vitalsigns For Baptist Healthâ€™s Medical Staff
Table of Contents
VitalSigns is published for Baptist Health’s medical staff. To submit items, call the Baptist Medical Center Medical Staff office at 904.202.1117; Wolfson Children’s Hospital Medical Staff office at 904.202.8799; Baptist Beaches Medical Staff office at 904.627.2902; Baptist Nassau Medical Staff office at 904.321.3501; or Baptist South Medical Staff office at 904.271.6056. President and Chief Executive Officer, Baptist Health A. Hugh Greene, FACHE Chief Operating Officer, Baptist Health John Wilbanks, FACHE Managing Editor, VitalSigns Chief Medical Officer, Baptist Health Senior Vice President for Medical Affairs and Clinical Effectiveness Keith L. Stein, MD, FCCM, FCCP
2 • Summer 2013
A Message from the Chief Medical Officer
Baptist AgeWell Institute fills unmet need
Three Ds of senior behavioral health
Brain games can keep seniors sharp
Minimally invasive surgeries improve outcomes for older patients
Cancer treatment for seniors
Data helps forecast outcomes for cardiac surgery
Cardiac catheterization services growing in Baptist Health
HgbA1c values in seniors
Patient-Centered Medical Home for older patients
Joint revision safer and more effective
Pilates reformer at Baptist Beaches
JOI surgeon honored
Baptist Connect rollout begins
Baptist Health Foundation Notes
Physicians recognized with Spirit of Magnet award
Baptist Clay Medical Campus opens
State-of-the-art Weaver Tower open
Two new pediatric neurosurgeons join Wolfson Children’s Hospital
Become a We Care volunteer
New Baptist Health Medical Staff Members
A Message from the Chief Medical Officer
Changing Health Care for Good.
t’s likely by now that you and your family have
decision that is made
facilities. On T-shirts. On television.
procedure or treatment
started seeing this phrase often. Inside our
But what does such a phrase signify for physicians? In reality, this is not a new concept for us. We’re
constantly innovating and changing, as evidencebased practices evolve, so that we can better care for our patients together. And we’re regularly
recognizing needs in our community and adjusting our practices to address them. A prime example is
with coordinated and compassionate care for seniors, the primary focus of this issue.
We created the Baptist AgeWell Institute because there was a significant gap perceived in how our
community cared for older, frail adults. The specific needs of our aging families and friends were
sometimes going unrecognized or unmet. At AgeWell, fellowship-trained geriatricians, in close partnership with these patients and their families, examine all
of the factors affecting a senior’s health. Along with dedicated pharmacists, occupational therapists and
behavioral health specialists, all of whom contribute to the patient and family’s decisions about a path of care, an effective life plan is developed and
implemented. That’s changing health care for good. We’re further tailoring our care of seniors afflicted
with chronic conditions such as cancer, diabetes and
concerning a possible
will improve the patient’s quality of life as much as
possible. That’s changing health care for good.
We’ve expanded our healthcare offerings
into Clay County with a
sophisticated free-standing emergency department
Keith L. Stein, MD Chief Medical Officer
to address the needs of
children and adults. In addition, we are now offering more complex cardiac care at Baptist Beaches and
Baptist South to provide diagnostic and interventional options closer to where our patients and their families live. That’s changing health care for good.
We’ve always done this. What we’re really changing is the health of this community by focusing on our patients and families, innovating and providing
coordinated, compassionate care to the residents of Northeast Florida and beyond.
I invite you to read more of this issue that evidences
our ongoing commitment to our patients, particularly the growing senior population, and how these
practices are truly changing health care for good.
heart disease to ensure every recommendation and
Summer 2013 • 3
Baptist AgeWell Institute fills unmet need to coordinate care for geriatric patients
nside the conference room, the data for the first patient flashes on the screen.
Marisol Lance, DO, starts to run through the information of a 92-year-old patient who has made her first visit to the AgeWell Institute for Senior Health. Clinical Pharmacist Anne Cordes then goes through the list of medications that the woman is taking, including several painkillers, and relays the patient is having trouble sleeping and says her mind is constantly racing. Psychiatrist Michael Solloway, MD, chimes in on whether the patient is struggling with dementia or may have other mental health problems that are affecting her day-to-day life. Dr. Lance compiles the notes, and with consensus in hand on the steps to be recommended to the patient, another chart pops up on the screen.
Marisol Lance, DO, geriatrician; Richard Glock, MD, senior medical advisor; and Shikha Iyengar, MPH, executive director of Senior Services
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These are Wednesday mornings at the Baptist AgeWell Center for Senior Health, where the interdisciplinary team that helps makes AgeWell unique gathers to the discuss new patients seen in the last week. The meetings follow the senior’s initial three-hour geriatric consultation, a cornerstone of the approach to treating older adults that’s
“If you think about it, no one has addressed the health needs of the more frail elderly in a significant and meaningful way,” Greene said. “This is a powerful example of Baptist Health changing health care for good.” unique to Northeast Florida and almost unheard of for health systems outside of an academic setting. “We have stepped into a space that no one has stepped into to take care of this population,” said Hugh Greene, FACHE, president and CEO of Baptist Health. The success stories have been flowing in since AgeWell started seeing patients last year. One man had been in and out of local hospital emergency departments twice a month for two years. His medications were difficult for him and his son to manage – the man was taking some at the wrong time and not taking others at all. The AgeWell pharmacist sat with him for hours, color-coding the medication list to make a simple, organized medication administration system, and he’s now taking what he needs – and not paying for what he doesn’t. His story is shockingly common at AgeWell. The average patient is 82 years old and is on 15 different medications, said Dr. Lance, a fellowship-trained geriatrician at the Baptist AgeWell Center for Senior Health. Oftentimes, his or her health is on a steady decline and the primary caregiver, if there is one, is struggling to manage everything. “It’s not just the patient who is having difficulty,” Dr. Lance said. “We see caregivers who are understandably
AgeWell physicians and staff helped Nathan’s ability to relax and get a good night’s sleep.
frustrated: they’re doing the best they can, but they need some help taking care of Mom or Dad.” Older, frail adults have specific medical issues and needs that come with getting older that may not end up being addressed if they’re not examined in connection with overall health, Lance said. Greene said more and more of his friends and peers were having questions about caring for their senior parents or in-laws, oftentimes having to move them to Jacksonville to take care of them. Keeping people out of the hospital – the most expensive form of care – is a direct benefit already being seen with AgeWell patients. “Of course, AgeWell is consistent with our community mission. Also, as we look to the future, it will play an important role in care coordination with the Medicare population,” Greene said. “Clearly, AgeWell will play a vital role in improving the value of care.” The first patient visit is a complete geriatric assessment – a comprehensive evaluation of all the physical, psychosocial and environmental factors that can affect the health and wellness of older adults.
The clinical pharmacist can make tremendous improvements in a person’s life by simply adjusting medications and removing some that may not be necessary or are duplicative. Changes can even be as basic as moving the time a patient takes a diuretic so he or she won’t have to get up several times during the Thursday morning card game. Based on the findings of the geriatric assessment, an integrated care plan is developed and a care coordinator, who is a qualified social worker, works with the patient, family, primary care physician and the rest of the multidisciplinary team to implement the plan.
