SCMS BULLETIN - December 2018 by SCMS Bulletin

The

Bulletin Saginaw County Medical Society

December 2018 | Volume 77 | No 4

Update: CMS E/M Medical Missions New Categories Service Documentation p. 16-20 of CME Provided By Students p. 26 p. 15

www.SaginawCountyMS.com

WARNING SIGNS OF

STROKE

Sudden numbness or weakness of the face, arm or leg, especially on one side of the body. Sudden trouble walking, dizziness, loss of balance or coordination. Sudden, severe headache with no known cause. Sudden trouble seeing in one or both eyes. Sudden confusion, trouble speaking or understanding. For more information go to www.covenanthealthcare.com

Every minute counts CALL 911

Do not wait for the symptoms to go away.

The

Bulletin Saginaw County Medical Society

SAGINAW COUNTY MEDICAL SOCIETY 2018-2019 OFFICERS AND DIRECTORS

President Julia M. Walter, MD President-Elect Zubeda S. Khan, MD

contents 5

8 9

15 16-20

SCMS Physicians Participate in Panel Presentation to M2s

Secretary Caroline G.M. Scott, MD Board of Directors Mildred S. Willy, MD Anthony M. Zacharek, MD Jorge M. Plasencia, MD Kala K. Ramasamy, MD Tiffany K. Kim, MD Mark G. Greenwell, MD Bulletin Editor Louis L. Constan, MD Retiree Representative Rustico B. Ortiz, MD Resident Representative Mary J. McKuen, MD MSMS Delegates Elvira M. Dawis, MD Zubeda S. Khan, MD Julia M. Walter, MD Virginia R. Dedicatoria, MD Mildred J. Willy, MD Anthony M. Zacharek, MD Jorge M. Plasencia, MD Christopher J. Allen, MD

UPDATE: CMS E/M Service Documentation Provided by Students

SCMS Board Serves Its Members

Past President Virginia R. Dedicatoria, MD Treasurer Mohammad Yahya Khan, MD

CME Update & 2018 Annual CME Survey

4 5

24 Covenant HealthCare 25 January Birthdays 26 MSMS

President’s Letter Save the Date for Upcoming Membership Meetings

6 7 10

12 13 13 14 21 22

From the Editor

Attention Retired Members Barb Smith Suicide Resource & Response Network Upcoming ASIST Trainings Save the Date! 15th Annual Health Fair

28 29

New Members

30 31

In Memory

Applications for Membership

Key Provider of the Month – Bieri Hearing Ascension St. Mary’s Hospital

Medical Missions Ecuador – David B. Krebs MD Costa Rica – Jennifer Romeu MD Why I Go – Anthony de Bari MD

32 32

New Categories of CME

A Guide to 2019 Physician License Renewal Requirements CMU College of Medicine | CMU Health Call For Resolutions: Who Sets MSMS Policy? You Do! Advertiser Index Caduceus Meeting for Recovering Health Care Professionals UPDATE: Now on the Third Thursday of the Month Key Providers Calendar of Events for 2019

The Bulletin can be viewed online at www.SaginawCountyMS.com under the Bulletin tab.

MSMS Alternate Delegates Caroline G.M. Scott, MD Waheed Akbar, MD Mohammad Yahya Khan, MD Danielle C. Duncan, MD Steven J. Vance, MD Amandeep S. Dhaliwal, MD Miriam T. Schteingart, MD Peer Review Ethics Committee Waheed Akbar, MD, Chair Caroline G.M. Scott, MD James R. Hines, MD MSMS District 8 Director Thomas J. Veverka, MD EXECUTIVE DIRECTOR Joan M. Cramer ADMINISTRATIVE ASSISTANT Keri Benkert

ON THE COVER: (l-r) Drs. Jose Jurado, Zubeda and Mohammad Yahya Khan with Barb Smith (far right) at SCMS safeTALK Suicide Alertness Training EDITOR Louis L. Constan, MD

PUBLISHER Saginaw County Medical Society

EXECUTIVE DIRECTOR Joan M. Cramer

350 St. Andrews Rd., Suite 242, Saginaw, Michigan 48638-5988. Hours: Tuesday, Wednesday, Thursday 8:30 AM - 3:30 PM. Web: SaginawCountyMS.com

DESIGNER Lori Krygier

Telephone: (989) 790-3590. Fax: (989) 790-3640 E-Mail: jmcramer@sbcglobal.net

All statements or comments in the Bulletin are those of the writers, and not necessarily the opinion of the Saginaw County Medical Society. Contributions are welcome. We publish committee reports, letters to the editor, Alliance reports, public health activities of the members, and some personal items (birthdays, weddings, graduations and like events). The Editor determines which are accepted. Advertisements are accepted as space is available at our going rates. Members may advertise office information, professional services, skills, and procedures, also at our going rates. We do not accept advertisements from nonmembers, or non-Saginaw hospitals. The Bulletin is mailed free of charge to SCMS members as part of their membership. Complimentary copies are sent to various other parties. Others may subscribe at the rate of $50 per year.

The Bulletin | December 2018 3

PRESIDENTâ&#x20AC;&#x2122;S LETTER

Desiderata By Julia M. Walter, MD Go placidly amid the noise and haste, and remember what peace there may be in silence. As far as possible without surrender, be on good terms with all persons. Speak your truth quietly and clearly; and listen to others, even the dull and the ignorant; they too have their story. Avoid loud and aggressive persons, they are vexations to the spirit. If you compare yourself with others, you may become vain and bitter; for always there will be greater and lesser persons than yourself. Enjoy your achievements as well as your plans. Keep interested in your own career, however humble; it is a real possession in the changing fortunes of time. Exercise caution in your business affairs; for the world is full of trickery.

But let this not blind you to what virtue there is; many persons strive for high ideals; and everywhere life is full of heroism. Be yourself. Especially, do not feign affection. Neither be cynical about love; for in the face of all aridity and disenchantment, it is as perennial as the grass. Take kindly the counsel of the years, gracefully surrendering the things of youth. Nurture strength of spirit to shield you in sudden misfortune. But do not distress yourself with dark imaginings. Many fears are born of fatigue and loneliness. Beyond a wholesome discipline, be gentle with yourself.

You are a child of the universe, no less than the trees and the stars; you have a right to be here. And whether or not it is clear to you, no doubt the universe is unfolding as it should. Therefore be at peace with God, whatever you conceive Him to be, and whatever your labors and aspirations, in the noisy confusion of life keep peace with your soul. With all its sham, drudgery, and broken dreams, it is still a beautiful world. Be cheerful. Strive to be happy.

Max Ehrmann, Desiderata, 1927

Keep interested in your own career, however humble; it is a real possession in the changing fortunes of time.

The Bulletin | December 2018

SAVE THE DATES!

Register now for our Tuesday, January 15, 2019, Membership Meeting joint with the Saginaw County Dental Society and Genesee County Medical Society.

Mark your calendar now for our Tuesday, April 16, 2019, Membership Meeting at Horizons Conference Center. The social with cash bar starts at 6:30 p.m., followed by dinner, meeting and program at 7 p.m.

DATE: TIME:

Topic: “TED Talks* - The Human Challenge of Healthcare” Speakers: To be determined

Tuesday, January 15, 2019, Membership Meeting CME Credit Available!

Tuesday, January 15, 2019 6:30 p.m. Social (cash bar) | 7 p.m. Dinner, Brief Meeting and Program PROGRAM: “Surviving Acts of Violence” SPEAKER: Henry Reyna, Retired Police Officer and Owner of Secure Solution, LLC PLACE: Horizons Conference Center, 6200 State Street, Saginaw COST: SCMS Members, CMU Residents and CMU Medical Students – no cost Saginaw County Dental Society Members – no cost GCMS Members - $40 payable in advance Physicians who are not members of the SCMS/ GCMS - $100 payable in advance All others - $40 payable in advance RESERVATIONS ARE REQUIRED BY JANUARY 9, 2019 Online reservations are now being accepted at https://www. surveymonkey.com/r/SurvivingActsofViolence11519 Speaker:

Henry Reyna, was a law enforcement officer in Saginaw County for 32 years until his retirement in 2015. Additionally, he was also an instructor at the police academy for over 20 years, teaching recruits and in-service officers in the areas of defensive tactics, edge weapon defense, hand guns and the use of rifles. Henry owns a security consulting business Secure Solution, LLC - and has been providing his services to businesses, medical and dental offices. He is a certified Crime Prevention Specialist, and has participated in multiple advanced crime prevention training programs around the country.

Tuesday, April 16, 2019, Membership Meeting

*So what is a TED Talk? A TED Talk is about ideas. It is about real people making connections with other real people. These talks are concise, every word counts, lasting from 5-18 minutes. Generally these talks are delivered without notes, from memory, conveying passion and possibilities. A speaker need not be an educated professional. They can be illiterate. Their experience is what matters. The audience plays a role in that they need to encourage if they feel the speaker is nervous. As a speaker, be real and kind. This is an opportunity to promote great ideas by working together to open each other’s eyes. The theme of the evening will be The Human Challenge of Healthcare. So bring excitement, energy and focus on your idea and its application to the lives of others. To join the list of guest TED Talkers to be considered for the meeting, please contact Joan Cramer at jmcramer@sbcglobal. net with a brief synopsis of your proposed TED Talk. All ideas will be submitted to the SCMS Board for review and consideration to present at the April Membership Meeting.

Tuesday, May 21, 2019, Membership Meeting

Mark your calendar now for our Tuesday, May 19, 2019, Annual Membership Meeting at Horizons Conference Center. The social with cash bar starts at 6:30 p.m., followed by dinner, meeting and program at 7 p.m. Featured will be an update on CMU College of Medicine.

