The Pulse April 2005 by ACOEP

The PULSE

Osteopathic Emergency Medicine Quarterly VOLUME XXX NO. 2

APRIL 2005

Presidential Viewpoints

Paula Willoughby DeJesus, D.O., FACOEP We have set out on a path of change. That, in and of itself, stirs a sense of anxiety, uncertainty, anticipation, and excitement. This change of path is not for the sake of change, nor is it without purpose. We are an organization that has grown in size and complexity. Our initial needs of establishing our identity, an educational structure, and organizational framework have significantly evolved. Defining future educational standards, continuous re-certification, national inter-agency presence and position, establishing the emergency medicine agenda and advocating for patients in demanding circumstances, are what face us today as a physicians and an organization. In our practice of Osteopathic Emergency Medicine we are charged to practice evidence based medicine. As a College, we must build an organization that demonstrates competency and is responsive to its members. Its Board, Committees, and processes must be directed by evidence that validates its mission and behavior to its members. There must be an environment of handson leadership at all levels throughout our College that is responsible, accountable, and measurable. The structure needs to be dynamic to allow for all levels of governance to change, but has safeguards that preserve institutional memory. There

should be steps of leadership progression that takes the entry-level leader, provides structured learning experiences, and mentors the development of the individual as their leadership competencies evolve. It must continue to draw on the veteran leaders. It should be mindful that as leaders we are but stewards of the College on behalf of each member. It should establish an environment that nurtures creativity and boldness as it shapes our future. You begin any new project from the top. The first realization we must make is where the top is located. We will develop an organizational chart and reporting structure that positions the member at the top! This is our purpose and the basis for all decisions: what is in the best interest of our members. The organizational chart must allow for increasing levels of responsibility and accountability but not create structural lines that add burden to the members. Leadership roles will be defined and have delineated job descriptions. Our College documents will be revised to reflect these changes. Formal orientation processes will be established for Committee and College leadership. Committees will be entirely chaired by members. These roles should not be static. They should change to include all willing members to provide mechanisms of participation, cultivation of new leaders with previous members as their mentors. Members and leaders will participate in setting College priorities, objectives and action plans through the committee structure. Membership, Committee, and Board of

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Directors meetings will be retooled to reflect these priorities. The currency of this College will be the member, lead by member driven committees that are tended to by a member elected Board. The success of this vision lies within us, the members. We have begun to put this process in motion. All Committee Chairs and ViceChairs are from the membership at large. The Executive Committee of the Board selected the Chairs and Vice-Chairs in a group process. Board members will not chair committees with the exception of the Executive and Finance Committees. Board members will serve as liaisons to the Committees. Each Committee now has a specifically assigned Board liaison and staff member for support. The Committee Chairs and Vice-Chairs were given the responsibility to establish the composition Committee members. The first orientation program will kick off with our spring meeting in Scottsdale. Part of their first charge will be to revise each of their respective Committee goals and objectives. From there, they will take these goals and objectives to the next step by developing action plan with assigned tasks and time lines. It will be a process to engage all Committee members in the accomplishment and implementation of these goals as they are fulfilled. The Board and Membership Meetings will have totally new agendas and formats. They have been changed to Continued on page 4

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The PULSE APRIL 2005

Editorial

Drew Koch, D.O., FACOEP, Editor

they the answer Nurse Triage Protocols: toAreEmergency Department Overcrowding? Having recently completed a tour of night shifts, I was reminded of the overcrowding of the emergency department and the waiting room at the hospital where I work. I am employed at an inner city/ community hospital that was created when two similar sized hospitals merged several years ago. The resultant hospital is smaller in both the number of hospital beds and emergency department beds than each individual hospital. This was a merger of equals that was projected to decrease healthcare costs. The result is a hospital that is either full because of patient census or lack of nursing personnel. Because of the bed and/or nursing shortage our emergency department is constantly holding admitted patients, thus creating poor patient movement through the emergency department. There are two solutions to correct this overcrowding. The ﬁrst method involves ﬁxing the back door and addresses the real issue of overcrowding. This involves several facets and requires a large capital expenditure, policy changes, and increasing personnel. The hospital administra-

tion felt that expanding the emergency department; hiring more nurses, secretaries, techs, etc; opening more beds; changing hospital policy regarding admitted patients occupying floor hallways, allowing the ED to go on divert, eliminating the policy of floor capping their census on weekends, thus decreasing staffing were not the solutions for emergency department overcrowding. Recently, the hospital has opened an EAU (Express Admitting Unit) that has 8 beds and is opened only from 7am until 11pm, Monday through Friday. This unit has decreased the emergency department overcrowding when it is open. The operating room and cardiac catheterization lab are holding admitted patients in their recovery rooms overnight. Although overcrowding has been a long standing issue the hospital administration is only now in the process of renovating the emergency department to increase the current bed size by about 15 beds. This renovation is occurring because admitting physicians complained of the overcrowding issue. Hopefully these beds will not become admission-hold beds!! Finally, the hospital is addressing the back door of the emergency department. The second method of alleviating the overcrowding in the emergency department is fixing the front door, or window

dressing. Our hospital embraced this concept with open arms. They hired greeters to “work” the waiting room, interacting with the “customers” while they wait. Bedside registration is another concept that is employed. When beds are available, the patient is brought to an ED bed and then registered. This concept works if you have adequate nursing and there is an available bed. The latest craze is beepers that beep when a patient is ready to be brought back to the ED. I am beginning to wonder if the hospital administration thinks we are a TGI Friday’s restaurant and soon we will have “take out” menus. They are also working on an LED screen that tells the patient how long their anticipated wait will be. Lastly, nurse triage protocols that have evoked the wrath of the Emergency Department Physicians are here to “solve” the overcrowding issue. The emergency department waiting room, until recently, was not an issue. However, with the advent of Press Gainey scores, LWOT’s (left without treatment) and bad outcomes of a few patients waiting to be seen, the waiting room has become a very real issue for the hospital. LWOT’s are reported to the Pennsylvania State Department of Health and are responsible Continued on page 16

Table of Contents Presidential Viewpoints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Guest Column, Alan R. Janssen, D.O., FAOECP . . . . . . . . . 13

Executive Director’s Desk . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Continuing Medical Education Calendar . . . . . . . . . . . . . . . . 14

Editorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Member Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Member Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Guest Column, Edward Cho, D.O. . . . . . . . . . . . . . . . . . . . . 17