“It’s not just the patient who is having difficulty,” said Marisol Lance, DO, a fellowship-trained geriatrician at AgeWell. “We see caregivers who are understandably frustrated: they’re doing the best they can, but they need some help taking care of Mom or Dad.”
Summer 2013 • 5
AgeWell is available to patients 65 or older with multiple or complex issues affecting their daily life. Some of the more common issues include: • Memory loss • Decline in function or ability to care for oneself • Multiple ER visits or unplanned hospitalizations • Multiple prescribed medications • Diagnoses of multiple diseases or conditions • Compromised caregiver support
The care plan also includes a Health Passport, which includes prescription history and reminders for various milestone tests. Patients are encouraged to bring the passport to all of their medical encounters, both to record the new events and to provide medical history to those delivering the care. “By simply coordinating their care and getting them on track, we are seeing our patients make some remarkable progress,” Dr. Lance said. There’s the patient in her 90s whose painful arthritis kept her from writing her memoirs. With some strengthening exercises and a thick grip added to her pen, she’s now writing away. And the occupational therapist added the same grips to her utensils so she’s able to feed herself more easily. Another elderly woman struggled with incontinence, suffering daily accidents. Part of the issue was she was too weak to get up quickly enough to make it to the bathroom in time. Physical therapists worked with her to strengthen muscles that would give her more control – and strengthen her arms so she could lift herself out of the chair to make it to the restroom. “If you think about it, no one has addressed the health needs of the more frail elderly in a significant and meaningful way,” Greene said. “This is a powerful example of Baptist Health changing health care for good.”
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State of Geriatric Care
aptist Health will host its inaugural “State of Geriatric Care - Clinical Update” in November at the University of North Florida.
Local and national experts will present at the all-day symposium on Nov. 16, discussing the latest evidencebased practices and issues in caring for older adults. Topics include managing dementia patients in a primary care practice, and understanding when and how to begin discussion on advance care planning with patients and families.
Speakers include: • Daniel R. Hoefer, MD, CMO, Outpatient Palliative Care and Hospice, Sharp Hospice Care, Mesa, Calif. • Judith S. Black, MD, MPH, medical director, Senior Products, Highmark, Inc., Pittsburgh, Penn. • Marshall B. Kapp, JD, MPH, director of the Center for Innovative Collaboration in Medicine and Law at the University of Florida, Gainesville, Fla. • Rosemary D. Laird, MD, MHSA, medical director of the Health First Aging Institute in Cape Canaveral, Fla.
The program will also examine how physicians can most effectively partner with a geriatrician to ensure medical care is targeted to the body, mind and soul of older adults as our population ages. The symposium is the first of its kind in Jacksonville and will come almost exactly one year after Baptist Health opened its AgeWell Center for Senior Health.
Register for the conference at agewell.eventbrite.com
Spring 2013 • 7
The three Ds of senior behavioral health Delirium, Dementia and Depression: How They Differ and How They Relate
ften, delirium and dementia are mistaken as the same condition, and even though the symptoms can be similar, there is a huge difference between the two. However, to diagnose a patient (usually an older adult), you have to rule out delirium.
What is Delirium? Baptist Health psychiatrist Michael Solloway, MD, medical director of Baptist Behavioral Health, said delirium often involves a significant decline in attention and thinking ability, disorientation and use of inappropriate language, but it’s always due to an outside cause and has a rapid onset. “Delirium is a temporary behavioral state and can come on in minutes to hours rather than in weeks to months,” he stated. “Delirium can be caused by dehydration, malnutrition, narcotics and other medications, infection, pain or stress, or an unfamiliar environment.” Michael Solloway, MD Psychiatrist Baptist Behavioral Health Baptist Medical Center
Risk factors for delirium include advanced age, pre-existing brain disease and taking certain medications. Fortunately, it is treatable. “The most important thing to do is to take care of the cause if you can,” explained Dr. Solloway. “If the patient has a urinary tract infection, it needs to be treated, or if the patient is taking a lot of narcotic medication, it may need to be reduced while trying to control the patient’s pain.” A program called HELP (Hospital Elder Life Program) has revolutionized treatment for patients with delirium. “The 8 • Summer 2013
program advocates, for example, early intervention and reducing noise and light in the healthcare setting,” said Dr. Solloway. ”Baptist Health hospitals are working on implementing the HELP program.” Goals of HELP include: • Maintaining cognitive and physical functioning of high-risk older adults throughout hospitalization • Maximizing independence at discharge • Assisting with the transition from hospital to home • Preventing unplanned hospital readmissions
Dementia is Progressive Not everyone who has delirium also has dementia. Dementia is a syndrome that includes progressive loss of memory as well as other functions. The most common cause is Alzheimer’s disease, which is, at least in part, genetic. Other causes are physical injuries or those caused by small strokes or alcohol. Dementia may be part of other genetic disorders such as Huntington’s or Parkinson’s. The dementia seen in Parkinson’s disease is called Lewy body dementia and is often accompanied by vivid visual hallucinations.
“Unlike delirium, dementia comes on very gradually,” explained Dr. Solloway. “If someone has dementia, as it progresses, he or she is more likely to have memory issues and cognitive difficulty. They may become difficult for loved ones and caregivers to manage. Dementia can affect the individual’s judgment and personality.”
“It is often the family, not the patient, who notice their loved one’s disorientation and cognitive functioning,” says neurologist Syed Asad, MD, with Baptist Neurology. “Short-term memory is often affected first, depending on the type of dementia.” Therefore, interviewing relatives can help lead to a diagnosis. Treatment often includes medication, which can’t prevent dementia but can slow progression and allow the individual to have a better quality of life.
Depression and Delirium A major depressive disorder is thought to affect 1-2 percent of elderly people in the community at any one time; significant depressive symptoms affect up to 20 percent of elderly adults. Delirium and depression can go hand in hand in senior adults, and Dr. Solloway says that undiagnosed depression can actually appear to be dementia. “People with long-time depression can have a decline in their ability to think and remember and it can be so impaired that they can score as if demented, a condition called pseudodementia,” he explained. “Once you successfully treat the depression, the dementia may resolve. However, symptoms of depression can also precede dementia, so it’s important for patients to be properly screened.” Patients with depression are more likely to bring concerns about cognitive loss to the attention of their physician than are patients with dementia, who may actually be unaware of their memory decline.
“Programs like Baptist Health’s AgeWell Institute are really helpful in bringing to light the conditions senior adults are more likely to suffer from,” said Dr. Solloway. “Clinical professionals who specialize in geriatric medicine can help seniors live a better quality of life for as long as possible. This offers hope for these individuals and the people who love them.” Summer 2013 • 9
Diagnosing dementia: new tools in the fight for brain health
ften diagnosed in the hospital setting, dementia is a progressive disease without a cure that must be managed long-term.