DISCLOSURE: The planner(s) and speaker(s) for this session disclose no relevant financial relationships with commercial interests. STATEMENT OF ACCREDITATION: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Central Michigan University College of Medicine and the Saginaw County Medical Society. CMU College of Medicine is accredited by the ACCME to provide continuing medical education for physicians. Central Michigan University College of Medicine designates this live activity for a maximum of 1.25 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The Bulletin | December 2018 5

FROM THE EDITOR

When More is Less By Louis L. Constan, MD

eople who text use abbreviations - a lot. One is TMI, for “Too Much Information.” Our world today is bombarded with information, most of which does absolutely nothing to contribute to our well-being, and some of which actually can be harmful to us. TMI is a cry for help. Please make it stop! We’ve been discussing the Choosing Wisely® campaign, where virtually all the specialty societies strongly encourage their members to stop doing certain tests, procedures, and treatments that are too costly, unnecessary or harmful. One of the Choosing Wisely® items is quite interesting. In 2015, the American Academy of Nursing (AAN), the academic arm of the four million member American Nurses Association, gave us one TMI. They pointed out that, for routine labor, there is no evidence that continuous monitoring of fetal heartbeat during labor is better than intermittent monitoring. Some background on this - in the 1970’s, the obstetric community embraced continuous electronic monitoring of fetuses during labor; basically they set up a monitor just like the one in coronary care units…for the baby. You could check out every single heartbeat of the coming baby.

Had to be good, right? Trouble was, every time some little glitch in the heartbeat occurred, the obstetrician pulled out his knife and a Caesarian Section was done. C-section rates soared to an embarrassing 32 percent of births; almost one-third of babies born in this country were born via a major operation! Did the soaring C-section rate contribute to the national well-being? It turns out the answer is NO. But it took 40 years for that to become clear. Far too long. The AAN, as I said, ultimately pointed out that there was no difference in obstetric outcomes between the old way (intermittent auscultation) and the new way, continuous electronic monitoring, with the exception, and this is the shocker, that the patient was half as likely to have a C-section if you had intermittent monitoring. Let’s put this another way - when we went to continuous electronic monitoring in the 1970s, we at least doubled the C-section rate TO NO BENEFIT FOR PATIENTS. The continuous monitoring was essentially TMI. It’s interesting that it took 40 years for this information to come out (and another two years for the OB/Gyns

to officially recognize this report) during which time two generations of Americans were subjected to needless risks of unnecessary surgery, unnecessary costs and rising insurance rates. Oh, and there is the little issue we’re just finding out about, the fact that babies born by C-section do not pick up the proper bacteria, the microbiome, from the birth canal, and are subject to diseases such as obesity and serious allergies. In the defense of doctors at the time (and I was one), we are only human. The increased monitoring seemed like a good idea. It seemed very necessary at the time. It seemed reassuring. That being said, when the C-section rates began to spiral out of control, we should have done something. We should have been able to sound the alarm in fewer than 40 years. Next time, someone needs to be willing to yell “TMI - please make it stop!” Here’s another one - imaging tests for lower back pain. Several specialty societies address this issue in Choosing Wisely®. There is wide agreement that it serves no purpose to do any imaging when someone has low back pain… no matter how bad it is…unless there continued on page 7

We should have been able to sound the alarm in fewer than 40 years. Next time, someone needs to be willing to yell “TMI - please make it stop!”

Louis L. Constan, MD

The Bulletin | December 2018

continued from page 6

are some warning signs such as neurologic signs, or signs of cancer such as weight loss or fever. Sadly, these tests continue to be widely and unnecessarily done, even though there are indisputable reasons not to do them: 1. Almost everyone with back pain gets better within one month no matter what you do (physical therapy, pain pills, manipulation) even if you do nothing. Your choice. 2. Radiation can be harmful. 3. Imaging costs money, and if the patient is going to get better anyway, why incur cost? 4. Many, many patients have abnormal back X-rays, and they have had them prior to their injury. Spondylosis, spondylolisthesis, spurs, kyphosis, scoliosis, misalignments, funny-looking discs. If you find these, what do you do? Further tests, referrals, surgery? This may very well be a TMI situation. My brother-inlaw was once told his low back is “a mess” and he spends his life worrying about it, although I have never seen him act as though he were having pain or spasms. TMI. What then, have we learned from Choosing Wisely®? It is that, above all, we must be true to what we, as physicians have been for the past 1,500 years, healers who look patients in the face, engage them as fellow human beings, lay hands on them during an examination, then bring in technology if and only if it has been proven scientifically to provide benefit to them at a reasonable cost and without harm.

ATTENTION RETIRED MEMBERS!

Retired physicians meet for lunch every Wednesday at 12 noon at IHOP, 2255 Tittabawassee Road in Saginaw. Those attending are responsible for their own lunch, and the informal gathering lasts about an hour. Join your retired colleagues whenever you like! If you have any questions, please contact Joan Cramer at the SCMS office at 790-3590 or by email at jmcramer@sbcglobal.net.

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989-272-8123 IT Specialist to the SCMS and many physician practices Hours: MON-FRI 9 AM to 5 PM The Bulletin | December 2018 7

SCMS Board Serves Its Members Have you ever wondered who keeps the SCMS functioning? As the year comes to a close, it is a perfect time to thank the men and women of the SCMS who volunteer their service on the SCMS Board. Nine times a year, the Board meets to discuss and act on local issues, legislative issues, what they can do to better serve our members, decide on educational programs for future Membership Meetings and much more. The list of officers, directors, delegates and alternates and other representatives serving on the Board can be found on page 3. We also have several physicians who serve the MSMS on our behalf as district director or committee chair/members. Perhaps you can take a moment the next time you see them and say “thank you for your service.” We all know how precious time is, and these physicians work to make the SCMS better for YOU and your practice. In addition to regular business on November 20, the Board listened to a presentation by Julie Novak, CEO of MSMS, on MSMS Reorganization. If anyone is interested in Julie’s presentation and the proposed plans for the future, please contact Joan Cramer at jmcramer@sbcglobal.net. If you would like to be considered for a position on the 2019-2020 Board, please contact Joan or a Board member. As mentioned, the Board meets nine times a year on the third Tuesday of every month at 5:30 p.m. except in July, August and December. Board Meetings are held prior to the Membership Meeting in January, April, May, September and October, and at CMU College of Medicine on Stone Street in Saginaw in February, March, June and November. Meetings last about an hour, and dinner is provided when the Board meets at CMU in Saginaw. Attendance at 50 percent of Board Meetings is required per the Bylaws.

If you would like to be considered for a position on the 2019-2020 Board, please contact Joan or a Board member.

Above (top to bottom) (l-r) Drs. Tiffany Kim, Anthony Zacharek, Tom Veverka, M3 Lindsay Murphy and Dr. Chris Allen (l-r) Drs. Kala Ramasamy, Miriam Schteingart, Millie Willy, Caroline Scott, Mary McKuen, Tiffany Kim and Anthony Zacharek (l-r) Julie Novak, CEO of MSMS, and Drs. Steve Vance and Lou Constan (l-r) Dr. Tom Veverka, M3 Lindsay Murphy, Drs. Chris Allen, Rustico Ortiz, Elvira Dawis, Julia Walter, Zubie Khan and Mohammad Khan

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SCMS Physicians Participate in Panel Presentation to M2s On Tuesday, November 13, Dr. Millie Willy facilitated a Physician Panel for M2 students at CMU College of Medicine in Mt. Pleasant. The topic of the evening was “Career Choices in Medicine - The Good, The Bad and The Ugly.” Drs. Danielle Duncan, Miriam Schteingart and Julia Walter from the SCMS participated, as well as, Drs. Noshir Amaria, Ashley Aultman and Shreya Wachob. Dr. Amaria is Assistant Professor of Family Medicine & Sports Medicine at CMU, as well as, CMU Team Physician; Dr. Aultman is an Emergency Medicine physician with MidMichigan Health; and Dr. Wachob is a Pediatrician with MidMichigan Health. Almost 60 M2 students attended the event. Physicians on the Panel told about themselves, why those chose their specialty, briefly described a “day in their life,” what they enjoyed most and least about their job and would they make the same specialty choice today. They also talked about work/ life/family balance, how they keep from burning out and what their career has allowed them to do outside of daily practice. Finally, Dr. Willy asked Panel participants for a parting message to the M2 class. Several physicians said not to be discouraged if someone tells you there is something you can’t do or accomplish (so do it and prove them wrong!), make time for your spouse/significant other, attend your children’s

(l-r) Drs. Willy, Walter, Aultman, Wachob, Schteingart, Amaria and Duncan

activities whenever possible and take time for yourself. Whether it’s going for a run, spending time outdoors, some sort of hobby or something else you enjoy, make time for it. At the end of the evening, students mingled with the physicians and asked any other questions they may have had. Dr. Willy hopes to make the Physician Panel an annual event, as it was very informative and well received by the students. Several students commented it was nice to have an interaction with physicians that was more personal than academic or clinical. If you are interested in participating in a future Physician Panel, please contact Joan Cramer at jmcramer@ sbcglobal.net. Thank you to Dr. Willy for arranging and facilitating, and our physicians for participating.

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The Bulletin | December 2018 9

About this Training

SCMS Sponsors safeTALK Training On Saturday, November 10, the SCMS sponsored another safeTALK Suicide Alertness Training presented by Barb Smith. Three of our members along with community members, survivors, teachers, nurses, medical students and a Saginaw County Sheriff’s Dept. Victim Advocate learned what to look for, say and do to help those who may be suicidal choose life. This is the second safeTALK training the SCMS has sponsored in 2018. CME credit was available to physicians who participated in the training. If you are interested in attending a future training, please contact Joan Cramer at jmcramer@sbcglobal.net.

