new Pediatric Hematology/Oncology Fellowship Program hasalso been instituted at MFCH by the physician-educators of CWPW,LLP, under the aegis of Dr. Cairo. The three-year accredited programincludes training in hematology, oncology, and stem celltransplantation, as well as involvement by trainees in the hospital’scellular and tissue engineering laboratory.

Basic research has not been overlooked and constitutes asignificant part of the Pediatric Hematology/Oncology and stem celltransplantation program. “We’re involved in peer-reviewed research

in childhood cancer genetics, stem cell biology, tumorimmunology, cellular therapy, and transplantation immunology,” Dr.Cairo explains.

All in all, CWPW’s division of Pediatric Hematology/Oncology andStem Cell Transplantation has extended its reach in terms ofsuccessful research, diagnosis and treatment, as well as training topphysicians to contribute to this challenging and important field. Dr.Cairo is proud of his efforts to date, and is enthusiastic about the workyet to come. He is especially proud of the success in terms ofoutcomes and growth and in the breadth and depth of the program.CWPW

A Message From The Presidentcontinued from page 2

Fibrosis Center at New YorkMedical College. The Center isone of only 10 nationwidechosen to participate in theunique Learning and LeadershipCollaborative 8 Committee. JohnWelter, MD, and Charles Boyer,MD, both of CWPW, also serveon the Committee. These doctorsand their associates are doinggreat work toward helpingchildren with this difficultdisease. They have a great storyto tell, and it’s in our newsletter.

Also at CWPW we’re verypleased to welcome OliverMuensterer, MD, to the Divisionof Pediatric Surgery. Dr.Muensterer specializes inminimally invasive, orlaparoscopic, surgery in treatinginfants, children and adolescents.Making a smaller incision andusing minute instruments, Dr.Muensterer is able to operatewith a minimal amount ofdisturbance to the skin, withminimal scarring and reducedrecovery time. He will beworking in the division headedby Gustavo Stringel, MD.

You’ll also see in thisnewsletter that Robin Altman,MD, Chief of General Pediatricsat CWPW, has been appointed tothe prestigious Committee onMedical Liability and RiskManagement of the AmericanAcademy of Pediatrics. TheCommittee reviews AAP policystatements, clinical and technicalreports, as well as clinicalpractice guidelines developed byother committees. The ChapterPresident is Lance Parton, MD, aneonatologist at CWPW.

In addition, Sheila Nolan,MD, has been appointed to theposition of Chief of the Divisionof Infectious Diseases at CWPW.Dr. Nolan is a dedicatedresearcher, academician andhands-on physician who overseesa dedicated team at CWPWfocused on the study of infectiousdiseases and finding innovativeways of diagnosing and treatinginfectious illnesses in infants,children and adolescents.

We hope you enjoy thisexpanded edition of the CWPWnewsletter. Feel free to get intouch with us with yourcomments, questions or storyideas. We’d love to hear fromyou. Email us at [email protected] your summer! CWPW

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Heather Brumberg, MD, MPH, FAAP, Clinical Public Health,Director of Neonatal Public Health Programs at the RegionalPerinatal Center; Yogangi Malhotra, MD, RPC, Regional QualityAssurance Coordinator; Susan Sippel, RNC, MS, Coordinator NYSPerinatal Database System; and Donna Dozor, RN, MS, NICUDatabase Manager, comprise the regional database managementteam, which benchmarks all of the eight hospitals in the affiliatednetwork staffed by the neonatal group.

Drs. Jordan Kase, Raja Senguttuvan and Semsa Gogcu conductHigh Risk Neonatal Follow-up and Developmental testing at six sitesin the Lower Hudson Valley to ensure that perinatal interventions areclosely tied to long-term outcomes.

The RNICU treats the highest case-mix index in New York Statewith nearly 19,000 patient days and an average daily census of 52.Patients are drawn from approximately 23,000 deliveries at 32 areahospitals within 5,000 square miles, and six Level II and three LevelIII programs that refer neonates to Dr. La Gamma and his team ofneonatologists.

The program at Maria Fareri Children’s Hospital is widelyrecognized in terms of always accepting patient referrals, forimplementing the best procedures for positive outcomes, and for apolicy of active return-transport to community hospital affiliates toallow the newborn to convalesce with their family closer to home.This system of integrated health care is dictated by the New YorkState Health Department Perinatal Health Code. Dr. LaGamma wasinstrumental in writing many of the guidelines for this service modeland, with his team, for implementing these actions in the LowerHudson Valley.

“Positive patient outcomes developed in a supportive careenvironment where families are included in the care process are whatthe RNICU is well-known for,” says Michael Gewitz, MD, thehospital’s Physician-in-Chief and CWPW Vice President. “RNICUand the perinatal center program has been a major force for theadvancement of the health of mothers and babies in the entireregion,” according to Dr. Gewitz, “and Ed is justifiably proud of hisgroup’s success.”