Neurologist Syed Asad, MD, with Baptist Neurology and Chief of Neurology at Baptist Jacksonville noted that a hospital visit often includes compounding factors such as infection and chronic physical disorders that can make identifying the type of dementia an individual has, and treating it, much more difficult. “In the outpatient setting, we can begin by checking the components of cognition in a less stressful environment,” said Dr. Asad. “Simple questions such as asking the patient what day it is, what time it is, and where they are can help us check short- and long-term memory and language function.” From this quick assessment, neuropsychologists in partnership with neurologists can move to other standardized testing and more advanced evaluation to determine how much the disease is progressing and if it is possible to slow progression. The most common standardized test, usually administered by a neuropsychologist, is the mini-mental status examination. This brief 30-point questionnaire screens for cognitive impairment caused by dementia. It is also used to estimate the severity of cognitive impairment and to follow the course brain changes occur in an individual over time; this can help the clinician identify an effective way to document the patient’s response to treatment. “The mini-mental status examination and another screening tool called the Montreal Cognitive Assessment can help us rule out what are called ‘reversible’ causes of dementia, such as a vitamin B12 deficiency, thyroid disease, HIV or syphilis, or a metabolic problem such as liver disease,” explained Dr. Asad. “In this case, reversible, or ‘neurostandard dementia’ doesn’t mean the patient is cured, but he or she may show improvement and we can halt the progression of the disease.” Once neurostandard dementia is ruled out, other types of dementia can be identified with more advanced techniques. 10 • Summer 2013
“A positron emission tomography (PET) scan can measure the uptake of sugar in the brain and significantly improves the accuracy of diagnosing a type of dementia that is often mistaken for Alzheimer’s disease,” explained Dr. Asad. “Temporal Syed Asad, MD dementia is caused by damage to the frontal and temporal lobes of the brain. By identifying the type of dementia a patient has, we can treat the disease more effectively.” A newer test approved last year, called “Amyvid,” detects brain plaque often tied to Alzheimer’s disease. A spinal tap can identify certain proteins in the spinal fluid that can help neurologists determine the type of dementia from which a patient may be suffering. In particular, those with a rapidly progressing form could greatly benefit from immediate treatment for an improved quality of life. According to Dr. Asad, there are other interventions the patient and his or her family can apply to delay the age of onset of dementia, and affect the progression of the disease once it occurs. These include regular exercise, but not just physical. “Brain exercise is equally important,” said Dr. Asad. “This can include an activity as simple as doing crossword puzzles. It’s about stimulating your brain, which can also be accomplished by, for example, learning a new language or how to play a musical instrument. Or by doing anything analytical.” And older individuals at risk for dementia shouldn’t discount preventing the disease by avoiding brain damage that can lead to vascular dementia, caused by multiple strokes within the brain. “Stroke is the No. 3 cause of death and the No. 1 cause of disability, but a lot of people don’t know it can lead to dementia,” said Dr. Asad. “Stroke, and resulting vascular dementia, can be caused by lifestyle and medical issues such as high blood pressure, smoking, high cholesterol and diabetes.”
Brain gamesDementia: Diagnosing can keep seniors New Tools sharp in the Fight for Brain Health
he image on the computer screen shows three people inside a coffee shop, having what sounds like a routine conversation.
A color outline appears when one person is speaking, and they talk about one friend being an expert sandwich-maker, another person they know getting hair extensions and that someone else recently got a puppy. The conversation suddenly stops and a question appears on the screen, asking the user to pick which of the attributes belongs to the friend named Electra. (For the record, it was her knack for making sandwiches). It seems like a game, but it’s becoming an increasingly important therapy in treating older patients for Christopher Rossilli, PsyD, a neuropsychologist with Baptist Behavioral Health. Some older patients are somewhere in the middle between normal, healthy aging and a serious cognitive disorder such as Alzheimer’s or dementia. Traditionally, one option can be putting a patient on medication that can slow down the progression of the illness but not cure it. That medication can have side effects including nausea and diarrhea, which can then limit a person’s activity.
Each assessment with Dr. Rossilli begins with a one-hour clinical interview to become familiar with the patient. The next step is a four-hour session where the patient completes memory, attention and other cognitive tasks. He also interviews the patient’s family members or caregiver to get a sense of the person’s capabilities and emotional state. Once Dr. Rossilli has compiled a full report, including a review of the patient’s medical records, a third
appointment is scheduled to review the results and develop a recommended care plan. “A common reason people schedule an appointment is a patient saying he or she is starting to forget more and more, Dr. Rossilli said. “Oftentimes, the brain scans come back without obvious pathology and clinical tests evaluating the patient’s cognitive function are not indicative of an illness.” The fact that a person is aware that he or she is having some
difficulty is a function measure Dr. Rossilli uses that actually weighs in favor of not having a severe cognitive issue. And those are the patients he says can benefit the most from these brain activities as a supplement to medication. The brain isn’t the only thing people need to take care of. Unhealthy habits, and lifestyle won’t just foster heart issues or high blood pressure or sleep apnea. “Whatever it’s doing to your body,” Dr. Rossilli said, “it’s doing to your brain.”
“The more inactive a person is, the less their neurons are firing, meaning the less their cells are communicating,” Dr. Rossilli said. He is working to promote memory training and exercises to capitalize on the concept of neuronal plasticity. This is critical for older patients who may be hoping to keep living independently and participating in activities they enjoy. Dr. Rossilli recommends that patient’s treatment plan needs to be crafted for that person’s individual needs, but also offers therapy that includes brain games and training can help by stimulating activity in the brain.
Baptist Behavioral Health neuropsychologist Christopher Rossilli, PsyD, walks a patient through a memory exercise.
Summer 2013 • 11
Minimally invasive surgeries improve outcomes for older gynecologic oncology patients
any seniors who see Stephen Buckley, MD, feel that robotic surgery is not an option for them. They feel that their condition or health status does not make them a candidate for such a procedure. However, Dr. Buckley says this group of patients offer some of the best candidates. “The truth is, it’s more advantageous to them than anybody else,” said Dr. Buckley, a Baptist Health gynecologic oncologist. Dr. Buckley says that he frequently has to reassure seniors that robotic surgery is not only safe for them, but may, in fact, be a preferred procedure. He explains that the da Vinci Robotics Surgery System is simply an advanced tool he uses to do laparoscopic surgery. It has facilitated significant advances in laparoscopy that allow him to perform extensive surgery laparoscopically due to its advanced optics and movements. He reassures them that the surgeon controls every movement during the operation. Robotic surgery saves a patient from a large cutaneous incision which typically requires several days of recovery in the hospital and six to eight weeks of potentially painful recovery at home.
Stephen Buckley, MD, performs up to 10 minimally invasive surgeries a week using the da Vinci surgical system.