Upcoming ASIST Trainings MIDLAND | Tuesday-Wednesday, January 29-30, 2019 8 a.m. to 4:30 p.m | Fee $50 Midland Evangelical Free Church | 7221 N. Jefferson Avenue Midland, MI 48642 Register at give.classy.org/asistmidland SAGINAW | Tuesday-Wednesday, February 19-20, 2019 8 a.m. to 4:30 p.m. | Fee $50 Diocese of Saginaw | 5800 Weiss Street | Saginaw, MI 48603 Register at give.classy.org/asistsaginaw Special Note from Joan Cramer, SCMS Executive Director: I participated in the two-day ASIST Training in September, and can truly say it was one of the best things I have ever done in my career. The skills learned can be used in day-to-day interactions with patients, colleagues, family and friends. One of our surgeon members who took the ASIST training said it helped her better understand her patients, and how she talks to them about an illness or condition they may have that can cause depression or suicidal ideation. I highly recommend the training to physicians and health care providers.

10 The Bulletin | December 2018

Applied Suicide Intervention Skills Training (ASIST) is a two-day interactive workshop in suicide first aid. ASIST teaches participants to recognize when someone may have thoughts of suicide and work with them to create a plan that will support their immediate safety. The ASIST method helps reduce suicidal feelings in those at risk, and is a cost effective way to help address the problem of suicide. ASIST helps to build regional networks of trained caregivers who can support each other, and use common terminology to approach suicide and safety. Due to the content of the training, you are required to attend two full days (no exceptions). Class size is limited to 45.

Who Should Attend Anyone can experience thoughts of suicide. By giving participants the skills to help friends, family members, colleagues and clients stay alive, ASIST supports suicide-safer communities. Although ASIST is widely used by healthcare providers, no formal training is needed to attend the workshop. Anyone 16 or older can learn and use the ASIST model.

Learning Goals & Objectives Over the course of the two-day workshop, ASIST participants learn to: • Understand the ways that personal and societal attitudes affect views on suicide and interventions • Provide guidance and suicide first aid to a person at risk in ways that meet their individual safety need • Identify the key elements of an effective suicide safety plan and the actions required to implement it • Appreciate the value of improving and integrating suicide prevention resources in the community at large • Recognize other important aspects of suicide prevention including life-promotion and self-care Questions? Contact Barb Smith at sosbarb@gmail.com or (989) 781-5260

ASIST is sponsored in part by the Alden & Vada Dow Family Foundation ASIST is a program offered through:

LivingWorks Education is a suicide intervention training company that trains community helpers of all kinds to work in this intervention context. Operating as a private social enterprise corporation, it employs all of the financial discipline, innovation and determination of any private sector business to achieve its mission

CME Update & 2018 Annual CME Survey College of

Medicine Central Michigan University Office of Continuing Medical Education (OCME) is pleased to announce changes in CME course accreditations available for physicians and the interdisciplinary healthcare team. New features include the: • Ability to offer AOA Category 1-A, Social Work CE and other credit (i.e., physical therapy). • Selection of Continued Certification or Maintenance of Certification (MOC) with several American Boards of Medical Specialties (ABMS) currently collaborating with the Accreditation Council for Continuing Medical Education (ACCME), including the: o American Board of Anesthesiology (ABA) o American Board of Internal Medicine (ABIM) o American Board of Otolaryngology – Head & Neck Surgery (ABOHNS) o American Board of Pathology (ABPath) o American Board of Pediatrics (ABP) • Additional ABMS boards will be added periodically • All courses certified for MOC or CE will be listed on the ACCME CME Finder

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• Courses certified for ABIM MOC can use their logo in promotional materials:

The OCME is focusing on the following major categories required for Commendation in accredited CME: • Public health priorities • Enhancing skills • Demonstrating educational leadership • Promoting team-based education • Achieving outcomes For further information about CME or to apply for CME credits, please check out our website where you can find the latest CME application documents; claim CME credit; print a CME certificate or transcript; find the latest CME activities; review the monthly Calendar of Events; locate Category 2 Credit Forms for teaching residents and medical students; utilize Physician Resources … and more! continued on page 12

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For any questions, comments or suggestions about CME, please contact us at: CMUCME@cmich.edu or call us at 989-746-7555 or 989-746-7602.

2018 Annual CME Survey To: All 2018 CME Activity Attendees, Learners and Planners It’s that special time of year again when we invite - and need - your experience, opinions and suggestions about our Continuing Medical Education programs and courses over the past year. Has anything you learned affected or improved your knowledge, competence, performance, and/or possibly, patient outcomes? What kinds of educational activities do you envision for yourself and others? We ask that you please complete our 2018 Annual CME Survey which only has a few questions and should take no more than three minutes to complete. Your participation is greatly appreciated and we appreciate your time and feedback! Thank you! Office of Continuing Medical Education CMU College of Medicine 1632 Stone St., Saginaw MI 48602 Office: 989-746-7514 | Fax: 989-746-7579 Email: CMEDCME@cmich.edu Website: med.cmich.edu/cme Joint Providership of CME activities available. Please contact our office for further information.

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APPLICATIONS FOR MEMBERSHIP Please contact Joan Cramer at jmcramer@sbcglobal.net or 790-3590 if you have any questions or would like more information on the applicants. FIRST READING Below is an Application for Membership that may be recommended for acceptance at the Tuesday, February 19, 2019, Board Meeting. Monique S. Turner, DO (Women’s Ob-Gyn, PC) Specialty: Ob/Gyn (Board Certified 2018) Medical School: Michigan State University College of Osteopathic Medicine, 2012 Internship/Residency: Henry Ford Macomb Hospital, Ob/Gyn, 2012-16 Military: U.S. Air Force, 1996-98 and Michigan Army National Guard, 2000-present Prior Practice: Matrix Providers, Madigan Army Medical Facility, 2017 Sponsors: Doctors Jennifer R. Schmidt and Kristine K. Spence SECOND READING Below are Applications for Membership that may be recommended for acceptance at the Tuesday, January 15, 2019, Board Meeting. Judy S. Blebea, MD (CMU College of Medicine – Associate Dean, Faculty Affairs, Faculty Development) Specialty: Radiology – Diagnostic (Board Certified 1989) Medical School: State University of New York Health Science Center, Brooklyn, NY, 1983 Internship: George Washington University Medical Center, Washington, DC, Internal Medicine, 1983-84

Residency: Columbia – New York Presbyterian University Medical Center, New York, NY, Diagnostic Radiology, 1985-89 Fellowship: University of Rochester Medical Center, Rochester, NY, Body Imaging and MSK Radiology, 1989-90 Prior Practice: (1) University of Rochester School of Medicine, Rochester, NY, Assist. Prof. of Radiology, 1990-91; (2) University of Cincinnati School of Medicine, Cincinnati, OH, Assist. Prof. of Clinical Radiology 1991-97; (3) Penn State University College of Medicine, Hershey, PA, Assist./Assoc./Clinical Assoc. Prof. of Radiology, 1997-08; (4) Cleveland Clinic Lerner College of Medicine, Cleveland, OH, Clinical Prof. of Radiology, 2009-12; (5) University of Oklahoma College of Medicine, Tulsa and Oklahoma City, OK, Clinical Prof. of Radiology 2012-17; and (6) Central Michigan University College of Medicine, Clinical Professor of Radiology, 2017-18 Sponsors: Doctors John Blebea and Mildred J. Willy Mark J. Hass, MD (Advanced Diagnostic Imaging, PC) Specialty: Radiology - Diagnostic (Board Certified 2006), Breast Imaging Medical School: Spartan Health Sciences University, St. Lucia, West Indies, 1999 Internship/Residency: Oakwood Hospital & Medical Center, Dearborn, MI, Diagnostic Radiology, 2000-05 Fellowship: University of Virginia Health System, Charlottesville, VA, Breast Imaging, 7/16-6/17 Prior Practice: (1) Grand Traverse Radiologists, PC, Traverse City, MI, 7/05-5/06; (2) Drs. Harris, Birkhill, Wang, Songe & Associates, Dearborn, MI, 7/06-03/09; (3) Radiology Muskegon, PC, Muskegon, MI, 03/09-06/16; and (4) Marshfield Clinic, Minocqua, WI, 8/17-9/18 Sponsors: Doctors Mark R. Ludka and Harvey K. Yee

NEW MEMBERS Nicholas E. Haddad MD CMU Health - Internal Med. 1000 Houghton Saginaw, MI 48602-5303 Office (989)-746-7916 www.cmich.edu/colleges/cmed/ Internal Medicine, Infectious Diseases Wynee S. Lou DO CMU Health Primary Care 5421 Colony Drive North Saginaw, MI 48638-7128 Office (989)-790-3141 www.cmich.edu/colleges/cmed/ Internal Medicine, Sports Medicine

Venkat Maganti MD Ascension Medical Group Heritage Family Physicians 3570 Shattuck Road Saginaw, MI 48603-3153 Office (989)-792-5353 healthcare.ascension.org/sites-of-care/michigan/ Family Medicine Michael W. Warren MD Advanced Diagnostic Imaging, PC 3400 N. Center, Suite 400 Saginaw, MI 48603-7920 Office (989)-799-5600 www.adirads.com Radiology - Diagnostic The Bulletin | December 2018 13

IN MEMORY James E. Packer, MD On Thursday, November 15, 2018, Dr. James (Jim) Packer Sr., loving father, grandfather, brother and friend passed away at the age of 86 at his son’s home in Marble Falls, Texas surrounded by family. Jim was born in Flint on September 24, 1932, to Vera and Athol Packer. He is survived by his son, Jim Packer Jr.; his son, John Packer and wife Diane; his brother, Athol Packer and wife Dee; his sister, Jean (Packer) Hinkin; nine grandchildren and 16 greatgrandchildren; and many beloved nieces and nephews. He was preceded in death by his parents; his son, Jeff Packer; brother, Tom Packer; brother-in-law, Dave Hinkin; and Joyce Packer, mother of his three sons. Jim grew up in Saginaw and graduated from Arthur Hill High School. He attended Graceland College for two years where he played football. He transferred to Michigan State University where he received both Bachelor’s and Master’s degrees in Chemical Engineering. He then worked for Dow Chemical, but soon decided to follow his passion for helping people and attended the University of Michigan Medical School where he earned his medical degree.