In the very delicate period of as early as 23 weeks’ gestation, theRNICU has seen successful outcomes in 43 percent of its patientscompared with 26 percent nationally. These higher survival rates andlower morbidities are what distinguishes the program from others inthe region, and even nationally. “It might occasionally look easy,when seeing the successes of these 23-week-old babies, but there is

so much extraordinary technology and medical expertise at workhere,” Dr. LaGamma explains.

An important advancement to ensure that vulnerable full-termbabies survive is ECMO, or Extra Corporeal MembraneOxygenation, which helps children with respiratory or heart failure,as well as CoolCap® technology to treat asphyxiated babies withbody cooling. In addition to this technology, “we provide everyform of ventilator support,” Dr. La Gamma says. For example, aspecialized device called the “Bronchotron” is also employed,which helps babies who suffer from a collapsed lung due toaspiration syndromes, a phenomenon that is not uncommon incritically ill newborns. “Every modality that exists in the world isoperational under our guidance at Maria Fareri Children’sHospital,” he adds. New research is also being pursued related tothe areas of lung, brain and infectious disease topics. Importantwork on using stem cells to help critically ill infants is also on thehorizon.

When it comes to neonatal intensive care, coordination is key:doctors, nurses, technologies and transfer stations all have to bechoreographed together to respond smoothly to premature infantsin crisis. “It all has to work perfectly — not just in sprint runs, butin long-distance coordinated marathons as well,” Dr. LaGammasays. And it does — the successful outcomes speak forthemselves.

Dr. LaGamma points out that among the strategic strengths of theRNICU program are that the 30 neonatologists are all employed byCWPW, and not as individuals competing with regional hospitals.“They see themselves as one large, effective division with access tofellows and research,” he explains. “It’s the concept of being part ofsomething larger. It’s a subtle strategy but it’s all very effective. Weseek the best approaches, review them, apply them, and get thebest that those interventions can possibly bring. We always look fora better path toward improving outcomes for our patients.”

Maria Fareri Children’s Hospital was ranked 80th in U.S. News &World Report’s Best Children’s Hospitals. Our RNICU ranked #38nationally out of 179 children’s hospitals and our RNICU was 3rd inNew York State’s 9 ranked children’s hospitals.

The program is second to none, Dr. LaGamma believes. “What Itell the staff is this: The standard of care in the country is thebaseline from which we begin. You can’t be too good. There is trulyno top tier —we want to function at the highest performingpercentile — I’m proud of the work we do.” CWPW

Dr. LaGamma Continued from page 1

how we can care for patients and on how to provideoptimal care,” Dr. Welter says. “The Dartmouth course onquality improvement offers invaluable tools” on assessingprogress at the Center, and how physicians can fine-tunepatient care and target improvements.

Joseph Boyer, MD, also sits on the committee. A CFspecialist and pediatric pulmonologist at CWPW, Dr.Boyer notes that the course is valuable in myriad ways. “Itopens our eyes — for many of us,” he says. “We’relearning a lot that will allow us to make our whole set-upmuch better. The Foundation has a strong commitment tooverall quality, and improvement of our work. It’s all aneffort on the part of the CF Foundation to improve qualityacross the board.”

Committee member Lisa Monchil, a registeredrespiratory therapist and study coordinator, echoes thecourse’s importance. “One essential thing is that this is alearning and leadership collaborative,” she states. “This isthe eighth year the Cystic Fibrosis Foundation has donethis. We’re one of only ten pediatric centers chosen; it’s anice compliment to us. We’re actually many steps aheadof other centers.”

Elizabeth de la Riva-Velasco, MD, and Suzette Gjonaj,MD, round out the physicians on the LLC8 group.MaryAnn Francella, an LPN in the Cystic Fibrosis Center,and Joseph Naranjo, a receptionist at the facility, also siton the committee.

“Like in industry, ownership as opposed to buy-in, hasbeen essential to the success of our project,” explains Dr.Gjonaj. “The fact that everyone has a voice means thatthere is a personal stake in the success of our projectrather than being told what to do. Group discussions andvoting have been the means to achieve this.”

In explaining how the group’s work will impact MariaFareri Children’s Hospital and CWPW, Dr. de la Riva-Velasco notes: “We do plan on undergoing other QualityImprovement projects in the future using the skills wehave learned from this program, and these future projectsmay be done with inpatients at Maria Fareri. We also hopethat our work may be an example for other divisions atCWPW to also implement QI projects that will helpimprove patient care throughout the entire pediatricdepartment.”

CF Center LPN Francella says: “It has been nice to seethe progress and changes that have occurred in theCenter since we have been working in this committee.”

Committee member Joseph Naranjo notes: "Since wehave improved our scheduling procedure, encouraging all

CF patients to schedule multiple future appointments,patients are much happier. They now can get theappointment times they want, without having to missschool or work."

The group has adopted an acronym — EPEQ — to summarize the committee’s approach to assessmentand treatment. It stands for Every Patient, Every Quarter,and is literal: The Center’s physicians vow to see everypediatric CF patient four times a year for assessing data,treatment, testing, and follow-up care. “One of the thingsthe CF Foundation wants us to focus on is (the role of)nutrition on pulmonary status,” Dr. Boyer explains. “Butwe can’t monitor any of that unless patients come in fourtimes a year.”