Member Survey on Pediatric Emergency Medicine. . . . . . . . . . 7

Student Chapter Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Foundation Forum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Positions Available. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6, 8, 16

The PULSE APRIL 2005

THE PULSE–AN OSTEOPATHIC EMERGENCY MEDICINE QUARTERLY 142 E. Ontario St., Suite 1250 Chicago, IL 60611 312-587-3709/800-521-3709 Editorial Staff Drew A. Koch, D.O., FACOEP, Editor Paula Willoughby DeJesus, D.O., FACOEP Peter A. Bell, D.O., FACOEP Bobby Johnson, Jr., D.O. Janice A. Wachtler, Executive Director Publications Committee Drew A. Koch, D.O., FACOEP, Editor & Chair Peter A. Bell, D.O., FACOEP, Advisor Bobby Johnson, Jr., D.O., Vice Chair/Asst. Editor James Bonner, D.O., FACOEP Annette Brunetti, D.O., FACOEP Randall A. Howell, D.O., FACOEP William Kokx, D.O., FACOEP The PULSE is published quarterly (January, April, July, and October) and distributed at no cost by the ACOEP to Members and libraries of Colleges of Osteopathic Medicine by the National Office of ACOEP. The Pulse and ACOEP accept no responsibility for statements made by contributors or advertisers. Display and classified advertising are accepted. Display advertisements should be submitted as camera-ready, pdf, or jpg formats in black and /white art only. Classified advertising must be submitted as typed copy, specifying the size, and number of issues in which the copy should be displayed. The name, address, telephone numbers and E-mail address of the submitting party must accompany advertising copy. Advertisers will be billed for ads following the publication of their advertisements and payments will be due within 30 days of the issuance of the invoice. The deadline for submission of advertising is the first of the month preceding publication, i.e., December 1, March 1, June 1, and September 1. The deadline for article submission is November 15, February 15, May 15, and August 15. ACOEP and the Editor reserve the right to decline advertising and articles for any issue. The PULSE and ACOEP do not assume any responsibility for consequences or response to an advertisement. All articles and artwork remain the property of the Pulse and will not be returned. Subscriptions to the Pulse are available to nonACOEP members or other organizations at a rate of $50 per year.

Presidential Viewpoints, Continued from page 1

the challenges of the uncertainty. I fully anticipate the outcome will be exciting!

allow an interactive process for members to receive pertinent information and most importantly give their Board direction. This too will be unveiled at our Arizona meeting.

Please join me in extending the sincere appreciation of this College to our past Committee leadership. They have made an outstanding contribution to the members of this College. They have by no means “retired.” They will be an immeasurable resource to our new Committee leaders and certainly take on other leader-

The member is the building block of this College and this process, the foundation and the tower. We are volunteers in this organization and we are challenged in our abilities to respond to the call. We are also a unique group of volunteer leaders. We are natural leaders by the character of our profession and how we are drawn to it. The College can provide the tools and materials to experiment and build your leadership style. I am anxious to begin to work with you. I am looking forward to

The ACOEP has recognized

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The PULSE APRIL 2005

Executive Director’s Desk Janice Wachtler

Confessions of a Volunteer I don’t know how I began volunteering. I sometimes wonder if I was overly influenced by Gene Roddenberry’s vision of the new world order through Star Trek® and the episode, “The City on the Edge of Forever, “ where the phrase “How can I help you?” almost toppled the world order during the Depression making the Axis Powers vulnerable to Nazi Germany, but whatever it was, it influenced me enough that I began volunteering as a 16 year old. At first, it was with an ulterior motive, I could hang out at a music school and learn guitar. Later, it was for the greater good of whatever I truly believed would make an impact at that time. During my lifetime, I have volunteered at folk music festivals where I met and in some cases came to know the likes of performers like Ella Jenkins, Bob Gibson and Steve Goodman. I volunteered to organize events for children when I was a teacher, and when volunteer staff failed to help with the petting zoo, I scooped poop on one more than memorable July day in Chicago. I’ve handed out leaflets at el and subway stops to advertise community meetings and inform the public about events that may affect life in our community. I have distributed thousands of political brochures for different candidates running for local and national office that I believed my time would make a difference in their ability to make needed changes in the City, State and Country. I walked door to door to canvas neighbors on their feelings for declaring our precinct dry and having the City declare our Victorian homes as landmarks to prevent further teardowns of some beautiful homes.

When it comes to serving on Committees, I have served on many. I have been on a neighborhood board of directors on and off for 25 years. I served as vice president, secretary, treasurer, secretary-treasurer and membership chair. For this Board I have taught sessions on board operations, strategic planning and safety. I served as a community coordinator for the Chicago Police Department and wrote more reports than I thought humanly possible to get the City to get a grant for matching funds for several projects within our community. I have cooked for AIDS patients in a contamination unit in the 1980’s when you had to gown and glove before entering because I had a friend who was dying from the disease and wanted home-cooked meals before he died. I have walked in fundraising events for AIDS, animal shelters and breast cancer. Why do I do it? That’s a question I have asked myself and that my family has asked me. Partly, I believe in things strongly enough that I put my money where my mouth is and support the cause. Other times, it simply is a way to give back. I cannot financially donate money to support these activities, but I can tithe my time to them. Volunteering is an important thing to any organization and can mean the difference between success and failure of any event. Money is usually something that you need to make things happen, but you need volunteers who are willing to provide time to make organizations and their work successful and grow. An organization, like ACOEP, needs its members support through membership and participation in its CME programs; but it also needs your time. We are an organization that must rely on volunteers

The PULSE APRIL 2005

to assist us conduct the business of the College. We need our members to act in a volunteer capacity to help us do committee business so that we can make the College better meet the need of our members. Your support is vital to us, but your time as a volunteer is irreplaceable. As we continue to grow and change, the impact of volunteers will determine the rate at which both of these things happen. They will determine if we meet a goal in a month or a year. They will determine if we seek to pursue a currently intangible goal or if we sit by and let the opportunity pass by us. Volunteers will move the ACOEP from being a good organization a great organization. ACOEP doesn’t have the monetary resources to reward all its volunteers for the job done; we recognize our members’ service in awards given for lifelong achievement or meritorious service. We will never be able to pay our Board members, Committee Chairs and speakers the true value of their time – if we did we would be bankrupt in months. But for those volunteers who give just a few hours every few weeks to conduct an inspection, review a file, write a question for the in-service examination, we can only say thanks for sharing your expertise and donating your time. As for me, I will continue to volunteer because I know that I may take time away from my personal life, forsaking a few hours from my family and friends, but I know that when I look at all my accomplishments ones that mean the most to me are the ones that were gained through my volunteer efforts and knowing that somehow, I helped make the world a better place for those that come after me.