Dr. Packer spent over 40 years practicing as a Family Physician in Saginaw, delivering over two hundred babies into this world. He built his own private practice for over 20 years in Saginaw, then went to work for Blue Care Network for 20 years. Jim was a compassionate, caring, intelligent, capable and humble person and physician, admired and respected by anyone who met him, and by his peers in the medical community. He took time to listen. He gave his full attention during conversations, asking about you, not telling about himself. Dr. Packer was a member of the SCMS for over 53 years. Jim also had his private pilot license and loved the outdoors. Fishing, hunting, skiing and flying his family and friends around in the pontoon plane in northern Michigan is what he loved to do. The world lost a great one. Jim will be truly missed by everyone he touched. A celebration of Dr. James E. Packer’s life was held on Saturday, December 8 at 11 a.m. at the Community of Christ Church, 300 N. Center Road in Saginaw. Those planning an expression of sympathy are asked to consider the American Cancer Society or the Saginaw County Medical Society Foundation.

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The Bulletin | December 2018

UPDATE: CMS E/M Service Documentation Provided by Students CMS transmittal 3971 issued on 2/2/2018 (and updated in transmittal 4068) modified the restrictions on the use of medical student documentation. The teaching physician is no longer required to re-document items documented by the student. As before, any contribution of a medical student to a billable service must be performed in the physical presence of a resident or teaching physician. In summary: • Students may document all components (E/M) of the medical record • The teaching physician or resident must be physically present • The teaching physician must personally perform (or re-perform) the history of present illness, the exam and MDM activities • The teaching physician must verify or correct all of the student’s documentation and does not need to re-document The following is an example of a possible attestation: “This note was prepared with the aid of a medical student. I personally performed and verified the history, exam and medical decision making. I agree with the findings and plan of care.” References: Pub 100-04 Chapter 12, 100.1.1 B (Items in red indicate new language) 100.1.1 - Evaluation and Management (E/M) Services B. E/M Service Documentation Provided By Students Any contribution and participation of a student to the performance of a billable service (other than the review of systems and/or past family/social history which are not separately billable, but are taken as part of an E/M service) must be performed in the physical presence of a teaching physician or physical presence of a resident in a service, meeting the requirements set forth in this section for teaching physician billing. Students may document services in the medical record. However, the teaching physician must verify in the medical record all student documentation or findings, including history, physical exam and/or medical decision making. The teaching physician must personally perform (or re-perform) the physical exam and medical decision making activities of the E/M service being billed, but may verify any student documentation of them in the medical record, rather than re-documenting this work. ACEP FAQs 12. What are the Medicare performance and documentation requirements when a medical student is involved in the care of a patient? Answer: As a result of CMS transmittal 3971 issued on 2/2/18, a medical student’s note has become more meaningful. If you follow the new guidelines, a teaching physician can now use

a medical student’s note to document and bill for a patient’s visit. As before, any contribution and participation of a medical student to a billable service (other than the review of systems and/or past family/social history) must be performed in the physical presence of a resident or teaching physician. In order to use the medical student’s note for billing, the teaching physician must verify in the medical record all student documentation or findings, including history, physical exam and/or medical decision making. The teaching physician must personally perform (or reperform) the physical exam and medical decision making activities of the E/M service being billed, but may verify any student documentation of them in the medical record, rather than re-documenting this work. If the teaching physician chooses to rely on the medical student documentation and chooses not to re-document the E/M service, contractors shall consider this requirement met if the teaching physician signs and dates the medical student’s entry in the medical record. 13. What recommendations would you give teaching physicians when using medical student documentation? Answer: The teaching physician should document that he/ she personally saw the patient and participated in the management of the patient. In order to use medical student documentation in the medical record, the teaching physician should enter a personal notation verifying the history, physical examination and medical decision making. For clarity, it may be helpful for teaching physicians to include an attestation such as: “This note was prepared with the aid of a medical student. I personally performed and verified the history, exam and medical decision making. I agree with the findings and plan of care.” 14. What guidance would you give a medical student when helping to document a patient encounter for a teaching physician? Answer: A medical student is not licensed to provide any care independently, but they may assist a teaching physician by documenting the history, physical exam and medical decision making including the plan of care for a patient. All patients seen by a medical student must be seen and have their care supervised by a teaching physician, even if a resident is involved. For clarity, it may be helpful for a medical student to include an attestation that they helped prepare the note for the teaching physician such as: “I, Linda Smith, MS IV, helped prepare the medical record for my supervising physician, Dr. X.” The Bulletin | December 2018 15

Medical Missions Ecuador

David B. Krebs, MD When asked by an old friend with whom I trained some 25 years ago, whether I would be interested in joining him on a cataract mission to Ecuador, I jumped at the opportunity. I’ve often thought about doing this, but the rigors of life seemed to get in the way. Now, as an empty nester, there was no reason to say no. I jumped at the opportunity to connect with an old friend, do a good deed and learn a few things along the way. Riobamba, Ecuador is located 120 miles south of Quito, the capital city. It’s a mountainous region, where the indigenous people work and live off the land and sell their handicrafts. They have a strong sense of family and community. Surrounded by five snow-capped volcanos, its physical beauty is as beautiful as the people of this mountain community. Most of our group were from the Long Island, New York area where I grew up. From Quito, our arrival city, we boarded the bus to take us to Riobamba. Upon arrival, we were introduced to the local staff and toured the facilities. We unpacked our supplies, checked equipment, sterilized instruments and familiarized ourselves with the OR’s that would be our home for the next five days. As we awoke on Monday, the excitement became reality. Our goal was to complete 20 surgeries each day, an easy goal to achieve for three surgeons in the United States, but difficult in Ecuador with antiquated equipment. Add to that incredibly dense cataracts, and these next five days would be challenging. But we were ready! We were determined! News of our mission travelled fast. Patients traveled far and wide, some over 14 hours by bus through small mountain towns, for a chance at sight-saving surgery. Entering the clinic, we were greeted by more than 50 patients and their families, all hoping for a chance at sight. Clinic staff began screening exams and surgical scheduling as the surgical team got started. We worked through the inefficiencies, finding a rhythm

and managed to complete a total of 19 surgeries in a 12hour day. We left the clinic that first day with a great sense of accomplishment. Each morning, we saw post-op patients and then headed to the operating room again. Four more grueling 12-hour days, followed by dinner, entertainment and a few hours of sleep. Difficult as these days would be, they were incredibly rewarding. The appreciation we received from patients and the smiles from the families were heartwarming. I was proud of the accomplishments we achieved, and humbled by the simple way of life and the sheer gratitude of these indigenous people. There were two noteworthy cases I’d like to share with you. These patients are extremely interesting, as these are situations that we so rarely see, and these only scratch the surface. • Maria is a 16-year-old girl with a congenital cataract (from birth) in her right eye. Before our arrival, there was no opportunity for Maria to have it removed and for this reason, she will never regain useful function of her eye. To attain useful function of the eye, the problem needs to be addressed by the age of seven or eight, which is why only small children are patched. Although she will never really see from the right eye, the three surgeons all agreed the cataract should be removed because she was bothered by her white pupil’s cosmetic appearance. She will look like every other 16-year-old girl. She will no longer peer at herself in the mirror and see the white cataract staring back at her. After the surgery, before the surgical team patched her eye, we snapped a picture to show Maria and her family. We showed Maria her new eye and her face lit up!

Saving Hearts Together - Human Trafficking Victims in Costa Rica Jennifer Romeu, MD, MSM CMU Family Medicine PGY-3 Chief Resident

Not Just a Medical Mission Trip, but a matter of Preventative Health.

She was so happy! We then showed her mother and sister that accompanied her on this journey. They burst into tears and there were hugs all around. What a beautiful exchange we witnessed. • Juan presented with another interesting case. Juan is 32 years old. He suffered from traumatic cataracts from a tire explosion some 14 years ago. Ocular trauma often causes premature cataracts. But Juan’s trauma caused more than just a cataract. His natural lens was dislocated, and the support for the lens was weak. His other eye was completely blind from the accident, with no hope of useful vision. This presented many problems for the surgeons. Without the tools we have back home, this case would be a challenging surgery. The three surgeons discussed Juan’s case, and initially decided to hold off and come back next year with the proper instruments to perform the surgery. Juan was so disappointed, he could not hold back his tears. He got to us all. We thought long and hard about how to help Juan. We considered our alternatives. We decided to proceed with surgery and Juan was elated. The surgery was tricky, as we expected, but with proper management to control the risks, it went very well. He was thrilled with his outcome. This was a Cataract Mission, but as a team we did so much more. Sure, we did 85 cataract surgeries that changed lives forever. But as a team, we also completed 600 ophthalmic exams and distributed nearly 1,000 pairs of glasses to the local community. A big success. These stories and the people of this mission will last a lifetime! They were all warm, loving and uncomplicated. They are a true community. There is much to be learned about hope, love and perseverance from the folks of these mountain towns. This is why I became a doctor… To bring joy and a meaningful life back to those in need. It was rewarding. It was refreshing. It was humbling. It made us realize what a truly wonderful life we all have. As doctors, we may not be able to change the world, but we can make it better one patient at a time.