Results gleaned from the committee’s work are far-reaching. The group reviewed a meticulous assessmentof patient data — everything from insurance coverage togeographic location to results of a workforce jobsatisfaction survey — to optimize care. Longer waittimes, it was found, had a deleterious effect: “It created abarrier for patients coming in,” Dr. Boyer says. Bookingmultiple appointments in advance was recommended toensure patients received proper on-time care.

“Our CF Center is interesting in that we have so manyphysicians seeing our patients at multiple offices, andthose patients are melded into the rest of the practice,” Dr. Lowenthal points out. “It’s been challenging for usbecause it’s a little different from what happens in mostCF centers.”

The group is multi-dimensional and brings a mosaicof professional experiences to the program. “We’re usingskills that are broadly applicable,” Dr. Lowenthal explains.The rules of running meetings are strict: they convenetwice a month, must start on time and end on time, workwith an agenda, and have a timekeeper at every meeting.“It’s a source of pride for us,” she says. “We’reencouraged to share ownership of the committee.”Meeting leadership changes monthly as does the person taking minutes. “I really like it personally,” Dr. Lowenthal shares.

“There was a lot of skepticism in the beginning,” Dr. Welter notes, “but it’s turned out very well.”

In the end, the work of the LLC8 committee is provingmeaningful for the physicians and support personnelworking with pediatric CF patients, and for the childrenthemselves, who will ultimately reap the benefits of thecommittee’s work. CWPW

Cystic fibrosis is a debilitating illness that literallytakes the breath out of its victims. The inherited

chronic disease can make the autonomic act of breathingalmost impossible, robbing the lungs of their ability toprovide oxygen to the brain and maintain the balance oflife. Fluid fills the air sacks, inhibiting the essentialprocess of inhaling and exhaling. Digestion can also begreatly compromised.

The Cystic Fibrosis Foundation, the nationalorganization dedicated to research, education andawareness of the disease and based in Bethesda,Maryland, oversees a network of 115 accredited regionalcare centers across the country that strive to improve thequality of treatment for every patient in their purview.Regionally, the Armond V. Mascia Cystic Fibrosis Centerof New York Medical College is the outpatient center forchildren and adolescents being treated for cystic fibrosis.Data from this and all CF centers nationwide are funneledto the national CFF for study.

According to Diana Lowenthal, MD, attendingphysician in pediatric pulmonology at CWPW and anexpert in cystic fibrosis in children, the Center at NYMC is one of only ten nationwide to be chosen to participatein the Learning and Leadership Collaborative 8committee, or LLC8, an innovative initiative aimed atimproving the quality of care to CF patients, andultimately medical outcomes. The course is being takenconcurrently with the nine other specialist center teamsfrom around the country and is sponsored by the CysticFibrosis Foundation through grant funding. The regionalgroup meets twice monthly. The course is rigorous,interactive, demanding, and, in the end, profoundlyinstructive to participating practitioners.

“The focus is on continual improvement,” Dr.Lowenthal explains during a recent meeting of the LLC8committee, of which she is a member. “We’re nevercompletely satisfied with the goals that we’ve reached; we always want to exceed our expectations, and continueto improve.”

The one-year LLC8 Web-based program is runthrough Clinical Microsystems and its Dartmouth InstituteMicrosystem Academy. The online course consists ofmonthly coaching calls, in addition to travel to three face-to-face learning opportunities. Four members of the localCenter traveled to Minneapolis June 16 to 18 to meet withcourse leaders and with members of the nine other teams.“We have lots of reading of textbooks and articles, videosto watch, and homework to do,” Dr. Lowenthal says. “It's avery dynamic, interactive course,” which runs throughOctober 2013. “The expectation is that we will thencontinue the Quality Improvement work thereafter, evenafter the course ends,” she adds.

John Welter, MD, another pediatric pulmonologist andCF specialist at CWPW, is also a member of the regionalCenter and sits on the LLC8 committee. He and Allen J.Dozor, MD, chief of pediatric pulmonology at CWPW,provided the administrative leadership that resulted in thegroup’s involvement in the LLC8 endeavor.

“The unique aspects of this course are that it includesphysicians, nurses and clerical staff, all giving input on

MEETING OF THE MINDSCystic Fibrosis Course Aims to Improve Quality and Inspire Progress

4

From left to right: Joseph Naranjo, receptionist at Bradhurst, Elizabeth delaRiva-Velasco, MD - Pediatric Pulmonology Doctor, Diana Lowenthal, MD -Pediatric Pulmonology Doctor, Suzette Gjonaj, MD - Pediatric Pulmonology Doctor, Joseph Boyer, MD - Pediatric Pulmonology Doctor, Lisa Monchil,RRT - Registered Respiratory Therapist, MaryAnn Francella, LPN (nurse), John Welter, MD - Pediatric Pulmonology Doctor

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Westchester County

Pediatric Associates of Westchester

1 701 Bedford Road, Suite BBedford Hills, NY 10583• General Pediatrics – (914) 723-7444