Member Perspective

Michael Oster, D.O. FACOEP

Parallels Between Osteopathy and Religious Practice In our first weeks of medical school, we learned about the philosophy of holistic medicine as envisioned by our founder, Andrew Taylor Still. Our teachers informed us that the word holistic is derived from the word “holy,” and that we are partners in a health care delivery system that melds mind, body, and spirit. How long has it been since you thought about the parallels between how we practice (especially the laying on of hands – long known to help increase patient satisfaction and compliance) and religious practice. In ancient times, disease and disfigurement was believed to be caused by sin, breaking of the covenant with God, or a violation of one of the personal or social behaviors practiced by that faith community. Their rules, laws, and rituals addressed issues including food preparation (wash your hands), food choices (don’t eat pork), avoidance of certain people (others who were bleeding or who had leprosy), and observing the Sabbath. The religious leader (priest, rabbi or imam – commonly called teacher or master), advised the community to work honorably, pray, study and observe their laws. The leaders served as intermediaries between the faithful and their God, and accepted their offerings of goods or money as they sought to restore their relationship with God. Issues of complex morality were resolved by a group of elders. Currently, we regard many diseases to be caused or influenced by issues of the immune system, which is itself affected by human behavior. As physicians, we advise our patients to pay attention to their balance of work, play, and rest. We encourage patients to eat a balanced diet, exercise regularly, avoid over-consumption of

alcohol, avoid smoking, and avoid risky sexual behavior. We teach our children to wash their hands, develop their spirituality, and do their best. Our Hippocratic Oath includes a promise to “do no harm;” the etiology of our role of “doctor” is “master” and “teacher.” Complex health care issues are debated through public forum, hospital ethics committees, and Board of Directors. Our modern patients seek to restore and protect their health through self-help efforts (exercise, prayer, meditation, rest, proper diet), through education, and through our services (payment for which has certainly changed over the years!). Though we often hesitate to initiate political or religious conversations with strangers, it is becoming controversial whether we should advise our patients regarding risky social and sexual behaviors, child rearing issues, seatbelt use, smoking, excess in food and alcohol consumption. Is our professional behavior akin to that of the religious leader who advises others regarding issues of mind-body-spirit? Please send your comments to moster244@msn.com for a follow-up article on this topic.

For more information on hospitals and history of medicine, the following are suggested: The Time Chart History of Medicine, Gill Davies, Editor The Hospitals, Leonard Everett Great Inventions Medicine, Paul Dowswell Medicine in the American West, Lucile Davis The History of Medicine, Lisa Yount Early Health and Medicine, Bobbie Kalman What’s Inside a Hospital, Sharon Gordon The Hospital Book, James How Curious George goes to the Hospital, H.A. Rey

POSITION AVAILABLE Pennsylvania, Erie - Currently seeking an energetic BC/BE Emergency Physician to join our 13 member hospital-based group. Saint Vincent Health Center is a 413-bed tertiary care hospital with yearly patient volumes of 35,000, with 47 hours of physician coverage daily plus 6 hours of midlevel coverage. Physicians currently see less than 2 patients per hour. Osteopathic Emergency Medicine Residency established in 2004. Majority of physicians have at least 10 years ED experience. Excellent compensation/ incentive package with full benefits. Ideal candidate will have ultrasound and research experience. Erie, Pennsylvania's fourth largest city, is a scenic lakefront community with exceptional recreational, educational and cultural opportunities. Erie is an excellent place in which to live and Saint Vincent Health Center provides a superb environment in which to practice Emergency Medicine. Contact: Sue McCreary, (814) 452-7822, FAX: (814) 455-1524, email smccrear@svhs.org.

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Member Survey on Pediatric Emergency Medicine The American College of Osteopathic Emergency Physicians has developed an Ad Hoc Committee on Pediatric Emergency Medicine to assess the potential for creating an educational program for emergency medicine and pediatric physicians to become recognized in pediatric emergency medicine. As part of the needs assessment, we ask that you complete the following questions and FAX your response to the ACOEP at 312-587-5591 between now and May 31, 2005. Please circle the most appropriate answer. Thank you. 1.

What percentage of your patients are less than 18 years of age? 0 – 10 %

Not conﬁdent

No (if no, skip to question 8)

18 hours daily

12 hours daily

Other

No (if no, skip to question 8)

If you are eligible to work in the pediatric emergency department, do you choose to do so? No

Do you believe that the existence of a pediatric emergency department decreases your exposure to pediatric patients? Yes

Not very conﬁdent

Are you eligible to work in the pediatric emergency department?

Yes 8.

Somewhat conﬁdent

How many hours is your pediatric emergency department open?

Yes 7.

Moderately conﬁdent

Do you have a separate pediatric emergency department?

24 hours daily 6.

Over 25%

How conﬁdent are you in caring for critically ill or injured pediatric patients (compared with comparatively ill or injured adults)?

Yes 5.

21-25%

Very conﬁdent 4.

16 – 20%

Are you required to maintain PALS or APLS certiﬁcation in order to maintain hospital privileges? Yes

11- 15%

Are you interested in pursuing a Certiﬁcate of Added Qualiﬁcations (CAQ) in Pediatric Emergency Medicine, if available? Yes

10. Do you believe you are qualiﬁed to sit for a CAQ in Pediatric Emergency Medicine, with through completion of a dual resident; fellowship training, or signiﬁcant experience? Yes

No Thank you for taking time to assist the College in gaining member input on this important issue. Results of the survey will appear in the July issue of The Pulse.