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Compare that scenario with one of the first robotic procedures Dr. Buckley performed in 2007 on an 88-year-old patient striken with uterine cancer. She stayed one night in the hospital and was able to return to playing bridge with her friends two weeks later. “Robotic surgery reduces the Stephen Buckley, MD number of days recovering in the hospital. It almost eliminates most postoperative complications,” Dr. Buckley said. Convenience is great, but for older patients, the health benefits are even greater. When a patient’s abdomen is sore from a large surgical incision, it is more difficult and painful to breathe deeply and walk normally. These things can increase the risk of pneumonia. According to Dr. Buckley, elderly patients are at the highest risk for contracting pneumonia after surgery. With robotic surgery, which is minimally invasive with small incisions, most elderly patients are able to walk more comfortably and breathe deeply within one day. This greatly reduces pneumonia risk. Seventy percent of the surgeries performed by Dr. Buckley and his partner are minimally invasive. Therefore, most patients and their surgical conditions are candidates for robotic surgery. During a typical week, Dr. Buckley performs as many as 10 minimally invasive surgeries. Following minimally invasive surgery, patients are typically given a prescription for pain medication. Dr. Buckley states that many patients return saying that they did not need it. “Everyone is frightened of surgery,” Dr. Buckley said. “When the recovery is easier and outcome is better than the patient was expecting, it is a tremendous relief for patients and their families.”
In older patients with cancer, sometimes you can’t “just hammer the nail you’re used to hammering”
hen a 20-year-old is diagnosed with cancer, an oncologist’s plan of attack is straightforward: Fight hard to eliminate the cancer.
But what if the person is 80? Cancer treatment in geriatric patients can be far more complicated – especially since cancer is often among a litany of health issues the person has, said Troy Guthrie, MD, a hematologist/oncologist at Baptist Cancer Institute. “It’s really critical to get a big picture of the patient before you just hammer at the nail you’re used to hammering,” Dr. Guthrie said. “You can’t treat an 80-year-old the same way you treat a 20-year-old.” Dr. Guthrie has studied the varying effects cancer chemotherapy has on people as they age and, in otherwise healthy people, found patients over 65 and up to 80 saw positive outcomes from chemotherapy without any more side effects than younger patients would encounter. But once a patient reaches 80, the side effects dramatically increase and often outweigh the benefits, Dr. Guthrie said. The toxicity of chemotherapy can become too much for the body to handle and end up doing as much harm as good. The standard for cancer screening is that the person have a projected life span of at least five years. And once a person gets into their mid-80s, that projection is unlikely. “No matter how healthy you look, your likelihood of living another five years is less than your likelihood of dying within five years in cancer patients above 80,” Dr. Guthrie said. Dr. Guthrie recalls a patient in his early 90s who was diagnosed with acute myelogenous leukemia, a blood malignancy that’s very difficult to treat. Dr. Guthrie told
the patient and his family aggressive treatment would make the man’s life shorter, force him to spend his last days in the hospital and subject him to painful side effects. Instead, Dr. Guthrie and the patient and his family opted to treat the patient with blood transfusions and medication to stimulate his appetite. The man lived four months. “I am certain his quality of life and his quantity of life were better without getting a specific therapy to treat his leukemia,” Dr. Guthrie said. Cancer is seen as inherently fatal in the elderly, and it can be, but in many cases, seniors have heart disease or other issues that will likely take their life before the cancer becomes an issue. “The older a person gets, the quality of their life becomes more important than the quantity,” Dr. Guthrie said. “They want the remaining time to be the best it can possibly be.”
Summer 2013 • 13
Data helps forecast outcomes for cardiac surgery
harles “Don” Cousar, MD, chief of Cardiothoracic Surgery at Baptist Jacksonville, has seen plenty of changes during his 25 years in cardiac and thoracic surgery. But when asked about the biggest change, Dr. Cousar doesn’t hesitate: “Data.” Every anticipated patient risk factor and outcome is now recorded and tracked, which Dr. Cousar said ultimately improves patient care by showing surgeons what worked as intended and what didn’t. To retain certifications, Dr. Cousar and his peers are required to submit data to the Society of Thoracic Surgeons National Database. The database sorts information into the three major subspecialties of thoracic surgery: adult cardiac, general thoracic and congenital heart surgery. There are now more than 4.5 million surgical outcomes housed in the database and 94 percent of cardiac surgery programs in the U.S. participate. On one hand, the numbers make it simple to compare doctor to doctor, hospital to hospital, and even one region of the country to another. That, Dr. Cousar says, is positive for caring for patients and for health care providers looking to refer a patient. Another benefit is the ability to help gauge whether a patient is a candidate for surgery, based on risk factors that include: • Age • Whether the patient has had previous heart surgeries and, if so, how many • If the patient is in heart failure now or has been in heart failure • The degree of lung disease, if any • Whether the patient has renal failure The surgeon can then input these and many other data points that apply to his individual patient and then learn the number of patients contained in the national database with the same risk factors and the likelihood of any
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A national database houses outcomes from more than 4.5 million cardiac surgeries, including the one Charles “Don” Cousar, MD, is performing here. The data is used to help determine whether a patient, given his or her risk factors, is a candidate for surgery.
adverse outcome. These would include predicting the risk for the need for dialysis following the surgery, ventilator dependence, prolonged hospitalization, stroke, death or discharge to a long-term care facility without returning to live at home. The data is by no means a crystal ball for how the individual patient will do – every patient reacts differently. But what it does do is aid a physician’s communication with the patient or his or her family, so they can make an informed, sound decision on how to move forward. “It’s good to be able tell them, ‘There’s this amount of predicted risk’ for different complications that could arise,” Dr. Cousar said. “That way, they will be prepared for that. We hope it doesn’t happen, but we do know there’s often a significant amount of data to suggest it will. Sometimes we know that surgery is simply not advisable and medical treatment is the way to go.” The statistics measure more than just mortality rate, which Dr. Cousar says can be a misleading statistic. “If a patient isn’t going to go home and function at a higher level than they did before,” Dr. Cousar said, “then we haven’t done them any favors.”
Cardiac catheterization services growing in Baptist Health
ollowing the scope expansion of the Cardiac Catheterization Lab at Baptist South to include providing interventional cardiac procedures (which started there in October), Baptist Health recently opened the new Rackley Center for Cardiac and Interventional Radiology at Baptist Medical Center Beaches. The Rackley Center, named for longtime Beaches philanthropists Tom and Cheryl Rackley, opened in April, offering diagnostic heart catheterizations and interventional radiology procedures at Baptist Beaches. Bernardo Utset, MD, who is board-certified in cardiology, interventional cardiology and internal medicine, is medical director of the catheterization lab. “Cardiovascular disease continues to be a leading cause of death among American men and women and claims more lives than all cancers combined,” said Dr. Utset. “Cardiac catheterization is the definitive anatomic assessment of the presence and severity of coronary heart disease, so we are pleased to add this to the other diagnostic tests already available at Baptist Beaches.” On the treatment side, the Interventional Radiology Lab
dramatically increases the services available at Baptist Beaches, said board-certified radiologist and interventional radiologist Steve Shirley, MD, medical director of the lab. “Having the technology to more aggressively attack and treat tumors in this new hybrid lab, along with capability to conduct more extensive procedures to remove clots from arteries and veins, adds to the wide range of vascular services available at Baptist Beaches,” Dr. Shirley said. The Baptist Beaches facility comes about a year-anda-half after the Baptist South facility. Cardiologists at Baptist South needed just nine months to complete the 300 procedures required by the state to start performing coronary artery stenting procedures. Now, Baptist South does 75 procedures a month, 40 percent of which are stenting for angioplasties, said Edward Bisher, MD, an interventional cardiologist at Baptist South and medical director of the Baptist South Catheterization Lab. Historically, patients undergoing diagnostic cardiac catheterization at sites not offering cardiac surgery would be transferred to a tertiary facility for the angioplasty/ stent procedure needed to correct their coronary artery disease, Dr. Bisher said. Now, patients undergoing cardiac catheterization at Baptist South can undergo the most advanced interventional cardiology procedures in a safe and effective environment at their local hospital. “This allows expansion of not only the clinical practice of cardiology, but remarkable improvements in the quality of life and convenience for the area served by Baptist South,” Dr. Bisher said. Services at Baptist South also expanded in May to treat patients suffering active heart attacks. With the expansion of these services to Baptist Beaches, Baptist Health will continue to be the leader in comprehensive cardiovascular care in Northeast Florida.