Bronxville Women's Care

2 1 Pondfield Rd #302Bronxville, NY 10708• Obstetrics/Gynecology – (914) 337-3715

Douglas Savino, MD

3 1 Pondfield Road WestBronxville, NY 10708• General Pediatrics – (914) 771-8990

Polly Kanganis, MD

4 4 Studio ArcadeBronxville, NY 10708• Obstetrics/Gynecology – (914) 771-9441

Chappaqua Pediatrics

5 175 King StreetChappaqua, NY 10514• General Pediatrics – (914) 238-8550

Croton Pediatrics

6 130 Grand StreetCroton-on-Hudson, NY 10520• General Pediatrics – (914) 271-4727

Eastchester Pediatric Medical Group

7 266 White Plains RoadEastchester, NY 10709-4423• General Pediatrics – (914) 337-3960

Children’s and Women’s Physicians ofWestchester LLP at Bradhurst

8 19 Bradhurst Avenue,Suites 1400, 2400 & 2550Hawthorne, NY 10532• Cardiology – (914) 594-4370 • Endocrinology – (914) 366-3400• General Pediatrics – (914) 493-7235• Hematology/Oncology – (914) 493-7997• Infectious Disease – (914) 493-8333• Medical Home – (914) 594-4602• Nephrology – (914) 493-7583• Neonatology Follow-Up Program – Referral Only

• Pediatric Surgery – (914) 493-7620, (914) 761-5437

• Psychology – (914) 493-7697• Pulmonology/Allergy – (914) 493-7585• Rheumatology – (914) 594-4835

Sound Shore Medical Center

9 16 Guion Place New Rochelle, NY 10802• Cardiology – (914) 594-4370• Endocrinology – (914) 366-3400• Hematology/Oncology – (914) 365-3065

Pediatric Associates of Westchester

10688 Post Road, Suite 232Scarsdale, NY 10583• General Pediatrics – (914) 723-7444

Briarcliff Pediatric Associates

11755 North Broadway, Suite 500Sleepy Hollow, NY 10591• General Pediatrics – (914) 366-0015

Medical Service Building at Phelps Memorial Hospital

12755 North Broadway, Suites 400 & 540Sleepy Hollow, NY 10591• Endocrinology – (914) 366-3400• Neurology – (914) 358-0188/0190

Pediatrics of Sleepy Hollow

13150 White Plains Road, Suite #101Tarrytown, NY 10591• General Pediatrics – (914) 332-4141

Village Pediatric Group

14115 Main Street, Suite # 301Tuckahoe, NY 10707• General Pediatrics – (914) 771-7070

Nephrology Associates of Westchester

1519 Bradhurst, Suite #100Valhalla, NY 10595• Adult Nephrology – (914) 493-7701

Children’s and Women’s Physicians ofWestchester LLP at Grasslands Road

16503 Grasslands Road, Suites 200 & 201Valhalla, NY 10595• Adolescent Medicine – (914) 304-5300• Developmental – (914) 304-5250• Gastroenterology – (914) 367-0000• Medical Genetics/Metabolic –(914) 304-5300

Gastrointestinal and HepatobiliaryConsultants NYMC Munger Pavilion

17Valhalla, NY 10595• Adult Gastroenterology –(914) 594-3415

Children’s Rehabilitation Center

18317 North StreetWhite Plains, NY 10605• Neonatology – (914) 597-4080/4115

Bridgespan Medicine

19 222 North Westchester Ave, Suite 201White Plains, NY 10604• Adolescent Medicine – (914) 698-5544

Westchester Park Pediatrics

20222 North Westchester Ave, Suite 202White Plains, NY 10604• General Pediatrics – (914) 761-1717

Peter Liebert, MD

21 222 Westchester AvenueSuite # 403White Plains, NY 10604• Pediatric Surgery – (914) 428-3533

Douglas Savino, MD

22328 South Broadway Yonkers, NY 10705• General Pediatrics – (914) 771-8990

Rockland County

Bardonia Pediatrics

23446 Route 304Bardonia, NY 10954• General Pediatrics (845) 623-8031

North Rockland Pediatric Associates

24171 Ramapo Road Garnerville, NY 10923• General Pediatrics – (845) 947-1772

Pediatrics and Adolescent Medicine of New City

25337 North Main StreetNew City, NY 10956• General Pediatrics – (845) 634-7900

Pomona Pediatrics

264 Medical Park Drive, Suite CPomona, NY 10970• General Pediatrics – (845) 362-0202

Suffern Medical Pavilion at Good Samaritan Hospital

27255 Lafayette Avenue, Suites 370 & 390Suffern, NY 10901• Cardiology – (914) 594-4370• Endocrinology – (914) 366-3400• Gastroenterology – (914) 367-0000• Medical Genetics/Metabolic – (914) 304-5300