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Foundation Forum Victor J. Scali, D.O., FACOEP Foundation President

As you may know, The Foundation for Osteopathic Emergency Medicine, created in 1998 through the vision of ACOEP Past President, Dr. Benjamin Field continues to move forward to strengthen its infrastructure in the fiscal year of 2005-2006 and insure its future financial growth as a self-sustaining entity. The Foundation’s vision is to expand support of emergency medicine basic research studies conducted by residents and faculty as well as support studies to improve the educational strategies and metrics for residency training in line with the ACGME/AOA core competency guidelines. To achieve the future financial security of FOEM, the Board of Directors made the difficult decision in November 2004 to temporarily suspend research and education based grants for this fiscal year so erosion of the Foundation’s principle does not continue to exceed its contribution base which has lacked sustained growth in the past two years. It is antici-

pated with a strong Capital Campaign designed to increase member contributions and secure corporate sponsorship from the medical equipment and pharmaceutical industry, FOEM will reopen the grant sponsorship and funding opportunities in 2006-2007. The Board of Trustees and I, as president, will devote all our energies to this goal. The funding moratorium should not deter our residencies from promoting research among our residents and young, talented faculty, as all research awards will continue to be funded. During this funding hiatus the Research Consortium under the direction of FOEM will continue to seek multi-center trials with funding from Pharma to offer to individual residencies. The FOEM Research Consortium will need the research databases of all 39 residencies updated to the website if the Consortium is to have the national prominence and respect of the industry. If you are having trouble utilizing the website in this endeavor please contact Jan and she will mail you a formatted disc for easy completion.

this period, the Foundation will launch a broad based corporate funding initiative with emphasis on the medical industry. However, in the past, the generous donations to FOEM by members of our College have been the mainstay of our rapid growth as a foundation and the resultant stimulation of research production by our residency programs. We hope our past donors will continue their support and make tax deductible contributions to FOEM on an annual basis. If you are a new college member or a non contributor in the past, please consider joining our convenient pledge program which can simplify your giving by charging your credit card. End of year tax documentation will be mailed to you at your request. If you have interest in serving on the FOEM Board of Trustees, please call me at 312587-1765. The foundation is looking for college members to help make our vision a reality. Stay tuned for more information on the Capital Campaign as it unfolds.

The Foundation’s capital campaign will be three years in length beginning in 2005 and completed in 2008. During

Position Available Looking for a better career destination? Make your next stop Frankford Hospitals of the Jefferson Health System.® The Frankford Health Care System’s three premier locations have proudly served the communities of Philadelphia and Bucks Counties in Pennsylvania for 100 years. Ever evolving and with an ED patient volume approaching 100,000 per year for all three campuses, we include a Level II Trauma Center, systemwide digital and comprehensive cardiac services including EPS and stat interventional cath labs. Emergency Physicians As an integral member of our ED, we seek physicians with Board certification or eligibility in emergency medicine. You must be qualified and licensed to practice without restrictions in Pennsylvania and registered with the DEA. 8, 10 and 12 hour shifts available. As a member of the Frankford Health Care System, you will enjoy partnering with an exceptional professional team. We offer a Sign-on Bonus, competitive salary and comprehensive benefits package. Send your resume to: Human Resources, Frankford Hospital, Knights and Red Lion Roads, Philadelphia, PA 19114; E-mail: dprincipe@fhcs.org; Fax to 215-612-4073. www.FrankfordHospitals.org EOE

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AstraZeneca

is pleased to support the

American College of Osteopathic Emergency Physicians AstraZeneca is one of the worldâ&#x20AC;&#x2122;s leading healthcare companies, providing innovative, effective medicines for serious medical conditions. Skilled research is at the heart of our continuing success and we spend more than $2.7 billion each year on the discovery and development of new and improved medicines. Our track record of innovation includes leading treatments for gastrointestinal disorders, heart disease, cancer, central nervous system (CNS) disorders, respiratory diseases and pain and infection. With US headquarters based in Wilmington, Delaware, we are committed to maintaining a flow of new products around the world which protect and improve human health and quality of life.

www.astrazeneca-us.com ÂŠ 2002 AstraZeneca Pharmaceuticals LP

research and development organization With 100 years of combined experience, scientists at AstraZeneca have discovered and developed several of today’s leading prescription medicines—pharmaceuticals that contribute to a higher quality of life for millions of patients and to a better health economy worldwide. Based in Sweden, AstraZeneca’s R&D organization is international in scope and comprised of approximately 10,000 researchers. Through its own resources and through collaboration with dozens of universities and strategic alliances with numerous research and biotechnology companies, AstraZeneca has broad access to advanced technologies in biomedical research, including genomics, bio informatics, chemical libraries, high throughput screening and product delivery systems.

leading with products

AstraZeneca’s success ratio of bringing new

Priority research is being conducted for the

products to market is among the best in

development of treatments for high cholesterol,

the pharmaceutical industry. The company

blood clot formation, lung cancer and other

produces a wide range of products that make

types of cancer.

significant contributions to treatment options and patient care.

With an R&D pipeline that has been recognized as the best in the industry, the company is well

AstraZeneca has one of the world’s leading

equipped to maintain a flow of high quality

portfolios to treat cancer and gastrointestinal

medicines over the coming years. These

disorders, in addition to the areas of anesthesia

medicines will offer improved health and quality

(including pain management), cardiovascular

of life for patients, better health economics for

disease, respiratory and central nervous system

society and attractive growth for AstraZeneca.

disorders.

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AstraZeneca is a major international research

AstraZeneca operates nine different R&D sites

based pharmaceutical company engaged in the

and has sales activities in over 100 countries

development, manufacture and marketing of ethical

and manufacturing facilities in 19 countries.

(prescription) pharmaceutical products. Our long

The Company has a workforce of more than

heritage of innovation and documented ability to

50,000 strongâ&#x20AC;&#x201D;with over 10,000 employees in

develop new concepts in medicine has made us

the U.S. alone.

one of the top five pharmaceutical companies in the world. AstraZeneca PLC is headquartered in London with its U.S. headquarters located in Wilmington, Delaware. Wilmington is also the global home for the companyâ&#x20AC;&#x2122;s Central Nervous System (CNS) commercial and research and development efforts.

leading in the community and the workplace patient assistance program AstraZeneca is acutely aware of the growing costs of healthcare in the United States. The AstraZeneca Foundation Patient Assistance Program (PAP) (formerly the Zeneca Pharmaceuticals Foundation Patient Assistance Program), which has been in existence since 1978, and the

In addition to its products and research and development efforts, AstraZeneca provides health education information, support services and health guidance to millions of Americans through public awareness campaigns including: • National Breast Cancer Awareness Month • Prostate Cancer Awareness Month • Capitol Hill Briefing Program with Asthma and Allergy Foundation of America (AAFA) • National Alliance for the Mentally Ill (NAMI) Helpline Online

AstraZeneca LP Patient Assistance

• NAMI’s Campaign to End Discrimination

Program provide AstraZeneca products

• Migraine Mentors Program with the

free of charge to patients who cannot afford them and who do not have insurance or other programs that can provide the product. Currently there are more than 250,000 patients enrolled in these programs. Over the past year, AstraZeneca donated medicines valued at over $250 million to indigent patients across the United States and Puerto Rico.