Bernardo Utset, MD, medical director of the Catheterization Lab, and Steve Shirley, MD, medical director of the Interventaional Radiology Lab
Summer 2013 • 15
In patients with diabetes, a HgbA1C of 7 percent or less is optimal but does it always make sense in seniors?
linical guidelines and standards are in place for a reason. There are evolving bodies of evidence derived from research used to craft the guidelines, and they are constantly being re-evaluated. For patients with diabetes, one of the most important parameters is a patient’s hemoglobin A1C, which relates to a person’s average blood sugar level over the course of three months. A normal level is between 4 and 5.6 percent, with anything higher than 6.4 percent suggesting a person has diabetes. All evidence-based clinical standards recommend that diabetic patients maintain a level below 7 percent, said Leslie Salomone, MD, a Baptist Health Leslie Salomone, MD endocrinologist who practices in Mandarin and at Baptist South. Anything higher on a chronic level can increase the risk of blindness, lower-extremity amputation and kidney failure, Dr. Salomone said. Yet, there comes a point with some senior patients that the A1C number is no longer the definitive sign of success. “Some guidelines are more applicable to people who will be living with the disease for much longer,” Dr. Salomone said. “We need to first do no harm in achieving that goal.” She uses the example of a person in his 80s who is just diagnosed with mild diabetes. The likelihood of diabetes causing this person to lose his sight or an extremity is very low because he will likely not live as long with the disease. So rather than add another medicine to the several the
16 • Summer 2013
patient is likely taking, it may be best to focus on diet and lifestyle – important for people of all ages with diabetes. While the available diabetes medications have improved tremendously over the years, many may be associated with undesirable side effects, especially in patient who has underlying kidney disease or heart disease or history of stroke, Dr. Salomone noted.
Balancing blood sugar is a challenge and while the focus is generally on keeping it low, having it too low presents its own set of problems. And older patients are more likely to be on multiple medications, which can mask the symptoms of low blood sugar (which include sweating, rapid heart rate and feeling dizzy or uneasy). The key in older patients is assessing the severity of the diabetes and whether or not it is causing symptoms and complications and/or limiting their activity or quality of life, said Dr. Salomone. It is also important to determine how aggressive a patient wants to be with his or her diabetes regimen and also establish goals for that individual, taking into consideration life expectancy and other co-morbid conditions. From there, a treatment plan can be developed. That plan may or may not include medication. The balance, Dr. Salomone said, is weighing the potential benefit to the patient versus the risk of causing harm.
s health care moves more toward coordinating care through various providers, the Patient-Centered Medical Home model is gaining traction with patients and among industry leaders. Two dozen Baptist Primary Care clinics have already earned the Patient-Centered Medical Home recognition from the National Committee for Quality Assurance. The Medical Home model provides patients easier access to care and is ideal for people working to manage chronic diseases such as diabetes and high blood pressure. The focus is on preventative care and working with patients on creating a healthy lifestyle. The primary care physician leads the patient’s healthcare team, directing the patient to various specialists based on the person’s individual needs. This model of care is ideal for seniors, who are often managing several chronic illnesses and are being prescribed various medications that need to be monitored. “This form of care really makes sense for patients, especially when a patient has multiple conditions that they as patients and we as physicians need to stay on top of,” said Adam Dimitrov, MD, a Ponte Vedra Beach family practice physician and chair of the Baptist Health PatientCentered Medical Home Task Force. The Medical Home practices, of which there are currently 24 in the Baptist Health system, focus on building an
even stronger relationship between the medical office and the patient. Patients have access to test results before their appointment and are reminded of various tests that need to be completed in advance. That allows time with the physician to be spent on medical issues and answering questions – not more mundane items.
Pati en t
Patient-Centered Medical Home ideal for older patients
ered Medi ent ca -C
Adam Dimitrov, MD
The Medical Home model also encourages teamwork and staff members carry greater responsibilties for patient care, from the medical assistants to the nurse practitioners. Coordination of care is the key, and it must happen at the primary-care level. “Medical care right now is too uncoordinated and disjointed,” said Dr. Dimitrov. “Patients and their families are often left to advocate for their own health and it shouldn’t be that way.” “Medical care is too complex these days for the doctor to do it all alone,” Dr. Dimitrov said. “You have to have a team to share the responsibilities, which ultimately leads to better outcomes, coordination and satisfaction for the patient.” Summer 2013 • 17
Joint revision safer and more effective than ever
ore than 1 million Americans have a hip or knee replacement surgery every year. Joint replacement is one of medicine’s greatest success stories, and after such surgery, nine out of 10 people can walk and do other normal activities without pain.
William Pujadas, MD
“Now, we can perform the surgery using minimally invasive techniques, reducing scarring and speeding recovery,” said William Pujadas, MD, an orthopaedic surgeon with Jacksonville Orthopaedic Institute, affiliated with Baptist Health. “The implants are better, the ways we fix them in place are improved, and there are exciting developments coming down the pike that will help the replaced joint last longer.” However, with more wear and tear on joints caused by obesity, and on the flip side, more active lifestyles among middle-aged and senior adults, orthopaedic surgeons are seeing an increase in the number of patients requiring joint revision surgery. Dr. Pujadas says current hip and knee replacements should last 10-20 years in the majority of patients. “However, some patients will eventually require revision because of loosening of the implant, a fracture, wear and tear on parts of the artificial joint that lead to osteolysis (damage to bone surrounding the implant), instability of the joint, or infection,” he said. Patients who have had joint replacement surgery should be examined annually by their orthopaedic surgeon, even if there are no problems. If the patient is experiencing pain, stiffness or discomfort at the site of their joint replacement, he or she should be seen sooner. “A number of factors go into determining if revision surgery is the right choice for a patient,” said Dr. Pujadas. 18 • Summer 2013
“Any time you have to do surgery on the same joint, there is a higher risk of complications compared to the first surgery; however, the majority of the time, patients can expect a good outcome.” Recovery from a revision depends on why the surgery is needed in the first place, whether it’s a relatively simple replacement of a bearing or plastic, or replacement of the entire joint. Most patients go home within two days of revision surgery, and some will go home the next day. All patients will begin physical therapy in the hospital, often within 24 hours of surgery, which they may continue for up to three months at home or at a rehabilitation facility. This therapy, and the use of assistive devices to protect the joint for a period of time, will make a significant impact on the success of the patient’s joint revision. “Like joint replacement, revision surgery can give patients a new lease on life,” said Dr. Pujadas. “It can offer them many more active years and a return to most, if not all, of their normal activities.”