• Neonatology Follow-Up Program – Referral Only

• Neurology – (914) 358-0188/0190 • Pulmonology – (914) 493-7585

Orangetown Pediatric Associates

28422 Western HighwayTappan, NY 10983• General Pediatrics – (845) 359-0010

Orange County

Children’s and Women’s Physicians ofWestchester at Middletown

29100 Crystal Run Road, Suite 108Middletown, NY 10941• Cardiology – (914) 594-4370• Developmental – (914) 304-5250• Endocrinology – (914) 366-3400• Gastroenterology – (914) 367-0000• Hematology/Oncology – (914) 493-7997• Medical Genetics/Metabolic – (914) 304-5300

• Neonatology Follow-Up Program –Referral Only

• Neurology – (914) 358-0188/0190• Pulmonology – (914) 493-7585

Pediatric Arts of Monroe

3091 Lakes RoadMonroe, NY 10950• General Pediatrics – (845) 782-8608

Pediatric Care of the Hudson Valley

31266 North StreetNewburgh, NY 12550• General Pediatrics (845) 565-5437

Medical Center of New Windsor

32575 Hudson Valley Avenue, Suite 203New Windsor, NY 12553• Cardiology – (914) 594-4370• Gastroenterology – (914) 367-0000• Pulmonology – (914) 493-7585

Herbert Kania Pediatric Group

3310 Ronald Reagan Blvd.Warwick, NY 10990• General Pediatrics – (845) 986-2058

Washingtonville Pediatrics

3410 Weathervane DriveWashingtonville, New York 10992 • General Pediatrics (845) 496-5437

Putnam County

Virgilio Monteleone , MD

35 263 North Brewster RoadBrewster, NY 10509

• General Pediatrics (845) 279-5161

Carmel Pediatrics

36 11 Fair StreetCarmel, NY 10512

• General Pediatrics (845) 225-7337

Putnam Pediatrics

37667 Stoneleigh Avenue, Suite #111Carmel, NY • General Pediatrics – (845) 279-5131

Bennett Pallant, MD

38 906 Route 6 Mahopac, NY 10541

• General Pediatrics (845) 628-2015

Dutchess County

Kathleen Ennabi, MD

39 2529 Route 52, Suite #3Hopewell Junction, NY 12533

• General Pediatrics (845) 227-0123

Children’s and Women’s Physicians ofWestchester LLP at Poughkeepsie

40104 Fulton AvePoughkeepsie, NY 12601• Pulmonology – (914) 493-7585 • Endocrinology – (914) 366-3400• Neonatology – (914) 493 - 8431• Nephrology – (914) 493-7583 • Infectious Disease – (914) 493-8333• Cardiology – (914) 594- 4370• Neurology – (914) 358-0188/0190

Pediatric Sub-Specialty Center at Vassar Brothers Medical Center

41 45 Reade PlacePoughkeepsie, NY 12601

• Cardiology – (914) 594-4370• Gastroenterology – (914) 367-0000• Hematology/Oncology – (914) 493-7997• Medical Genetics/Metabolic – (914) 304-5300

• Pulmonology – (914) 493-7585

Bronx County

Children’s and Women’s Physicians ofWestchester, LLP at Riverdale

42Skyview Shopping Mall5683 A Riverdale Avenue, Bronx, New York 10471 • General Pediatrics (347) 843-6136

CWPW LOCATIONS

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Children’s and Women’s Physicians ofWestchester, LLP at Woodlawn

434350 Van Cortlandt Park East Bronx, NY 10470• Allergy – (347) 226-6437 • Adolescent Gynecology – (347) 226-6437

• Cardiology – (914) 594-4370• Developmental – (914) 304-5250• Endocrinology – (718) 231-6565• Gastroenterology – (914) 367-0000• General Pediatrics – (718) 231-6565• Hematology/Oncology – (347) 226-6437• Medical Genetics/Metabolic – (914) 304-5300

• Neurology – (914)358-0188/(347) 226-6437

• Pulmonology – (914) 493-7585

Southern Connecticut

Children’s and Women’s Physicians of Westchester, LLP at Danbury

4467 Sandpit RoadDanbury, CT 06810• Cardiology – (914) 594-4370• Gastroenterology – (914) 367-0000• Medical Genetics/Metabolic – (914) 304-5300

Children’s Medical Group of Greenwich

4542 Sherwood PlaceGreenwich, CT 06830• General Pediatrics – (203) 661-2440

Children’s Specialty Center at Norwalk Hospital

4630 Stevens AvenueNorwalk, CT 06856• Cardiology – (914) 594-4370• Gastroenterology – (914) 367-0000• Pulmonology – (914) 493-7585

Pediatric Gastroenterology

47149 East Avenue, Suite 39Norwalk, CT 06851• Gastroenterology – (203) 853-7170

Pediatric Heart Specialists

48107 Church Hill RoadSandy Hook, CT 06842• Cardiology – (203) 426-0225

New Jersey

Herbert Kania Pediatric Group

491900 Union Valley Road Hewitt, New Jersey 07421• General Pediatrics – (973) 728-4480

Summer 2013, Vol. 4, No 1CWPW Newsletter is published four times a year byChildren’s & Women’s Physicians of Westchester, LLP. Munger Pavilion, Room 123, Valhalla, NY 10595Phone: 914-594-4280 • Fax: 914-594-3693www.cwpw.org