National Headache Foundation • Clinical Outcomes Research Initiative (CORI) with the American Society for Gastrointestinal Endoscopy • Nationwide Asthma Screening Program with the American College of Allergy, Asthma and Immunology (ACAAI) • Human Medicine Symposium Series with the Minority Health Institute While AstraZeneca is committed to educating the public, the business’s commitment to its own employees is equally important. AstraZeneca offers onsite breast, prostate, colorectal and skin cancer screenings as well as preventive health programs for employees in all of our therapeutic areas.

Guest Column

Alan R. Janssen, D.O., FACOEP

TEMS Providers in Michigan Acquire Liability "Body Armor"

For those who are involved in Tactical Emergency Medicine the challenges that are faced on a daily basis are countless. Everything from the preparation prior to a mission, monitoring the ongoing physical and psychological conditions that face the team, and keeping ahead of all potential medical conditions before you need to act on them. The job is challenging, but also more rewarding than most that I can imagine. One of the hurdles many of us face is the issue of liability. Just look at any online forum related to TEMS, and you will find that the issue of liability is a popular topic to say the least. We all want to know how everyone else is “getting it done”.

medicine that I have practiced. My desire to practice tactical medicine, and do so in the safest manner possible lead me to an interesting sequence of events this past year. As my training in this, field and my interaction with others in the field expanded; so did my education. I began to seek out what others had done to fill in the “malpractice chiasm” in tactical medicine. It wasn’t long before I stumbled across a bill that addressed this very issue, in the state of Georgia. I am not a politically savvy, but knew the task to develop a level of protection in my own “home” had to be tackled. It process took almost a year, and required about as many legislative tactics as a high profile TEMS operation.

We are involved in this line of activity because we have a passion for it. Some are fortunate enough to have a compensated position, or perhaps a department that in some fashion protects them from medical liability. Many providers, however, are completely voluntary, some with no formal medical malpractice coverage. Some would consider us crazy for practicing in a tactical environment, and would consider us even more so to practice with no malpractice protection. You would hope that if you are striving to protect the lives of officers, that you would not have to be too concerned with risk. The bottom line is that in a society that is so ready to jump on medical malpractice cases; you must be concerned. It is a reality that must be taken into consideration. As a member of numerous TEMS oriented organizations, this topic is a struggle for many of us.

My education in the process began early in 2004 when I came upon Georgian Law (Georgia General Assembly SB 408) that states “A law enforcement officer shall not be liable at law for any action or actions done while performing any duty at the scene of an emergency except for gross negligence, will or wanton misconduct or malfeasance . . . such term shall include any physician licensed under Chapter 34 of Title 43 who volunteers to assist law enforcement officers while law enforcement officers are engaged in tactical operation whether the physician volunteer is working with or without compensation.” Although not perfect to what I was looking for, it did provide a springboard for our project in the upcoming year.

I have been involved as a tactical physician for only a little over three years. Although a novice in comparison to many of my tactical colleagues, I enjoy the practice as much as any other aspect of

I work on the Special Response Team with the Oakland County Sheriff’s Office in Michigan. Our team, like many others has numerous providers of various backgrounds including physicians, nurses, and EMS providers. My goal was to create a law that would encompass as many providers as possible. It is impossible to create

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such a law that can cover all possible providers in all possible situations, but we did the best that we could to protect as many as possible. My first task was to find a sponsor for the bill. I am proud to say that I am a qualified Emergency Medicine physician. I have worked on national committees, and am the Director of an Emergency Medicine Residency Program, but when it comes to mastering the intricacies of the legislative arena; I am truly a novice. Therefore, the first step in the process was finding a sponsor for the bill, someone who could be the catalyst in the process. Truth be told, the behind the scenes work, campaigning, and diligence deserves way more than the simple description of “catalyst.” The primary sponsor of our bill was Representative Ruth Johnson. Representative Johnson, her staff, and I worked by taking the Georgian bill, and tailoring it to meet the need of our teams in Michigan. We had countless support from numerous sources including Sheriff Bouchard from Oakland County, Michigan, and ITEMS to name a few. The year involved numerous revisions, and “running defense” to prevent special interest groups from contaminating it. On face value one wouldn’t think that a bill that protects officers, care givers and the public would be subject to much controversy, but there are as many groups with issues to protect, as there are lawyers, and there are no shortage of them. Once it had been created it then went to the House Judiciary Committee, and once passed to the House of Representatives for a vote. It passed unanimously, but not without some sweaty palms from yours truly. Then the process started over with Continued on page 18

ACOEP JOINS PhRMA EFFORT TO PROMOTE PRESCRIPTION ASSISTANCE In March, the ACOEP joined PhRMA, AOA, ACOFP, ACOI, and many allopathic agencies to promote The Partnership for Prescription Assistance. This program brings together national and local organizations to help low-income, uninsured patients obtain free or nearly free medicines through a “one-stop shop” via the internet and telephone, that links patients and providers to public, private and government assistance programs. In 2003, almost 45 million people were uninsured at some point during the year, and there were over 28 million Americans under 200% of the Federal poverty line. Emergency physicians see the consequences of this situation every day, as the public turns to the Emergency Department for care because no other source is available. Additionally, after receiving care, patients cannot afford many of prescriptions they receive to control or cure a condition. In the past, many physicians tried to match up patients with programs for patients in this situation, however, with the number of programs out there it was often an effort to locate programs that could provide the correct drug. Now that will change. By answering a series of short questions, patients (or their caregivers) will find out what programs they are most likely to qualify for and can apply directly for assistance. If help is required from more than one program, they will only have to answer common application questions one time, so there will be no more filling out the same information on multiple forms and sites. When the program debuts, in April, patients will be able to call a toll-free number and get assistance over the phone from a live customer service representative. Patients will no longer need access to the internet or have their health-care professional fill out forms for them. Trained operators will work with patients, heath-care providers, or caregivers to complete the necessary forms and submit them for submission (a prescription and verification will need to be submitted for eligibility).