Family Medicine and Preventative Health - a duo of disciplines that are often intertwined together in practice. How then are physicians able to prevent such unfortunate trends as Human and Sex Trafficking? Several Family Medicine residents were in the search as to discover how. A diverse group of second-year CMU College of Medicine Family Medicine residents embarked on a journey to explore and better understand the medical, social and emotional implications and stigma that Human and Sex Trafficking may inflict on an individual. The location for such a journey - Costa Rica. Alongside with their community faculty preceptor, Jorge Plasencia, MD, FAAFP, several visits on their two week endeavor included Salvando Corazones Costa Rica, National Children's Hospital, INS Trauma Hospital and St. Bryce Mission to name a few. The mission trip began January 21 and extended through February 4, 2018. Prior to the trip, there had been an active attempt for fundraising for the 501(c)(3) non-profit organization of Saving Hearts Together. Such fundraising attempts have included a Santa Claus fundraiser where the local Santa, Dr. Triptpal Sanghera, took photos with families for a small donation. All proceeds went to Saving Hearts Together to help rebuild a safe house for girls who were victims of Human Trafficking. The fundraising amount collected was matched by community preceptor, Dr. Plasencia, who has been the pivotal representative and pioneer in the organization of the mission trip. The total raised amounted to $3,025. When discussed amongst the second year residents about what impact they may have on the community during their three years of residency, common responses were "helping the poor,” "providing services to those who cannot afford medical care" and "increase awareness of vaccination use." All prospective concepts were quite ambitious, however, when the idea was presented by community preceptor, Dr. Plasencia, about addressing Human Trafficking on a global scale, the decision was easy. With increasing awareness and mandatory training the state of Michigan Licensing and Regulatory Affairs (LARA) have now required practitioners to obtain, the continued on page 18

The Bulletin | December 2018 17

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residents found the topic relevant and applicable to these current times. As of 2017-2018, per LARA, a one-time training, independent from CME credit, will be required for renewal of licensure in the state of Michigan. The ability to listen and aid those affected, in different circumstances, is an invaluable experience that one cannot bear to carry alone. Although such events can never be erased in the lives of those victimized, the goal for the residents were to simply learn to understand and identify early stages of the engulfing nature that is Human and Sex Trafficking, and that with better awareness, we can prevent the further coercion of individuals at risk.

(l-r) Drs. Triptpal Sanghera, Jennifer Romeu, Rita Agayby and Jorge Plasencia

With increasing awareness and mandatory training the state of Michigan Licensing and Regulatory Affairs (LARA) have now required practitioners to obtain, the residents found the topic relevant and applicable to these current times. (l-r) Pediatric resident, Drs. Jorge Plasencia, Triptpal Sanghera, Rita Agayby, Jennifer Romeu, Marie Plasencia and Roberto Bogarin Solano

WHY I GO

Anthony de Bari, MD I thought that after about 30 mission trips and several articles for the SCMS Bulletin, I would write not about a specific trip, but why I go on these mission trips. It might inspire someone to want to go; it might not. My first mission trip was to Honduras in 2004 with a group led by Dr. Larry Whiting, who had retired from his family practice in Frankenmuth around then to spend the rest of his time on the mission field. For me, this was an OK trip - I was doing family practice in the mountains of Honduras, pretty far from “civilization.” That part of it was alright, but I’m an orthopaedic surgeon - I need to be in the operating room. It took about three years, in 2007, for me to find the right fit and take my next mission trip - to Egbe, Nigeria. I dragged along my two daughters (15 and 17 at the time) and a surgical tech from Covenant, whom I had gone to Honduras with. This trip was much better, and I was able to see a lot of patients and do a lot of surgery. I found that mission trips are like Lays potato chips - hard to have just one, so I kept on going. My last trip was this May to Egbe again, my 14th time there. In between, I have traveled to several continents and have taken care of countless patients. 18 The Bulletin | December 2018

My list of reasons goes something like this: 1. I get to travel to lots of places. I have been to all sorts of places: Honduras, Haiti, Ecuador, Dominica, Nigeria, Sierra Leone, Kenya, Democratic Republic of the Congo, Rwanda, Georgia (country of ), Iraq and Nepal. Most of these are places that no one would think of going even on vacation, although in most countries, there are some interesting places to visit (OK, maybe not Nigeria). That said, I’m not going continued on page 19

continued from page 18

to any of these places on vacation, I’m going to work. And usually the work is dawn to dusk and beyond (especially Iraq). I did have an opportunity in Kenya to go on a safari, however, I found out I was on call that weekend, so I stayed on the hospital compound. I had been to Egbe, Nigeria 10 times before I actually left the hospital compound other than going to the local market, visiting a village for HIV screening and going to local churches. 2. I get to meet all kinds of people. a. Patients: The patients I am blessed to take care of are the most thankful, wonderful people that I have ever met. They often travel hours to see me, and I am humbled by their thankfulness and even generosity. I have received cookies from children, eggs from adults, and my favorite was ceviche from a family whose daughter I took care of after the earthquake in Ecuador. The patients’ smiles the days after surgery or if I have the pleasure to meet them again on a subsequent trip lift my spirit. I’m amazed at how they manage big surgeries with no pain meds other than ibuprofen; maybe Americans can learn from these folks on how to live with pain. b. Local workers: The hospital workers I’ve worked with range from people cleaning the floors, security, nurses and doctors. Since in most of these hospitals, pay is so little (or even non-existent), I am amazed at their willingness to keep working. When I’m at the hospital, they will often work the same long hours that I put in, even on Saturdays and Sundays to support the work I do. I am always greeted with a smile and a hello. “You’re welcome” is probably the most common phrase I hear in Egbe, even from people who don’t really speak English. And they truly mean it. The doctors I have worked with, especially in Egbe, were very dedicated. They were paid peanuts in comparison to what we are paid here, and yet take care of patients with the same, if not better, dedication than we have. The Iraqi doctors I worked with were Muslim - not Christians like the rest of us - and were there to take care of the injured victims of ISIS just like we were. They loved their fellow countrymen and women. It was a sacrifice for them as well - local doctors back in

Mosul would target several of the doctors if they found out that they were working with us. c. Other missionaries: The other missionaries I have worked with (mainly through Samaritan’s Purse) have become some of my best friends. They range from college students to men and women much older than me. Once, when I was in Iraq, after suffering a herniated disc after only three days there resulting in a drop foot and essentially constant pain, I was unable to sleep. I was a wreck in the morning. I felt like a resident again who had been operating all night. After we finished a case, the other orthopaedic surgeon who I had been working with, a 78-year-old hand surgeon, made me go back to bed while he took over for both of us so I could function the rest of the day. That 45-minute rest until the next case started was “just what the doctor ordered,” and I was able to keep going the rest of the day. Many of the missionaries I have worked with are young, post-college continued on page 20

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“kids” who are serving on the mission field rather than trying to get full time jobs. Most of the rest have full-time jobs but serve on missions rather than taking regular vacations. They are all awesome. 3. I get to experience different cultures and eat different foods. a. This probably goes without saying, but there are some very interesting customs and foods out there. Bush meat in Nigeria is not something I really want to eat, as I’m not sure just what kind of “meat” it really is. But I’ve had some awesome food just about everywhere I’ve gone, especially Georgia, Iraq and Nepal. 4. I get to take care of people who would otherwise not receive orthopaedic care. Egbe is about two and a half hours away from the nearest hospital. It is a teaching hospital with one general surgeon who thinks he can do orthopedics. I usually have to re-do a lot of what he’s done when I’m there. My heart breaks when I see what these patients have suffered at his hands, but also at the hands of the local “traditional bone setters” who basically use sticks and twigs to take care of fractures, including open fractures. I usually see a lot of chronic osteomyelitis patients in Nigeria, but I have also seen them in Haiti, Sierra Leone, Kenya and the Congo. In Sierra Leone, a country with a population of five million people, there are two orthopaedic surgeons (at least when I went there years ago). I met one of them who said he could only put people in traction for femur fractures, or put people in casts, as he had no orthopaedic equipment to do anything else. My friend in the Congo is a general surgeon who has to do everything from hernias to C-sections, from thyroidectomies and perforated bowels to major trauma including orthopaedics. This is the case in the vast majority of the world, actually. How the doctors can stand not having equipment to work with, and how the patients survive is beyond me. 5. I get to take lots of neat pictures. Thousands, actually. I take anywhere from 100-300 pictures when I go on mission trips. I take scenery pictures, clinical pictures and pictures of a lot of the people I meet. I used to print them all out and put them in binders, and write what they were about. Unfortunately, I haven’t done that in a while, so I’ve mostly forgotten a lot of what the pictures were of, but

looking at them will give me something to do when I’m old and gray (alright, old). 6. Finally, and most importantly to me, I get to serve my Lord Jesus. The reason I go on mission trips is to serve Jesus. Soon after I became a Christian (around 1999), I was given a book to read by an anesthesiologist friend of mine, “Living a Life That Counts,” written by a neurosurgeon, Dr. Melvin Cheatham, whom I have had the great pleasure to meet. This book changed my life more than any book I had ever read next to the Bible. God has given me special skills in orthopaedics to be able to take care of His children, and He has given all of us a command to evangelism. While I don’t think in any way that I am really qualified to evangelize, I am able to be a witness to the care and compassion of Jesus wherever I go. I am called to be medically responsible for the patients I take care of, but also spiritually responsible as well. This was most evident to me while serving in Mosul, Iraq last year, caring for the victims of the scourge of ISIS. The team prayed for each and every patient, and many became followers of Jesus, including one of the orthopaedic surgeons I worked with. Quoting Dr. Richard Furman, who along with his brother, Lowell, and Franklin Graham created World Medical Missions (part of Samaritan’s Purse): “The supreme accomplishment in medical missions is not healing the sick, but to bring men and women into the right relationship with God. We treat the sick so that others will know Jesus Christ.”