Leonard Newman, MD, President Michael H. Gewitz, MD, Vice PresidentGerard Villucci, Chief Executive OfficerPublisher: Yaeger Public RelationsEditor: Harold ClarkArt Director: Denise Stieve

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Dr. Muensterer has joined thededicated team of pediatric

surgeons under the leadership ofGustavo Stringel, MD, Chief ofPediatric Surgery for CWPW, LLP andSurgeon-in-Chief at Maria FareriChildren’s Hospital. The division iswidely respected for excellence instate-of-the-art surgical techniquesand exemplary patient outcomes. And now, with theappointment of Dr. Muensterer, the division is poised togain additional recognition and accolades as a center ofminimally invasive surgery (MIS) and the largest groupof pediatric endo-surgeons in the region.

“I was interested in joining a progressive surgicalpractice that has a great track record in endoscopicsurgery,” Dr. Muensterer states. “This is a superbappointment for me, and I am really looking forward tobeing a part of the CWPW and children’s hospital medicalfamily.”

Among Dr. Muensterer’s numerous academicappointments and sites of training was a PediatricSurgery Fellowship at the University of Alabama atBirmingham, where he worked with Keith E. Georgeson,MD, a pediatric surgeon and pioneer in MIS. It was therethat Dr. Muensterer perfected the technique of single-incision pediatric endo-surgery, or SIPES. “Instead ofmaking several incisions, we make one incision and usetiny instruments to operate on the child,” Dr. Muenstererexplains. In fact, the majority of all his minimally invasiveprocedures and practically all appendix, gallbladder,spleen and stomach operations, are performed this way.

Using endoscopes and laparoscopes, a minute incisionis made through the child’s umbilicus (belly button),which enables Dr. Muensterer and the surgical team torepair internal organs with a minimal amount ofdisturbance to the skin. And, cosmetically, operatingendoscopically is a vast improvement to children as theyage. “You can basically hide the incision,” he notes; thisis a powerful advantage as children grow intoadolescence and become more cognizant of their self-image. The procedure is performed on children fromnewborns to adolescents.

Dr. Muensterer notes that he is enthusiastic aboutjoining his esteemed colleagues at CWPW. “Dr. Stringelis a pioneer in endoscopic surgery, and Dr. (Samir)Pandya was trained in Atlanta by a co-fellow of mine fromthe University of Alabama,” he says. Whitney McBride,MD, Anthony SanFilippo, MD, and Peter Liebert, MD, areaccomplished, experienced and dedicated surgeons whoround out the division.

"Dr. McBride has recently taken the position ofDirector for the Surgical Residency Program atWestchester Medical Center. In this role hewill be providing first-class medicine, as wellas educating the future generation ofsurgeons. Taking the corresponding positionat the Maria Fareri Children's Hospital, Iwould like to support him in any way I canfor this mission," states Dr. Muensterer.

PEDIATRIC SURGERY Oliver Muensterer, MD, PhD, Is Making Huge Medical Advances with Small Incisions

Oliver Muensterer,MD, PhD

CWPW is unique in that the Pediatric Surgery divisionhas embraced MIS, Dr. Muenster says, unlike manymedical institutions in the area. “There isn’t a lot ofpediatric endosurgery being done in New York City,” heshares, “and there are not a lot of high-end pediatricendo-surgeons in the region. Single-incision surgery isvery avant-garde.” Many area pediatric surgerydepartments are “too conservative” to adopt cutting-edgeendo-surgery, he points out. “We have learned to do evenextremely complex cases with a single incision approach,leaving virtually no visible scar.”

Dr. Muensterer is taking pediatric surgery at CWPW tonew levels. Where heretofore robotic surgery has mainlybeen used by urological surgeons, Dr. Muensterer plansto introduce robotics to the pediatric surgery division atCWPW. “I’m credentialed in the use of the robot (namedDa Vinci), and would like to expand it to general pediatricsurgery here.”

Dr. Muensterer will also assume the role of AssociateDirector of Pediatric Trauma at the hospital. “I want tomove the Maria Fareri Children's Hospital along towardaccreditation by the ACS,” he says. “It will be the only onefor children in the region” certified to this level of care. Dr.Muensterer is a certified instructor in Advanced TraumaLife Support.

Dr. Muensterer also plans to concentrate on furtheringthe strong research program in pediatric surgery atCWPW, where he will also serve as Director of SurgicalResearch. “There are several things I’d like to do from aresearch standpoint,” he says. Among them is toinvestigate new treatment concepts in fetal surgery,particularly for maladies like diaphragmatic hernia.

A native of Canada, Dr. Muensterer earned medicaldegrees at both the University of Munich in Germany andat the University of Alicante in Spain. After postgraduatetraining in General Surgery, a complete residency inPediatrics at Duke University, and fellowships in PediatricSurgery as well as Pediatric Endosurgery, he heldappointments at the University of Leipzig and theUniversity of Alabama at Birmingham as pediatricsurgeon and director of pediatric trauma. In 2011, Dr.Muensterer came to New York and joined Weill MedicalCollege as the Director of Pediatric Endosurgery and theEducational Director of the Skills Acquisition andInnovation Laboratory.