Patients may enroll in the program simply by calling 1-888-4PPA-NOW (1-888-477-2669) or visit www.pparx.org to see if they are eligible for one or more programs beginning on April 5th when the program will be advertised in several national newspapers.

ACOEP will have a direct link to this website on its website and will provide its members with written information they can copy and use in their Emergency Department later in the spring.

Continuing Medical Education Calendar January 2005 – October 2007 2005 September 13

Physicians Advocacy Workshop Hotel TBD, Washington, D.C.

6 – 8 hours

September 14

DO Day on the Hill Washington, D.C.

September 15 – 16

Oral Board Review Hotel TBD, Washington, D.C.

10 hours

September 16 – 17

Emergency Airway Course Hotel TBD, Washington, D.C.

5 hours

October 23 – 27

Scientiﬁc Seminar & AOA Convention 25 hours Orange County Convention Center, Orlando, FL

2006 January 5 – 9*

Emergency Medicine: An Intense Review 40 hours The Westin Chicago – River North, Chicago, Illinois *Early Registration takes place January 4 at 5 p.m.

February 12 – 14

Program Directors Workshop 10 hours Hilton LaJolla Torrey Pines, San Diego, CA

February 14- 18

COLA Essentials 25 hours Hilton LaJolla Torrey Pines, San Diego, CA

April 18 – April 22

Annual Spring Seminar 25 hours Wigwam Resort & Golf Club, Litchﬁeld Park, Arizona

October 16 – 20

Scientiﬁc Seminar & AOA Convention 25 hours Las Vegas Convention Center, Las Vegas, Nevada

You can enroll in meetings through April 2007 on our website, however, please note that Scientiﬁc Seminar registration is done through the American Osteopathic Association. The AOA website can be accessed at www.do-online.org or by calling 800- 621-1773 for further information about the convention. If you are interested in the programs offered by the ACOEP please contact us at: American College of Osteopathic Emergency Physicians 142 E. Ontario Street, Suite 1250 Chicago, IL 60611-2888 800-521-3709 312-587-3709 312-587-9951 (fax) www.acoep.org

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Member Update The ACOEP would like to thank its members for acting as Chairs and Members of its many Committees during 2003 – 2004 and wishes to name all the physicians who participating in making our College so successful in the last few years with their dedication to the tasks given to them by the Board and Membership.

! l l A u o Y Thank

Steven Aks, D.O., FACOEP Paul Allegretti, D.O., FACOEP Victor Almeida, D.O. Robert Aranosian, D.O., FACOEP Jerry Balentine, D.O., FACOEP Gary Beasley, D.O., FACOEP John Becher, D.O., FACOEP Gregory Beirne, D.O. Peter Bell, D.O., FACOEP Nancy Bellemare, D.O., FACOEP Robert M. Biernbaum, D.O., FACOEP Paul Blackburn, D.O., FACOEP William Bograkos, D.O., FACOEP James Bonner, D.O., FACOEP Gregory L. Boris, D.O. Thomas Brabson, D.O., FACOEP Bernadette P. Brandon, D.O., FACOEP Steven Brunetti, D.O. Denise Buruse, D.O., FACOEP Joseph Calabro, D.O., FACOEP Arthur Calise, D.O., FACOEP A. Dale Chisum, D.O., FACOEP Ben H. Chlapek, D.O., FACOEP Gregory Christiansen, D.O., FACOEP Kevin Clark, D.O. Michael Coleman, D.O. Jon Conlon, D.O. Mark Cynar, D.O., FACOEP Paula DeJesus, D.O., FACOEP Lisa DeWitt, D.O., FACOEP Robert Dinwoodie, D.O., FACOEP James Distefano, D.O. Michael Doyle, D.O., FACOEP Paul Dubiel, D.O., FACOEP Anita Eisenhart, D.O., FACOEP Benjamin Field, D.O., FACOEP Charles Finch, D.O., FACOEP Bryan Fitzgerald, D.O., FACOEP Mark Foppe, D.O., FACOEP Albert Ford, D.O. J. J. Foutty, D.O., FACOEP Gregory Frailey, D.O. FACOEP Howard Friedland, D.O., FACOEP Theodore J. Gaeta, D.O., FACOEP Raul Garcia, D.O., FACOEP Roger Garcia, D.O., J.D., FACOEP Roger George, D.O., FACOEP Christine Giesa, D.O., FACOEP Keischa Glenn, D.O. Joseph Gomes, D.O. John Graneto, D.O., FACOEP Gregory Gray, D.O.

Brett Greenﬁeld, D.O. Anthony Guarracino, D.O., FACOEP Joseph Heck, D.O., FACOEP Melvin Hecker, D.O., FACOEP Bernard Heilicser, D.O., FACOEP Gregory Higbee, D.O. Douglas Hill, D.O., FACOEP Mary J. Hughes, D.O., FACOEP Raymond Hughes, D.O., FACOEP Christopher Jackson, D.O., FACOEP Alan R. Janssen, D.O., FACOEP Anthony Jennings, D.O., FACOEP Heath Jolliff, D.O. Wayne Jones, D.O., FACOEP Michelle Kallenborn, D.O. Ebrahim Karkevandian, D.O., FACOEP Randy Kellenberger, D.O., FACOEP Valerie Kemsuzian, D.O., FACOEP Tamara Kile, D.O., FACOEP Drew Koch, D.O., FACOEP Christ Kyriakedes, D.O., FACOEP Joseph J. Kuchinski, D.O., FACOEP Paul LaCasse, D.O., FACOEP Gary LaPolla, D.O., FACOEP David Lang, D.O., FACOEP Paula Lange, D.O., FACOEP Kevin Loeb, D.O., FACOEP Beth A. Longenecker, D.O., FACOEP Freda Lozanoff, D.O., FACOEP Mary Lynn Magarelli, D.O., FACOEP G. Edward Mallory, D.O. Gerald E. Maloney, D.O. Patty Manhire, D.O. Rosa Marino, D.O., FACOEP James Massimilian, D.O. Paul Mastrokyriakedes, D.O., FACOEP Gerald McClallen, D.O., FACOEP Douglas McGee, D.O., FACOEP Mark Menadue, D.O., FACOEP George J. Miller, III, D.O., FACOEP Mark Mitchell, D.O., FACOEP Michael Morgenstern, D.O., FACOEP E. Scott Morrison, D.O., FACOEP Housam Moursi, D.O., FACOEP Joe Nelson, D.O., FACOEP Brian Nester, D.O., FACOEP David J. Niles, D.O., FACOEP Thomas O’Hare, D.O., FACOEP Gerald O’Malley, D.O. Daniel Olsson, D.O., FACOEP Michael Oster, D.O., FACOEP Hema Pandit, D.O., FACOEP