Baptist Beaches: Pilates reformer
targets muscle groups for seniors in physical therapy
ost often, rehabilitation is thought of as a medical necessity in recovering from a specific injury or illness.
Pilates is especially effective in patients with spinal pain, balance issues, pelvic floor dysfunction/incontinence and musculoskeletal issues, Jordan noted. The rise in popularity of Pilates in recent years increases the likelihood that seniors can find a class or studio to continue using the exercise techniques, once rehabilitation is complete. “Patients are really able to improve their posture and balance with these exercises,” Jordan commented. “Overall, we see more effective outcomes than in basic exercises where you’re working one muscle group at a time.”
But for seniors, rehabilitation can be a way to maintain and strengthen muscles that have weakened and caused functional issues as people age. In older women, common problems that may need to be addressed are urinary issues and pelvic floor dysfunction, according to Jenna Jordan, a physical therapist and manager of Rehabilitation Services at Baptist Beaches. For seniors in particular, physical therapists focus on lower-impact exercises that can achieve the desired benefit without putting unnecessary stress on the joints, Jordan said. That puts Pilates at the top of the list because the exercises can simultaneously work on both strength and flexibility, and target specific muscle groups – often the pelvic floor and lower back in senior women. At Baptist Beaches, patients can further pinpoint areas for improvement with the Pilates Reformer machine that was purchased by the hospital last year. The machine is a flat board elevated about a foot off the ground with pulleys attached to provide resistance or assistance, depending on the exercise. Using the reformer, the physical therapist can easily modify exercises to fit the patient and adapt to the person’s individual capabilities and needs. “We can do stabilization-type exercises and recruit muscle groups that are in different parts of the body,” Jordan said. The result is more of a full-body workout, though still individualized for the patient. Instead of working just one muscle group, the Pilates Reformer engages several parts of the body simultaneously to strengthen targeted areas.
JOI surgeon honored
evin Kaplan, MD, an orthopaedic surgeon with Jacksonville Orthopaedic Institute, was named one of the “40 Under 40” by the Jacksonville Business Journal.
The weekly newspaper annually recognizes 40 Kevin Kaplan, MD professionals under the age of 40 who are seen as “up and comers” in their line of work. Dr. Kaplan, a fellowship-trained sports medicine specialist and a team physician for the Jacksonville Jaguars, was honored at an April luncheon. Dr. Kaplan joined JOI in 2009 and is also head team physician for the Arena Football League’s Jacksonville Sharks. He volunteers as a physician for local colleges and high schools and was honorary chair of the Arthritis Foundation’s annual walk in 2012. Dr. Kaplan earned his medical degree from New York University School of Medicine. He completed his residency at New York University Hospital for Joint Diseases and his orthopaedic sports medicine fellowship at Kerlan-Jobe Orthopaedic Clinic in Los Angeles.
Summer 2013 • 19
Baptist Connect rollout begins
Will allow hospital and Baptist Primary Care records to be seen together
he fields have been populating for months now. Every patient encounter from a Baptist Health hospital or a Baptist Primary Care clinic using an electronic record is being tracked in a database that will continue to build now that Baptist Connect has launched.
Between various physicians and practice groups now under the Baptist Health umbrella, there are as many as eight different EMR/EHR systems in use. Getting them to talk to each other is a challenge, but something Dr. Penrod says is in the works.
The incorporation of the new technology is accomplished through merging Continuity of Care Documents (CCD) from these sources into a unified view and represents Baptist Health’s next step in fully integrating Electronic Medical and Health Records (EMR/EHR) across the care continuum to enhance the patient care experience.
Time is valuable, and time spent logging in and out of various systems is time that could be better spent with the
Currently, Baptist Health hospitals are on one medical record platform and most of the Baptist Primary Care offices use another, said Louis Penrod, MD, chief medical information officer for Baptist Health. The Louis Penrod, MD documents don’t integrate and physicians now have to log into each of the separate systems to view records in the different systems. When Baptist Connect launched this spring, starting in the Emergency Departments of all Baptist hospitals, the physician gained access to the records accumulated since January – primary care and hospital – in one format to review. “This is the start of connecting them together,” Dr. Penrod said. “This allows the physician to see a more global picture of what the health history of the patient is.” Baptist Connect will soon be expanded to Baptist Primary Care. If a patient is admitted to any of the Baptist Health hospitals, the record will be viewable from within the ambulatory practice medical record, according to Dr. Penrod.
20 • Summer 2013
patient. Moreover, the concept is tying different providers together and giving them access to information to allow them to communicate easily and more thoroughly with patients and their families. “This will significantly improve communication and the flow of information to care for our patients more effectively,” according to Dr. Penrod.
Baptist Health Foundation Notes Allaire joins Baptist Health Foundation
n March 25, Baptist Health welcomed Pierre Allaire, PhD, as vice president of Baptist Health and chief development officer of Baptist Health Foundation. Pierre was formerly vice president for Institutional Advancement and executive director of the UNF Foundation at the University of North Florida. “Pierre is an incredible cultural fit with Baptist Health, and he exemplifies the leadership qualities that are so critical for this position,” President and CEO Hugh Greene said. “He is passionate about what he does, and about joining a faith-based, mission-driven Pierre Allaire, PhD organization and taking on a new set of opportunities. I consider Pierre to be the most widely respected fundraiser in Northeast Florida, and we are fortunate to have his depth and breadth of expertise.” In addition to his expertise, Pierre has an extensive record of involvement in Jacksonville’s philanthropic and business communities. He starts his term as president of the Jacksonville Rotary Club in July 2014, and he has chaired the club’s International Service Committee. He has previously served on the boards of the Museum of Contemporary Art of Jacksonville and the Jacksonville Zoo and Gardens. He was also a trustee of the JAXUSA Partnership, a division of JAX Chamber. “My welcome and first months at Baptist Health have been wonderful, and I’m looking forward to working with our physicians, health system leaders, board members and patients to maximize philanthropic support for our organization and the community’s health care,” Allaire said. Pierre earned his bachelor of science degree from St. Edward’s University in Austin, Texas; his master’s degree in biology from Stephen F. Austin State University in Nacogdoches, Texas; and his doctorate in biology from the University of Louisville in Kentucky.
The new Rackley Center for Cardiac and Interventional Radiology is named for philanthropists Tom and Cheryl Rackley.