He also plans to introduce a unique type of microscopeand is working with Weill Cornell collaboratively toevaluate and eventually build this special microscope forlaparoscopic use in patients. It could prove to be ofconsiderable help in treating illnesses such asHirschsprung’s Disease, a congenital condition causingblockage of the large intestine due to a lack of so-calledganglion cells in the bowel wall. “Presently, we takebiopsies and wait for their results while the patient isunder anesthesia,” Dr. Muensterer says. “We would liketo someday build a microscope device that can evaluatethe bowel wall in real time during the operation.”

There is a lot to accomplish in the days ahead, but Dr.Muensterer is fervent about his role in moving thedivision forward, and treating sick children. “I definitelyhave an agenda,” he states. “The issue is finding enoughtime in the day to get it all done. But I have fun doing it.It’s what I’m passionate about.”

Dr. Muensterer lives with his wife and three children inNew Rochelle. CWPW

www.cwpw.org Download our CWPW app — free for iPhone and iPad

by patients and caregivers. “We practice medicine, we talk to patients, colleagues, family members, etc.What I’m struck by is what we think we’re doing andcommunicating is not always what is being received onthe other side.” She stresses that it is critical thatphysicians ensure that they are understood in the contextof the medical environment. This is all part and parcel ofthe purview of the Committee.

“There are things you can do to make sure you’recommunicating effectively,” Dr. Altman says. “I reviewmalpractice cases, and I think a large percentage of thosecases come about not because the medical care wasn’tgood, but because of a breakdown in the perception ofcare on the part of the patient or the parent. So myquestion is, What happened while that care was beingprovided that made that person doubt it? This enters intothe liability risk” and this is some of what the Committeedelves into. “We’re perceived by patients as being gooddoctors based on how we communicate with them.”

According to Dr. Altman, the Committee reviews AAPpolicy statements, clinical and technical reports, as wellas clinical practice guidelines developed by othercommittees. “Once they’re developed by other taskforces, they all have to go through the Liability and RiskManagement Committee,” she explains. “We review thewording from the perspective of the provider to ensurethat it’s all clear.” Members also write articles on

assessing risk and can review as many as 50 new orupdated policies annually. The AAP is committed toreviewing and/or updating all policy statements andclinical practice guidelines every three years.

“It’s a great honor to be identified as someone beingnominated, and then to be chosen,” Dr. Altman says. Sheis one of two general pediatricians on the Committee; theother members represent medical subspecialties. TheChapter President is Lance Parton, MD, a neonatologistat CWPW. CWPW

Robin Altman, MD, FAAP, Chief of General Pediatrics

at CWPW, has been appointed to a six year term to the prestigiousCommittee on Medical Liability andRisk Management of the AmericanAcademy of Pediatrics (AAP).

Dr. Altman was nominated to serve on the committee by a fellowphysician, Jeffrey Brown, MD, whose six-year term was expiring. “He’s a very well-respected physician,” Dr. Altman explains. “He’s a community pediatrician whois very involved. He asked me if I was interested, and Isaid, Yes.”

There are six members who serve on the MedicalLiability and Risk Management Committee. “I think it’ssomething that’s really important for all pediatricians tobe knowledgeable of and aware of,” Dr. Altman says. “Ingeneral I’m very practical in my approach to things, and Ithink being aware of how we practice and how we speakto one-another, and to patients, is critical. It needs to bedone within the context of providing excellent medicalcare, while being aware of those behaviors that can createan environment that presents a higher risk.”

Dr. Altman notes that by risk, “It’s not just liability risk,but what we think we’re doing and saying,” and that whatphysicians say might not always be perceived accurately

DOCTOR’S APPOINTMENTCWPW’s Pediatrician Robin Altman, MD, FAAP, Named to American Academy of Pediatrics (AAP) Committee on Medical Liability and Risk Management

Robin Altman, MD,FAAP

As Division Chief, Dr. Nolan says she is committedto providing superior pediatric patient care, and toadvancing research into the diseases that affect infantsand children. “The primary focus of our division istreating patients, but one of my goals is to expand theresearch side of the practice,” Dr. Nolan explains. ManyCWPW divisions currently have very robust researchprograms and through collaborative efforts and externalgrant funding, Dr. Nolan hopes to build a strongfoundation for research within the I.D. Division. “Myprimary research endeavors and interests are studyingviral vaccines and viral respiratory diseases,” she adds.While at the NIH she conducted significant research intovaccine development for human parainfluenza virus.

“Another immediate goal is to build an antibioticstewardship program,” Dr. Nolan says. “The programwill entail helping to optimize antibiotic choices for(pediatric) in-hospital patients, while improving theoverall quality of patient care.” The challenges faced bymany specialists in the field of infectious diseases ofbattling organisms that develop resistance to antibioticscontinue to grow because the organisms can evolverapidly, and they require a multifaceted approach, Dr.Nolan points out. “One of the goals of the stewardshipprogram is to limit the creation of resistance through

TThe Division of InfectiousDiseases at CWPW is poised

to make greater strides in researchand patient care with the appointmentof Sheila M. Nolan, MD, to theposition of Division Chief. Theannouncement of Dr. Nolan’sappointment was made by Leonard Newman, MD, Presidentof CWPW.