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Steven Parrillo, D.O., FACOEP Susan Payson, D.O. Jon-Pierre Pazevic, D.O., FACOEP Donald Phillips, D.O., FACOEP Narasinga Rao, D.O., FACOEP Brian J. Robb, D.O., FACOEP Gregory Rokosz, D.O., FACOEP Alexander Rosenau, D.O., FACOEP Mark Rosenberg, D.O., FACOEP Charles S. Ross, D.O., FACOEP Fred G. Sabol, D.O., FACOEP Victor Scali, D.O., FACOEP Henry Schuitema, D.O., FACOEP Sandra Schwemmer, D.O., FACOEP Donald Sefcik, D.O., FACOEP James B. Shuler, D.O. William R. Siegart, D.O., FACOEP Steven Smith, D.O., FACOEP Theodore Spevack, D.O., FACOEP Murry Sturkie, D.O., FACOEP Robert Suter, D.O., FACOEP Scott Thomas, D.O., FACOEP Stevan Vukovic, D.O., FACOEP David Wald, D.O., FACOEP Jennifer Waxler, D.O., FACOEP John Weilbacker, D.O., FACOEP Bruce Whitman, D.O., FACOEP Elaine Lombardi Wilk, D.O., FACOEP Anthony Wilko, D.O., FACOEP Gary Willyerd, D.O. FACOEP Jennifer Bantley Wilson, D.O., FACOEP Jennifer Yorke, D.O., FACOEP Carolyn Zonia, D.O., FACOEP Michael Zufelt, D.O., FACOEP

Many thanks to those members who attended many of the meetings out of personal interests who were not formally named to the Committees without whose help the College could not survive.

The building block of Osteopathic Emergency Medicine

Nurse Triage Protocols, Continued from page 3

for decrease revenues of at least $200,000 per year. It appears that the hospital desires to decrease their liability and LWOT’s when patients are waiting to be seen. This is accomplished by instituting nurse triage protocols. The hospital feels these measures will not only decrease patient waiting times, but will increase the emergency departments Press Gainey scores and patient satisfaction and keep potential myocardial infarctions from sitting in the waiting room. The physicians are concerned about the liability and false sense of security these protocols provide the nurses and the patients. The nurse triage protocols involve: 1). giving Tylenol or Ibuprofen to a child with fever; 2). Drawing labs on women of child-bearing age with abdominal pain; 3). Administering albuterol nebulizer to an adult who is wheezing; 4). And obtaining an EKG and drawing cardiac markers on an individual who is experiencing chest pain. The policy also states that the Emergency Medicine Physician is to read the EKG and if no acute abnormalities are noted the patient returns to the waiting room. Our contention is that acute coronary syndrome is not static, but an evolving process. The patient is aware of a “negative” EKG and decides not to wait (4-6 hours is the average wait) and goes

home and dies. This is poor risk management and “bad medicine.” If the nurses are required to “work the waiting room” and feel compelled to do an EKG then the patient needs to be brought back to the ED to be seen, regardless of the bed availability.

ing room with their normal EKG and cardiac markers only to have a bad outcome that will increase liability both to the physician and the hospital. I hope I am not the physician on duty when this occurs.

This brings me back to my last night shift. The ﬁrst patient I saw fell prey to the nurse triage protocol. He presented to triage 11/2 hours after he experienced chest pain. He had an EKG done and interpreted appropriately as negative and had his cardiac markers drawn, and then admonished to the waiting room. I saw him seven hours after his chest pain began. This gentleman was in his sixties, had a previous myocardial infarct with stenting, coronary artery bypass, more stents and an occlusion of his distal LAD that was being treated medically. His cholesterol lowering medications were just increased and his cardiologist sent him to the ED. A second set of cardiac markers and a second EKG were negative, thank goodness. Since there were no beds in the hospital, his cardiologist recommended sending the patient home for an outpatient dual isotope nuclear stress test in the am. I felt the decision to discharge the patient was appropriate but potentially risky.

I expect to pass

The triage nurse was either an astute triage nurse or lucky or both! One of these days, a patient who is having an acute coronary event, pulmonary embolus, dissecting aneurysm, etc. will be banished to the wait-

this way again.

through life but once. If, therefore, there be any kindness I can show, or any good thing I can do for any fellow beings, let me do it now. . . as I shall not pass —William Penn

POSITION AVAILABLE Bay City, Michigan—Opportunity for a BC/BE Emergency Physician at a growing, profitable hospital in Bay City. Busy Level II Emergency department treating over 36,000 patients annually. The hospital has a friendly, cooperative medical staff and coverage for all of the major specialties, including 24-hour catheterization lab availability. Our group offers a stable contract, extremely competitive compensation, flexible and fair scheduling, pension and profit sharing plans. In addition, there is the potential for partnership after two years. If you are interested in learning more about this opportunity, please contact Konnie Licavoli, Physician Recruiter at 800-223-4242, or klmlicavoli@bhsnet.org or check us out on-line at baymed.org

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Guest Column Edward Cho, D.O.