Physicians inspire philanthropy at Baptist Medical Center Beaches An important step forward for heart disease services at Baptist Health, the opening of the Rackley Center for Cardiac and Interventional Radiology at Baptist Medical Center Beaches (see related story on page 15) is also a powerful example of philanthropy’s connection to the services that physicians provide every day. Baptist Beaches patients Tom and Cheryl Rackley made the naming gift for the center because they have experienced the benefits of cardiac catheterization, and they wanted to make it easier for Beaches residents to receive the procedure and other related services. They also have a strong relationship with their cardiologist, Pamela Rama, MD, and they discussed the center’s impact with her before they made their gift, the largest single donation ever made to Baptist Beaches. “It was such a wonderful experience to see the Rackley Center open and to see what it meant to Tom and Cheryl,” said Dr. Rama, the immediate past chief of staff at Baptist Beaches. “And the best is still to come. The convenience and services in the Rackley Center will help patients throughout the Beaches community and make it easier to provide them with the highest-quality care.”
Summer 2013 • 21
Physicians recognized with
Spirit of Magnet award
agnet™ designation is thought of by some to be a nursing recognition. But, at Baptist Health, it’s a philosophy engrained in our mission. It takes every member of the care team to deliver on Magnet expectations in each patient encounter. It applies to the whole health system — and is especially beneficial if the physicians are collaborative, according to Diane Raines, MSN, RN, NEA-BC, senior vice president and chief nursing officer for Baptist Health. “It makes the difference between something you say you are and something you are,” Raines said. Studies show that Magnet hospitals provide better patient outcomes, including lower mortality rates, and higher
patient satisfaction than hospitals without this distinction. Baptist Health was first recognized as a Magnet health system in 2007 and, through continuous improvements and documentation of positive outcomes, was redesignated in 2012. Magnet Physician Champions embody the traits the designation is built on – education, professional development and collaboration to improve patient care. More than 150 nominations were received this year.
Congratulations to the 2013 physician champions listed below:
Baptist Jacksonville: Charles (Don) Cousar, MD Cardiovascular and Thoracic Surgeon
Baptist Nassau: Timothy Lucey, DO Neurologist
“He excels at sharing knowledge with his patients, their families and friends. He is extremely patient teaching the patient and their families about open heart procedures and post-operative care. He puts his heart and soul into his craft. He has actually brought a patient’s daughter to the operating room to talk to her confused father to help make the decision for the better surgery outcome, in choosing the correct valve for him.”
“He embodies the characteristics of a professional that is passionate about his patients, practice and the hospital staff. Dr. Lucey is a champion of interdisciplinary collaboration and teaching. He encourages nurses, physical therapists and other members of the care team to round with him. He takes every opportunity to educate nurses and patients regarding disease process. Dr. Lucey takes the opportunity to explain the rationale of the treatment plan and disease process.”
“Many times, Dr. Cousar makes himself available to cardiologists in the catheterization lab during a heart catheterization in order to provide immediate consultation for the patient’s best interests and to best facilitate the needs of the cardiologists.”
22 • Summer Spring 2012 2013
“He is always available for professional collaboration. His bedside manner is one of the best I have seen and I have been nursing for 40 years. He gives the patient a layout of what their situation is now, and what they may be experiencing later with their stroke process.”
Baptist Beaches: Alison Bartfield, MD Internist, Hospitalist “Dr. Bartfield exemplifies the characteristics of a collaborative partner. She is not only a competent physician but also a compassionate and caring person. She works collaboratively with the nurses, physicians and other healthcare team members to assure a positive outcome on all patients. She is an example of an ultimate patient advocate.” “Dr. Bartfield attends the nursing staff meeting regularly to share her knowledge and teach the nurses about sepsis, pain management, etc. Her focus is on patient safety and satisfaction. She is also a nurse advocate. She is always willing to help the nurses and answer their questions at any given time.”
Baptist South: Richard Picerno, MD Orthopaedic Surgeon, Chief of Staff “Dr. Picerno elicits a true compassion for his patients, is an excellent surgeon who treats his co-workers and staff with the utmost respect and consistently maintains a calm demeanor. I witness his collaboration with nursing on a continual basis. He is generous with his time in educating staff, taking a weekend to speak and spend time at an OR retreat. He strives to encourage the medical staff to comply with hospital policies, by-laws and rules and regulations. He has been a tremendous support in regards to EMR and holding physicians accountable to expectations.”
Wolfson Children’s Hospital: Anthony Pohlgeers, MD Pediatric Emergency Medicine Specialist, Chief of Staff “Dr. Pohlgeers is well-liked by the nursing and respiratory staff and is viewed as a team player, a teacher, and a compassionate physician. Dr. Pohlgeers has worked with other physician teams in Wolfson Children’s Hospital to improve
quality care for our patients. He also writes notes to the leadership group when he feels the team came together and provided outstanding care during crisis situations, mentioning names of staff involved. The nursing team is uplifted when facing a busy day, and they see they will be working with Dr. Polhgeers. He stays calm and maintains a sense of humor that fosters a sense of camaraderie and unity among the team.”
Baptist Home Health Care: Joy Anderson, DPM Podiatrist “Dr. Anderson is always willing to speak with me personally when I call with questions or requesting orders. If she is with a patient when I call, she will call me back with an answer, or have the nurse in her office tell me so I will have the answer right away. She shows concern for her patients and always asks how their wounds are looking. She works late at the office to return calls or get things done for her patients. She uses Wound Vacs often, and even changes the dressings herself when patients come in for appointments, so their healing process is not interrupted.”
Baptist Primary Care: Darlene Bartilucci, MD Family physician “Dr. Bartilucci works together with other providers in order to give the best care to her patients. Dr. Bartilucci is a very kind and compassionate doctor, she has both cried and laughed with her patients and her staff and has made her patients and staff feel as if they were part of her family. She is never too busy to teach you something.” “Dr. Bartilucci is fully involved in the patient’s care. Not only does she refer patients to the specialty provider needed, but she tries to match the patient with the right provider for his or her medical needs and personality. She will personally contact the specialist for updates on the patient and has even visited patients while in the hospital.”
Summer 2013 • 23
New Emergency Center opens, physicians start moving in to Baptist Clay Medical Campus
aptist Health moved into a new area with a new concept this past spring, opening Baptist Clay Medical Campus on Fleming Island.
One of the cornerstones of the new 32-acre campus is Baptist/Wolfson Children’s Emergency Center, a freestanding emergency room that began operations May 1 and is open 24-hours, 365 days a year, for children and adults. The 26,000-square-foot emergency center has separate waiting and treatment areas for adults and children, bringing Clay County families access to emergency physicians who are specially trained in pediatric care. Baptist Clay Medical Campus is located on 32 acres at U.S. 17 and Village Square Parkway with robust room to grow with the community. “Our vision is for this to be the place for the very best children’s health care in Clay County. This campus will deliver many of the specialized children’s and adult capabilities that you’d expect at a hospital, with the convenience of an outpatient setting,” said Ron Robinson, Baptist Medical Center South president. Robinson provides administrative leadership for the Baptist Clay Medical Campus. The campus also includes a three-story medical office building with various physicians’ offices. Baptist Heart Specialists opened in May and other practices, including Baptist Primary Care, BorlandGroover Clinic and Orange Park Pediatrics are opening this summer. The Wolfson Children’s Specialty Center will open in
24 • Summer 2013
September, bringing pediatric orthopedics, cardiology, occupational therapy and other specialties with partners from Nemours Children’s Clinic, Jacksonville and the University of Florida College of Medicine-Jacksonville. The Baptist Emergency Center is open 24 hours a day. The center is staffed at all times by a board-certified emergency medicine physician. Pediatric emergency medicine physicians affiliated with Wolfson Children’s Hospital, along with pediatric subspecialists with Nemours Children’s Clinic, Jacksonville, and the University of Florida College of Medicine—Jacksonville, will be available at the new campus for children of all ages. The campus also includes Baptist Diagnostics and Imaging at Clay, featuring the latest digital equipment for X-ray, MRI, CT, mammography, bone density and ultrasound testing. Children’s images are evaluated by pediatric radiologists from Nemours Children’s Clinic.