I get to take care of people who would otherwise not receive orthopaedic care. 20 The Bulletin | December 2018

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Saginaw • Midland • Clare Bay City • Frankenmuth 1-800-329-1747 www.bierihearing.com The Bulletin | December 2018 21

Officially Ascension – Celebrating New Name, New Logo

Associates from Ascension St. Mary’s Hospital gathered late last month to celebrate the Hospital’s new name, new logo, bless the care teams and facilities and recommit to the Ascension mission of providing care to all the organization is privileged to serve, especially those who are most vulnerable. The new logo integrates the Christian trinity symbol with an “A.” The logo is a visible sign of a call to unity, community and love as a healing ministry of Jesus. The three colors each represent the hospital’s mission: Green for growth, blue for health and purple for compassion.

Welcome New Orthopedic and Primary Care Physicians Kevin J. Lawson MD brings 35 years of experience in orthopedics with a special interest in laser spine surgery to Ascension St. Mary’s. Dr. Lawson joins the Ascension St. Mary’s Orthopedics group which includes Waheed Akbar MD, Tarek Taha MD and Pervez Yusaf MD. Dr. Lawson is seeing patients at the orthopedic office located at 5275 North Colony Drive in Saginaw. Dr. Lawson is a graduate of the University of Michigan Medical School. His post graduate training included an orthopedic surgery residency at Cleveland Clinic Foundation in Cleveland, Ohio. He also completed an AO Traumatology Fellowship in Graz, Austria and an adult spinal surgery fellowship at Cleveland Spine and Arthritis Center in Ohio.

The Bulletin | December 2018

Dr. Lawson has special interest in minimally invasive lateral spinal decompressive technologies, reconstructive spinal surgery-deformity correction in adults, disc arthroplasty and vertebral augmentation procedures. To refer a patient, contact the office at 989799-1350. Rachael Kasperowicz, MD, a boardcertified family medicine physician, has assumed the practice of Dr. Ann Connaghan who retired this past summer. Dr. Kasperowicz has more than 15 years of experience, providing health and wellness care to individuals of all ages - from birth through the golden years. Born and raised in Michigan, Dr. Kasperowicz completed her undergraduate education at Northern Michigan University, and attended Saba University School of Medicine located on the Caribbean island of Saba, part of the Netherland Antilles. She completed a family medicine residency at Marquette General Hospital in Michigan’s Upper Peninsula and at New Hampshire – Dartmouth Family Practice Residency at Concord Hospital in Concord, New Hampshire. Dr. Kasperowicz is accepting new patients at the Bay City office, located at 4040 N. Euclid Avenue, near Wilder Road. To schedule an appointment, call 989-671-9153.

Annual Light up a Life Campaign Ascension St. Mary’s Foundation will host its Light up a Life campaign during the month of December. This annual holiday campaign is an opportunity to remember those who were such an important part of our life during the holidays ... and throughout the year. For a gift of $20, a white light will be illuminated in honor or memory of a loved one. For a gift of $35, a commemorative ornament will be mailed to an address of the purchaser’s choice. Donations of $125 will sponsor a tree in front of the hospital which be illuminated in honor or memory of a loved one. A sign will be placed in front of the tree, and notification of your gift will be sent to the address of your choice. A Remembrance Reception will be held on December 18 in the Ascension St. Mary’s Hospital Health Education Center beginning at 5:30 p.m. Proceeds will support cancer patients on their journey through treatment and recovery. For more information on Light up a Life campaign, call the Foundation at 989-907-8300.

Welcome New Physicians

Employed Medical Staff Expands Ascension St. Mary's continues to expand our care team and welcomes several new physicians to our employed medical staff. • Neurosurgery Eric Bialaski, DO, specializes in complex and reconstructive spine surgery and spinal oncology surgery. He joins neurosurgeons E. Malcolm Field, MD, Joseph Adel, MD & Naman Salibi, MD. (855) 298-9888

Welcome

Eric Bialaski, DO Neurosurgery

• Primary Care Rachael Kasperowicz, MD, joins St. Mary's of Michigan Bay City Family Physicians (formerly Women's Health Center). (989) 671-9153

• Orthopedics Kevin Lawson, MD, brings years of experience in orthopedics with a special interest in laser spine surgery. (989) 799-1350 • Podiatry Laura Reitz, DPM, specializes in foot and ankle surgery, wound care, hammertoes, tendon injuries and complex forefoot & rearfoot reconstruction. (989) 790-6719

• Hematology/Oncology Roma Srivastava, MD, joins medical oncologists Ernie Balcueva, MD and Asma Taj, MD to complement our comprehensive cancer care program. She will focus on the care of patients with disorders of the blood, bone marrow, and lymphatic systems. (989) 497-3226

Rachael Kasperowicz, MD

Primary Care

Kevin Lawson, MD Orthopedics

Laura Reitz, DPM Podiatrist/Foot and Ankle Surgery

Roma Srivastava, MD Hematology/Oncology

All are accepting new patients. The Bulletin | December 2018 23

Covenant HealthCare Receives an ‘A’ for Patient Safety in Fall 2018 Leapfrog Hospital Safety Grade Covenant HealthCare was awarded an ‘A’ from The Leapfrog Group’s Fall 2018 Hospital Safety Grade. The designation recognizes Covenant HealthCare’s efforts in protecting patients from harm and meeting the highest safety standards in the United States. The Leapfrog Group is a national organization committed to improving health care quality and safety for consumers and purchasers. The Safety Grade assigns an A, B, C, D or F grade to hospitals across the country based on their performance in preventing medical errors, infections and other harms among patients in their care. “I want to congratulate the Covenant HealthCare employees and medical staff who work day after day to provide highquality, safe care to our patients,” says Dr. Michael Sullivan, Vice President of Performance Improvement and Chief Medical Officer. “It takes an extraordinary commitment to achieve the highest standards of patient safety, not for recognition, moreover, they are driven by an unwavering goal to serve our patients in the best way possible.” “Leapfrog’s Hospital Safety Grades recognize hospitals like Covenant that focus on advancing patient safety. This ranking provides an important resource for patients, and a benchmark for hospitals, to determine how care at one hospital compares to others in a region,” said Leah Binder, president and CEO of The Leapfrog Group. “Hospitals that earn an A Hospital Safety Grade deserve to be recognized for their efforts in preventing medical harm and errors.” Developed under the guidance of a National Expert Panel, the Leapfrog Hospital Safety Grade uses 28 measures of publicly available hospital safety data to assign grades to more than 2,600 U.S. hospitals twice per year. The Hospital Safety Grade’s methodology is peer-reviewed and fully transparent, and the results are free to the public. Covenant was one of 855 across the United States awarded an A in the Fall 2018 update of grades.

Medical Staff Leaders Announced The Covenant Medical Executive Committee ratified the slate of Medical Staff officers and leaders for 2019-2020. Congratulations to the following elected Medical Staff leaders who begin their roles 1/1/2019. Many thanks to those who served 2017-2018 for their leadership, participation and direction for the Covenant Medical Staff.

MEDICAL STAFF OFFICERS

Chief of Staff - Sarosh Anwar MD Vice Chief of Staff - Kathleen Cowling DO Secretary/Treasurer - Sanjay Talati MD Past Chief of Staff - Michael Fiore MD

MEMBERS AT LARGE

Christa Persyn MD and Mayar Jundi MD 24

The Bulletin | December 2018

MATERNAL FAMILY/CARE

Department Chairman - Robert Hutchins DO Family Medicine Section Chief - Robert Hutchins DO Pediatrics Section Chief - Nicole Sinclair MD OB/GYN Section Chief - Thomas Minnec MD

MEDICINE

Department Chairman - Vipin Khetarpal MD Cardiology Section Chief - Peter Fattal MD General Medicine Section Chief - Muhammad U. Khan MD

SURGERY

Department Chairman - Todd Richardson MD Orthopedics Section Chief - Brian deBeaubien MD General Surgery Section Chief - Kimiko Sugimoto MD

CLINICAL SERVICES Department Chairman - Matthew Deibel MD Anesthesia Section Chief - Vasil Mamaladze MD Emergency Medicine Section Chief - Matthew Deibel MD Pathology Section Chief - David Stockman MD Radiology Section Chief - Sanjay Talati MD Hospital Medicine Section Chief - Ganesh Kini MD

COMMITTEES

Medical Staff Quality Improvement - Matthew Deibel MD Cancer - Sussan Bays MD Pharmacy & Therapeutics - Andy Bazakis MD Investigational Review Board - Michael Williams DO

Healthy Eating Classes to Improve Survivorship and Promote Prevention Throughout the year, the Covenant Cancer Care Center offers free healthy eating classes that are open to the public. Classes are designed to help participants learn about nutritious foods and how healthy eating can enhance survivorship, aid in prevention of cancer recurrence, help gain strength and energy, and assist in the loss, gain or maintenance of a healthy weight. In addition, attendees will learn about the newly updated American Institute for Cancer Research Diet, Nutrition, Physical Activity and Cancer Guidelines. Interested participants are welcome to attend any or all of the below upcoming classes: Monday, January 7 at 5:30 p.m. Thursday, January 10 at 2 p.m. (class repeated) All classes are held at Covenant Cancer Care Center, 5400 Mackinaw (at Tittabawassee), Saginaw, Third Floor Conference Room A (just left of the elevators). For more information, please contact: Ann Hoffman, RDN, CDE, CSO 989.583.5029 or ahoffman@chs-mi.com. Classes are free of charge and open to the public.