A dedicated researcher, academician and hands-onphysician, Dr. Nolan leads a dedicated team at CWPWcommitted to the study of infectious diseases, whilepursuing new avenues in diagnosing and treatinginfectious illnesses in infants, children and adolescents.Having conducted research at the National Institutes ofHealth and serving with an international manufacturer ofpharmaceuticals, Dr. Nolan has made research aconsiderable thrust of her professional career. She is anAssistant Professor of Pediatrics at New York MedicalCollege, and has served as a physician at severalrespected hospitals, including as Instructor of Pediatricsin the Division of Infectious Diseases at The Children’sHospital of Philadelphia.

NEW LEADERSHIPSheila M. Nolan, MD, MSCE, Appointed Division Chief of Infectious Diseases at CWPW

Sheila M. Nolan, MD,MSCE

judicious antibiotic use. There is ongoing research, butthe pipeline for new antibiotics to treat highly resistantorganisms is fairly small.”

At CWPW Dr. Nolan explains that she and hercolleagues are currently working to undertake a researchinitiative helping children with chronic refractoryClostridium Difficile infection. The disease is associatedwith antibiotic use and occurs when the normal balanceof bacteria in the intestines is disrupted and C. Difficilebacteria produce toxins that cause diarrhea. Theresearch currently under way includes fecaltransplantation to restore the normal flora of a child’sdigestive system. “In a small percentage of people theantibiotics used to treat C. Difficile does not work or thedisease returns as soon as treatment is discontinued,”Dr. Nolan explains. “It’s been shown that, at least inadults, if you restore the normal gut flora to the colon, itcan cure them.”

Treating children on a daily basis — and having thetime to conduct meaningful research into infectiousdiseases — are the aspects of medicine that intrigueand inspire Dr. Nolan. “I’m very happy to be back seeingpatients,” she says. “I’m very excited to be working withthe talented group of people at CWPW.” CWPW

www.cwpw.org Download our CWPW app — free for iPhone and iPad 8

SURVEY SAYS Two Pediatric DepartmentsCited by U.S. News & WorldReport as Exemplary

Comprehensive Pediatric Care

www.cwpw.org Download our CWPW app — free for iPhone and iPad 9

In the News

It will come as no surprise that the sub-specializations atCWPW, LLP, are among the finest anywhere, and now there

is additional confirmation. In a survey of 110 children’shospitals across the United States conducted by U.S. News &

World Report, nine were from New York State, among them Maria Fareri Children’sHospital, according to Michael Gewitz, MD, Physician-in-Chief at the Children’sHospital and Vice President of CWPW. The Divisions of Pediatric Gastroenterology/GISurgery and the Regional Intensive Care Unit/Neonatology were identified by USN&WRspecifically for excellence of care.

Edmund LaGamma, MD, is Chief of Neonatology at MFCH and CWPW; Stuart Berezin,MD, is Chief of Pediatric Gastroenterology at both; and Gustavo Stringel, MD, heads thesurgical programs for both. According to Dr. Gewitz, the three physicians preside overprograms that are at the forefront of subspecialty care and training and treat infants andchildren with the complete spectrum of disorders, including the most complicated.These programs typify the group of highly experienced physicians dedicated toproviding exceptional care to every patient that is the hallmark of CWPW. CWPW

Munger Pavilion, Room 123 • Valhalla, New York 10595

CWPW • V i s i t O u r We b S i te fo r Ad d i t i o n a l I n fo rm a t i o n : w w w. c w p w. o rg

Suzanne Kaseta, MD, Coordinates Dinner for CWPW Colleagues in Orange, Rockland Counties

Suzanne Kaseta, MD, CWPW’s Physician Director of Community Quality Initiatives and Pediatrician atWashingtonville Pediatrics, recently coordinated a dinner at the Overlook Lodge at Bear Mountain. Several CWPW

pediatric groups in Orange and Rockland counties came together for an evening of networking, learning and fine dining. Throughout the evening, doctors heard brief talks from their colleagues and had an opportunity to ask questions.

From left to right: Washingtonville Pediatrics doctorsMaureen McKenna, MD; Barbara Beyer, MD; Maureen Bezdickova, MD; Patricia Mangan, MD; andPediatric Genetic Specialist Susanna Sorrentino, MD

All from CWPW, from left to right: Sheila Nolan, MD,Chief of Pediatric Infectious Diseases; Robin Altman,MD, Chief of General Pediatrics; Joseph Giamelli,MD, Pediatric Cardiologist; and Robert Amler, MD, General Pediatrics

From left to right: Barbara Gannon, MD, Washing-tonville Pediatrics; Daniel Cohen, MD, North RocklandPediatrics; Suzanne Kaseta, MD, Physician Director ofCommunity Quality Initiatives; and Carey Goltzman,MD, Pediatric Critical Care