International Emergency Medicine Development through Primary Care (Excerpts from Emergency medicine development through primary care, submitted to the National Medical Journal of India, Jan 2005) In recent years, the concept of emergency medicine has come to the forefront in the advancement of medicine internationally. The epidemiologic shift within developing countries has transformed the medical landscape to witness increased incidences of time-sensitive illnesses, such as cardiac disease, trauma, and care for the elderly. Consequently, there has been a drive to establish an emergency system that suits the needs of developing countries. The recommendations from the international emergency medicine community have been to firmly establish a hospital-based emergency medicine system prior to development of an EMS system. The goal was to improve the health of populations and to meet the expectations of access to emergency care. Over the years, developing countries have taken these recommendations and have concentrated their efforts on developing urban tertiary care centers in cities with ancillary support programs. However, the plans for an emergency system that reach rural areas and underserved regions of urban areas have been delayed secondary to regional infrastructure problems. Furthermore, the international medical initiatives to developing countries have worked on vertical oriented programs towards medical management. While this approach has produced significant results with specific diseases that have plagued rural areas, vertical programs do not promote efficient health care. Consequently, the development of an advanced emergency care system extending to rural/underserved urban areas remains a long-term goal. Nevertheless, the economies of the largest developing countries

(Brazil, Russia, India, and China (BRIC)) together are projected to eclipse the current G-6 countries within a decade. To maintain a healthy workforce that reside primarily in the rural/urban underserved areas, immediate initiatives to efficiently improve access and quality is needed. However, attracting and retaining specialists to these areas is a problem not only for developing countries, but even countries with advanced health care systems offering financial incentives (i.e. United States). Without access to health care specialist, improving the quality of health care in these underprivileged strata of society becomes difficult. Emergency medicine development projects in India have focused on improving the health of populations by improving the quality and access to emergency care. Over the years, India has concentrated their efforts on developing urban emergency tertiary care centers and supporting infrastructure. However, like other developing countries, plans have been delayed in improving the access and quality of health care to the rural and underserved urban areas. Without access to health care specialist, improving the quality of health care in these underprivileged strata of society becomes difficult. Other strategic methods to development are needed to address this deficiency. By teaching fundamental emergency medicine skills and knowledge to the general practitioner, the physician is able to acquire the skills to recognize and to act as the first responder in the treatment of critically ill individuals. A cursory comparison of emergency medicine physicians and general practitioners indicate two fields that are opposite in mindset and practice, but represent the health care continuum of primary care. These two fields are integral parts of a successful health care model. The

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majority of medical cases seen in the emergency department and primary care clinics are similar in scope with obvious differences in a minority of cases (i.e. trauma/acute care and long term medical management, respectively). The two fields together allow all patients with acute/chronic problems, specific/basic needs to be treated or referred to a specialist. The empowerment of the general practitioner serves a critical dual role in India. The emergency medicine trained general practitioner advances emergent medical and surgical capabilities to the areas that are often deficient in these services. In addition, teaching emergency medicine to general practitioners avoids the expense and difficulty of recruiting and retaining multiple specialists to primary health and rural clinics. By creating a “broad spectrum” physician capable of addressing acute and chronic medical care for multiple specialties, efficient health care is served to the majority who are disadvantaged and underserved. The rapid economic growth of developing countries has called for a matching investment in maintaining a healthy workforce. International emergency medicine development is playing an enormous role in this emerging field. The unique organizational skills that emergency physicians possess place these physicians in a position to provide a smooth transition of policy development to clinical application. Consequently, the application of our skills can play a significant health impact to these countries. Osteopathic emergency physicians have long played a significant role in the development of emergency medicine. The involvement at this junction can play an enormous role for osteopathic physicians in the development of international emergency and osteopathic medicine.

Student Chapter Update Jeremy K. Selley, President Greetings from the Student Chapter! As the ACOEP Spring Seminar draws near the Student Chapter is ambitiously preparing for numerous activities, committee meetings, fundraising and a week filled with Arizona sun. If you are from Arizona, the answer to everything is, “It’s a dry heat.” In the last few years the Student Chapter’s attendance at the ACOEP Spring Seminar has more than tripled. We look forward to this year being no exception. We are excited to participate in both the committee meetings and CME offered. Last year the ACOEP generously offered one official student position on each of its committees. This is an excellent opportunity for Student Chapter members to get involved with the “nuts and bolts of the organization.” As the Chapter looks to the future, we would like to compile a mentor list among the College members for student use. This list would be used to match ACOEP physicians with Student Chapter members based on geographical location. Students need encouragement, guidance, and support to help them navigate the road to becoming

SHYNESS

an Emergency Physician, so please take the time to talk with the ACOEP office or email myself at acoepsc_pres@hotmail. com so we can put you on the list. This year the Student Chapter is highlighting some of the Osteopathic Emergency Residency Programs in the Emergent. The most recent issue highlighted Kingman Regional Medical Center and Botsford General Hospital. Program facts and figures are satisfactory, but resident views and interesting facts can have added benefit for students not familiar to the program or area. Please contact us to have your program highlighted in the next issue! We are always open to ideas you may have to help strengthen the student chapter by providing additional resources or activities, so please feel free to contact us! Thank you to ACOEP and its members for its continued support of the student chapter. Without your support, we could not function effectively to serve our Student Chapter members.

TEMS Providers in Michigan, Continued from page 13

the Senate Judiciary Committee, and the Senate. We had a few bumps, but after numerous trips to Lansing, MI, and testimonies to explain the background intent our efforts finally paid off. The original draft made emerged with only a few modifications. Governor Granholm signed the bill, and Public Act 428 went into law with immediate effect on December 17, 2004 In summary, it protects volunteer medical personnel (Physicians, Nurses, and EMT’s) from medical liability when working with tactical teams. Each individual is protected as long as they are practicing in the capacity of their training and licensure. In the process of compromises that were made

from the original draft, we were forced to give up the umbrella of all those “compensated or uncompensated.” In addition, we will probably have to go back to the drawing board for an amendment to include others i.e. physician extenders that may also be participating with tactical teams. It isn’t the answer for all participants in the field of Tactical Medicine, and it doesn’t protect those in other states. It is, however, a step in the right direction. I see this as paramount for those of us in Michigan, and in other states who want to use this to pursue similar legislature and protection in their own state.

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MAY SPUR HEART DISEASE A shy person may be just as likely to have a heart attack as someone with a hot temper. A study at the University of British Columbia found that people with a type D personality with negative or shy traits might have the same risk of a heart attack as those with a type A disposition who are impatient and hostile. A researcher posing as a technician verbally harassed students while they completed a math problem. Type D personalities were more likely to experience a spike in blood pressure and release the stress hormone cortisol. Both of these reactions indicate an increased risk of heart disease, a problem historically associated with a type A personality. Adapted from health

Nathaniel Sherman, MD Chairman, PHCS Diversity Committee PHCS physician since 1991

Doug Finefrock, DO Candidate for PHCS Leadership Program PHCS physician since 2003

Joan Kolodzik, MD PHCS Director of Education Past PHCS Board Chair PHCS physician since 1989

Steve Yamaguchi, MD ED Medical Director Mercy Hospital-Fairfield PHCS physician since 1998

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ACOEP NEWSLETTER

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