Season’s Greetings and Happy New Year From all of us at Covenant HealthCare, we wish you safe and happy holidays, followed by a joyous and healthy New Year!

JANUARY BIRTHDAYS Jamal U. Akbar MD Naveed Akhtar MD Ghaith Al-Qudah MD Sarosh Anwar MD Edward Austin MD Ernie P. Balcueva MD John K. Bartnik MD Ronald A. Bays MD Abbas Bekhrad MD Kaitlyn E. Matz Bishop DO Robert L. Borenitsch DO Gary A. Brooks MD Paul B. Bry MD Lowell A. Butman MD Doris D. Cataquiz MD Bryon C. Chamberlain MD Louis L. Constan MD Elvira M. Dawis MD Lara DeStefano MD Angie Lynn F. Domingo MD Robert M. (Matt) Dumas MD Preeti Gudimella MD Leatha B. Hayes DO Gregory C. Hazen MD Mali Him MD Carlyn M. Hinish DPM

1/9 1/27 1/25 1/30 1/29 1/20 1/22 1/20 1/28 1/31 1/28 1/12 1/27 1/30 1/3 1/6 1/11 1/10 1/18 1/27 1/9 1/17 1/25 1/9 1/14 1/19

Ali E. Ibrahim MD Mohammad Jafferany MD Shakeel M. Jamal MD Roger N. Kahn MD Samer H. Kais MD Humera (Mena) Khan MD Mohammad Yahya Khan MD Young H. Kim MD Menelito D. Lilagan DO Mark R. Ludka MD Ben R. Mayne MD B.L. Nahata MD Sunil P. Pandit MD Elizabeth A. Paulus MD S. Sethu K. Reddy MD Douglas J. Saylor MD Susan K. Schmiege MD Michael L. Schultz MD Maliha N. Shaikh MD Craig J. Thomas MD Venkatramana R. Vattipally MD Amanda K. Waterman MD Daniel J. Wechter MD Arno W. Weiss, Jr. MD Paul T. Werner MD

1/1 1/24 1/28 1/28 1/7 1/9 1/27 1/28 1/12 1/9 1/2 1/10 1/8 1/30 1/9 1/31 1/3 1/21 1/31 1/9 1/8 1/19 1/27 1/25 1/14

PROVIDING NEW

COVENANT REGIONAL WOUND HEALING & HypERbARIC MEDICINE CENTER

900 Cooper, Fourth Floor Saginaw, Michigan 48602 989.583.4401 Tel Hours: Monday – Friday 8 am – 5 pm

www.covenanthealthcare.com

Extraordinary care for every generation. The Bulletin | December 2018 25

New Categories of Continuing Medical Education The Board of Medicine has updated the previous six Categories of Credit into two Categories. As before, each medical doctor is required to complete 150 hours of continuing medical education approved by the Board of Medicine, which a minimum of 75 hours of the required 150 must be earned in Category 1 activities, and five in the areas of medical ethics (one hour), pain management (three hours) and human trafficking (one hour). The following is a breakdown of the two Categories for licensure: Category 1 A. Activities with accredited sponsorship (maximum 150 hours) B. Passing specialty board certification or recertification (maximum 50 hours) C. Successfully completing MOC that does not meet requirements of (A) or (B) above (maximum 30 hours) D. Participation in a board approved training program (maximum 150 hours) Category 2 A. Clinical instructor for medical students engaged in postgraduate training program (maximum 48 hours) B. Initial presentation of scientific exhibit, poster or paper (maximum 24 hours) C. Publication of scientific article in a peer-reviewed journal (maximum 24 hours) D. Initial publication of a chapter or portion of a chapter in a professional health care textbook or peer-review textbook (maximum 24 hours) E. Participation in any of the following as it relates to the practice of medicine (maximum 18 hours): 1. Peer review committee dealing with quality of patient care 2. A committee dealing with utilization review 3. A health care organization committee dealing with patient care issues 4. A national or state committee, board, council or association F. Until December 6, 2019, attendance at an activity that was approved by the Board of Medicine prior to December 6, 2016 (maximum 36 hours) G. Independently reading a peer-reviewed journal prior to December 6, 2016, that doesn’t satisfy the requirements of Category 1, subdivision (A) (maximum 18 hours) H. Prior to December 6, 2016, completing a multi-media self-assessment program that doesn’t satisfy the 26

The Bulletin | December 2018

requirements of Category 1, subdivision (A) (maximum 18 hours) Additional Resources For more information on CME requirements for relicensure, please click HERE To look up your license renewal date, please click HERE To renew your license, please click HERE If you are audited and need clarification of the requirements, please contact MSMS or an experienced health care attorney, prior to communicating with LARA or the Board of Medicine. For questions or more information, contact Brenda Marenich at bmarenich@msms.org or via phone at 517-336-7580.

Response to the Passage of Proposal 1: The Legalization of Marijuana As you know, recreational marijuana use is now legal in the state of Michigan. For the physician community, that means it is time to double down on our efforts to educate our patients and communities on the dangers associated with marijuana use. Emergency room visits, marijuana-related crime and traffic deaths - all will rise in the coming years. But just as troubling are the potential long-term consequences associated with relaxing law and societal attitudes on cannabis use. It has long been common practice for physicians to advise pregnant and nursing mothers to stop using marijuana and for good reason. Existing research indicates exposure to tetrahydrocannabinol (THC) negatively affects infant brain development, resulting in potential cognitive development problems and behavioral issues that can plague cannabisexposed youth well into their teen years. Despite these consequences, it seems that advice is being increasingly ignored. According to a 2015 analysis from the American Journal of Obstetrics and Gynecology, more than 70 percent of pregnant women see no harm in using marijuana a few times a week, and anywhere from 34 to 64 percent of marijuana users continue using through the course of their pregnancy according to a study published by the American College of Obstetricians and Gynecologists (ACOG). And it’s not just the infants that need our concern - marijuana has known adverse effects on adolescents as well. The human brain does not reach maturity until around age 25, and using marijuana before then can result in several negative effects not limited to psychosis, lower IQ compared to nonusers and addiction. In fact, according to the National Institute on Drug Abuse, one in six teens that use marijuana become addicted continued on page 27

continued from page 26

to its use, and it is now the number one reason kids enter treatment for substance abuse. Legalization only serves to reinforce these troubling statistics. The research in this area is limited, but that only strengthens the argument for pumping the breaks on recreational marijuana. We do not yet fully understand the consequences associated with cannabis use and exposure, and that is especially true for the children of pregnant and nursing mothers. That’s something we must work to rectify. And in the immediate term, the physician community must seek out ways to partner with the state and other stakeholders to effectively communicate to the public the dangers associated with marijuana use. Marijuana is a dangerous substance, and the physician community has a responsibility to see that it stays out of the hands of Michigan’s youth - the passage of Proposal 1 does not change that. Just because marijuana is now legal in Michigan does not mean it is safe. That needs to be the message, and the responsibility for broadcasting it now rests on all of us.

CPAN Files Federal Court Documents Coalition seeking to require state government officials to protect drivers from discriminatory auto insurance rates On November 13, the Coalition Protecting Auto No-Fault (CPAN) announced it has filed a motion in the U.S. District Court for the Eastern District of Michigan aimed at protecting Michigan drivers from excessive and discriminatory auto insurance rates. The court documents seek intervention to join a lawsuit filed in August 2018 by Detroit Mayor Mike Duggan. In that lawsuit, Mayor Duggan alleged that because auto insurance rates are excessive, the Michigan no-fault law has become unconstitutional and, therefore, should be judicially repealed. Although CPAN agrees that Michigan drivers deserve meaningful relief from high insurance premiums, it vehemently disagrees with Mayor Duggan as to the proper remedy for addressing the insurance rate problem. In its court filing, CPAN alleges that Michigan’s high auto insurance rates are directly related to the unfair and discriminatory rate-making practices utilized by Michigan insurance companies, particularly with regard to factors such as gender, marital status, educational level, home ownership and credit scoring. CPAN charges that these rate-making practices violate Michigan law and should have been prohibited long ago by the Michigan Department of Insurance and Financial Services (DIFS), which is currently headed by Director Patrick M. McPharlin. READ MORE

READY TO RENEW?

A Guide to 2019 Physician License Renewal Requirements

150 HOURS Physicians must complete 150 hours of Continuing Medical Education Credits during a three year period prior to requesting renewal. Of these 150 hours, a minimum of 75 must come from Category 1 Credits. Category 1 Credits include live in person programs, as well as, web-based programs

3 HOURS

Pain and Symptom Management

Of the 150 hours, a minimum of three hours must be in the area of Pain and Symptom Management. Examples Include: • Michigan Pain and Controlled Substance Laws • Opioid Management • Pain Definitions • Specific Pain Conditions • Ensuring Quality Pain Care • Public Health Burden of Pain • Michigan Programs and Resources Relevant to Pain

1 HOUR Medical Ethics

Of the 150 hours, a minimum of one hour must be in the area of Medical Ethics.

Human Trafficking Victim Identification Training A one-time training that is separate from contiuing education. Licensees renewing for 2019 must complete training by renewal in 2022. Beginning in 2021, a completion of the training is a requirement for initial licensure.

Need all three requirements? Visit MSMS.org for On-Demand Webinars (under the Education tab) The Bulletin | December 2018 27

College of

Medicine Students Take Medicine to the Streets College of Medicine and Health Professions team up to help people in need On a cold October afternoon, fourth-year College of Medicine student, Samuel Jackson, leaned closer to the grizzled 59-year-old man in a blue T-shirt sitting before him. “I see your blood pressure is a bit high,” Jackson said, then lifted the man’s hand. “Feeling any numbness in your hands or feet?” he asked, having learned of the man’s high glucose numbers and family history of diabetes. Fearing pre-diabetes, Jackson coordinated a visit with a primary care physician. Next patient. This could’ve occurred at any doctor’s office, but it was in a parking lot. On a bus. In Mt. Pleasant. This is street medicine, CMU style, and Jackson leads the charge. He is backed by a dedicated interdisciplinary squad of students who are directed by Bethany Brown, a doctor of nursing practice, certified nurse midwife and assistant director of Central Michigan University’s new nursing program

East Side Soup Kitchen Volunteers On November 7, CMU College of Medicine volunteers assisted in preparing and serving over 250 meals to people in need at the East Side Soup Kitchen in Saginaw. Volunteers included Tara Schultz, Angie Appold, John Jervinsky, Michele Reynolds, Sharon Coenis and Juliet Nicholls. In addition to volunteering their time, the team was happy to make a food donation. The idea to serve was inspired by a call to action from the Saginaw County Medical Society in The Bulletin. The tradition was started many years ago by Dr. Bill Engelman who passed away on May 11, 2018, and the SCMS and CMU volunteers carried on this effort in his memory.

Internal Medicine Residents and Medical Students Awarded at Regional Meetings

Samuel Jackson M4 and Bethany Brown, Assistant Director of CMU’s new Bachelor of Science in Nursing degree program, are taking medical care to the streets. Moved to make a difference Jackson, from Harbor Springs, found his medical path in February while on clinical rotation at CMU College of Medicine in Saginaw. It came in the form of a pregnant young woman, arriving amid a snowstorm for her initial prenatal appointment with injuries from a recent beating and carrying the remnants of her life in two garbage bags. Despite her pain and trauma, she had driven from the Saginaw emergency room to the clinic where he was working to begin caring for her unborn child. Her determination moved him. “I knew then that I wanted to continue to work with people in need,” he said. READ MORE.

The Bulletin | December 2018

The American College of Physicians Michigan Chapter meeting was held on October 12-14 in Traverse City. Two IM residents each received awards through the Society of Hospital Medicine (SHM) and will be presenting their posters at the national SHM meeting. Abhishek Bhandiwad MD’s poster is titled, “A Curious Case of the Chilblains,” and Sukhmanpree Singh MD’s poster is titled, “A Case of Rare Genetic Disease, Which was Not Inherited – Acquired Hemophilia A.” At the Michigan State Medical Society’s (MSMS) meeting in October, M2’s Derek Wolfe and Kultaj Kaleka placed second for their research poster on the new statewide opioid prescribing laws.

Women in Medicine November 1, the CMU College of Medicine’s Women in Medicine Student Interest Group welcomed a group of women physicians from diverse backgrounds and specialties to discuss practicing medicine from the female perspective. continued on page 29

continued from page 28

How Can You Help? Do you want to raise awareness, volunteer or participate in an upcoming event? Contact Barb Smith at sosbarb@gmail.com or 989-781-5260 and schedule a training or educational event or get more information. Topics included work-life balance, family planning, navigating careers and more. The program was also streamed to attendees at the Mt. Pleasant campus. Combined, the panelists have over 60 years of medical training, practice, research and leadership. The panel included Kai Anderson MD, Belinda Kakos DO, Juliette Perzhinsky MD, Delicia Pruitt MD and Renee Sundstrom DO.

Barb Smith Suicide Resource & Response Network is supported solely by donations and grants. To make a donation, please make your check payable to Barb Smith SR&RN and mail to: Barb Smith Suicide Resource & Response Network PO Box 6712, Saginaw, MI 48608-6712 The organization is a 501(c)(3) nonprofit, and your donation is tax deductible (EIN 38-3400293).

Call for Resolutions: Who Sets MSMS Policy? You Do! The Michigan State Medical Society (MSMS) House of Delegates (HOD), comprised of 319 elected delegates, is the official legislative and policy-making body of MSMS and its component societies, including the Saginaw County Medical Society (SCMS). Resolutions debated during the annual MSMS HOD are the vehicles by which MSMS policies, priorities and directives are determined. Deadline for resolutions is March 1 at 5 p.m. Resolutions must be submitted via the online submission form. If you have any questions, contact Stacey Hettiger at (517) 336-5766. The best way to get your idea or recommendation adopted as MSMS policy or directive is at the grassroots level. As a member in good standing of MSMS/SCMS, you have the right to bring your ideas to the annual HOD for consideration by MSMSâ&#x20AC;&#x2122; "legislators." To do so, present your suggestion and rationale at the SCMS meeting. If the SCMS agrees, the SCMS will work with you to draft a resolution to be presented at the next HOD meeting. The resolution should specify the desired MSMS policy or directive for MSMS action. If the SCMS does not agree with your idea, you may ask another delegate to submit a resolution on your behalf as an individual delegate. It is also prudent to check MSMSâ&#x20AC;&#x2122; current Policy Manual and, if relevant, the AMA Policy Finder to determine if policy on the issue already exists. The Bulletin | December 2018 29

ADVERTISER INDEX When you have a need for a service, please consider our dedicated advertisers first! Advanced Diagnostic Imaging, P.C. Ascension St. Mary’s Hospital Barb Smith Suicide Resource & Response Network Covenant HealthCare Covenant Wound Healing Center Jan Hauck – Century 21 Healthway Compounding Pharmacy Horizons Conference Center/Riverview Brownstones Lori Krygier Graphic Designer Norton + Kidd Accounting & Consulting, P.C. Peak Performance PC Services Shields Chiropractic Wolgast Corporation

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Caduceus Meeting for Recovering Health Care Professionals Third Thursday of each month at 7 p.m. Zion Lutheran Church 454 7th Street, Freeland, Michigan (Behind Pat’s Grocery Store on Midland Road in Freeland)

Caduceus meetings are available to health care industry professionals, and have adopted many of the principles of 12-Step programs. Caduceus meetings are “closed” meetings for recovering health care professionals including, but not limited to, nurses, doctors, dentists and pharmacists. We engage in group discussions where members may want to speak up, ask questions or share thoughts with fellow members.

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The Bulletin | December 2018

Customized Medications Bio-Identical Hormone Replacement for Men and Women

Proud to be a Key Provider to the SCMS for Seven Consecutive Years!

In 2007, we were the first compounding pharmacy in Michigan to become PCABaccredited.

Topical Medications Pain Medications Sugar-Free & Dye-Free Medications Liquid Solutions Discontinued Medications

Now, we are honored to have the distinction of being the first compounding pharmacy in Michigan to become PCAB accredited under the new standards set forth by the Accreditation Commission for Healthcare.

Healthway Compounding Pharmacy celebrating 30 years of

Better Solutions. Better Care. 2544 McLeod Dr. N. | Saginaw, MI. 48604 Ph. 989.791.1691 | Fax 989.791.4603 healthwayrx.com The Bulletin | December 2018 31

PRSRT STD U.S. POSTAGE PAID Saginaw, MI 48605 PERMIT #228

350 ST. ANDREWS ROAD | SUITE 242 SAGINAW, MI 48638-5988

ADDRESS SERVICE REQUESTED

2018-2019 KEY PROVIDERS

These Area Businesses Support Saginaw County Medical Society Membership Meetings. When you have a need for a service, please consider our Key Providers. Please mark your calendar for the following meetings and events in 2019. You will receive an email meeting notice and reminder each month for SCMS events. Non-SCMS events are listed as a courtesy and you must contact the sponsor directly to register. There is no Board Meeting in December. Tuesday, January 15, 2019 Horizons Conference Center - SCMS Board meets at 5:30 p.m. Membership Meeting joint with the Saginaw County Dental Society with Social (cash bar) at 6:30 p.m. followed by dinner and program at 7 p.m. Program: “Surviving Acts of Violence.” CME CREDIT AVAILABLE. See page 5 for more information. Tuesday, February 19, 2019 CMU College of Medicine, 1632 Stone Street – SCMS Board meets at 5:30 p.m. Saturday, March 16, 2019 Horizons Conference Center - 15th Annual Health Fair “The Doctor Is In!” from 9 a.m.-12 p.m.

Tuesday, April 16, 2019 Horizons Conference Center - SCMS Board meets at 5:30 p.m. Membership Meeting with Social (cash bar) at 6:30 p.m. followed by dinner and program at 7 p.m. Program: “TED Talks.” See page 5 for more information. Tuesday, May 21, 2019 Horizons Conference Center - SCMS Board meets at 5:30 p.m. Membership Meeting with Social (cash bar) at 6:30 p.m. followed by dinner and Annual Meeting at 7 p.m. Program: “Update on CMU College of Medicine.” Saturday, June 8, 2019 Saginaw Country Club – 10th Annual SCMS Foundation Golf Outing. Four person scramble. 12 p.m. Registration and Lunch, with 1 p.m. Shotgun Start.

Tuesday, March 19, 2019 CMU College of Medicine, 1632 Stone Street – SCMS Board meets at 5:30 p.m.

Joan Cramer/SCMS | Office 790-3590 | Fax 790-3640 | Cell 284-8884 | jmcramer@sbcglobal.net