Physicans began moving into the medical office building on the Baptist Clay Medical Campus in May.
State-of-the-art Weaver Tower open
he 11-story J. Wayne and Delores Barr Weaver Tower opened in December, boasting 167 private rooms for adult and pediatric patients.
The $200-million building features state-of-the-art neurosurgical suites with advanced intra-operative imaging capabilities, and includes neurosurgical suites for both adult and pediatric patients on the second floor. The tower includes a new pediatric behavioral health unit thatâ€™s expanding with the generous $10 million endowment from J. Wayne and Delores Barr Weaver, the largest single gift in the history of Baptist Health. The Baptist Neuroscience Institute is located in the new tower with expanded services from neurologists and neurosurgeons, along with four floors dedicated to the care of neuroscience patients. New pediatric and adult oncology units are equipped with spacious rooms to accommodate family members and streamlined laminar flow capabilities â€“ the ideal environment to care for immunocompromised patients who have received intensive chemotherapy.
26 â€˘ Summer 2013
Two new pediatric neurosurgeons join Wolfson Children’s Hospital
olfson Children’s Hospital recently welcomed two new physicians. Alexandra D. Beier, DO, specializes in epilepsy surgery, spinal dysraphism, hydrocephalus and central nervous system tumors. Nathan J. Ranalli, MD, specializes in brain and spinal cord tumors, epilepsy surgery, spasticity and minimally invasive craniosynostosis surgery. The Lucy Gooding Children’s Neurosurgery Center affiliated with Wolfson Children’s Hospital offers a comprehensive range of children’s neurosurgical services, ranging from surgical treatment of epilepsy, brain tumors, brachial plexus palsy, spasticity, and traumatic brain and spine injuries. Dr. Beier and Dr. Ranalli are on the faculty of the University of Florida College of Medicine–Jacksonville, practicing on the Wolfson Children’s Alexandra D. Beier, DO Hospital medical staff.
Become a We Care volunteer
27 • Spring 2013
Beier received her medical degree from Midwestern University, Chicago College of Osteopathic Medicine, and completed her Neurosurgery residency at Michigan State University. She completed her fellowship in Pediatric Neurosurgery at The Hospital for Sick Children (University of Toronto) in Toronto, Canada. Ranalli received a Bachelor of Arts degree in Neuroscience from The Johns Hopkins University and his medical degree from the University of Pennsylvania School of Medicine. He completed a General Surgery internship, followed by a Neurological Nathan J. Ranalli, MD Surgery residency at The Hospital of The University of Pennsylvania. He completed his fellowship in Pediatric Neurological Surgery at St. Louis Children’s Hospital (Washington University School of Medicine).
he We Care Jacksonville Health Network is now recruiting doctors and dentists to join more than 750 of your peers who currently volunteer to address the medical needs of uninsured Duval County residents. Most primary care is given in one of the 12 free clinics, while most specialists see patients in their own offices or in the hospital. By signing up to see just eight patients per year, you help people who are truly grateful and you obtain sovereign immunity for yourself, your partners and your practice when caring for We Care patients. It is important to consider signing up because, even if you cannot see a patient in a clinic or your office, it is valuable to have sovereign immunity should you see a We Care patient as a hospital consultant. To register, contact Executive Director Sue Nussbaum, MD, at 904.206.0611.
Summer 2013 • 27
New Baptist Health Medical Staff Members
NONPROFIT ORG. U.S. POSTAGE
800 Prudential Drive Jacksonville, FL 32207
PAID JACKSONVILLE, FL PERMIT NO. 3693
(March 2012 to March 2013) Baptist Medical Center Jacksonville
Joann Acuna, MD, Maternal and Fetal Medicine (S) Lielanie M. Aguilar, MD, Psychiatry (S) Junaid A. Ahmed, MD, Cardiology Evan D. Allen, MD, Teleneurology Nicole S. Anderson, MD, Radiation Oncology (B, S, W) Catherine Bagley, DO, Obstetrics and Gynecology Jessica N. Bahari-Kashani, MD, Radiation Oncology (B, S, W) Regina Bielawski, MD, Internal Medicine David A. Boyd, MD, Dermatology (S, W) Dustin H. Brimblecom, MD, Emergency Medicine (S, B) Robert G. Brown, MD, Dermatology (S) Christina M. Burch, MD, Teleradiology Jing-Jing Cardona, MD, Family Medicine Fadi R. Chalhoub, MD, Internal Medicine Hospitalist (B, S) Scott H. Chandler, MD, Teleradiology (S) Lara D. Church, MD, Family Medicine (S) Lori A. Cibik, MD, Emergency Medicine (B, N, S) Sarah S. Darbandi, MD, Ophthalmology (S, W) Leonard D. DaSilva, MD, Teleneurology Leslie A. Davis-Singletary, MD, Internal Medicine Hospitalist (S) Francis X. DeCandis, MD, Family Medicine Andrea E. DeNeen, MD, Cardiology (S) Apeksha D. Desai, MD, Internal Medicine Hospitalist (S) Hamma A. Diallo, MD, Emergency Medicine (FastTrack) (S) William L. Effinger, DO, Family Medicine Hospitalist Chinenye O. Ezedike, MD, Family Medicine (S) Justin R. Federico, DO, Internal Medicine Hospitalist (B, N, S) Nura Festic, MD, Family Medicine (S) Andrea M. Fritschle, MD, Psychiatry (B, S) Mason C. Gasper, DO, Teleneurology Josep Genebriera DeLamo, MD, Dermatology (S) Christina Gindele, MD, Emergency Medicine (B, N, S) Erika D. Glas, DO, Obstetrics and Gynecology Peter F. Gloersen, MD, Pediatric Anesthesiology (W) Eugene R. Griffin, III, MD, Family Medicine Hospitalist Reginald L. Griffin, MD, General Surgery (S) Jennifer N. Guram Porter, MD, Obstetrics and Gynecology Nadine Harris, MD, Internal Medicine Hospitalist (S) Saiyid A. Hasan, MD, Ophthalmology (B, S) Syed S. Hassan, MD, Internal Medicine Hospitalist (B, S) Melissa K. Hill, MD, Emergency Medicine (B, S) Jason G. Ho, MD, Pediatric Cardiology (W) David A. Holloman, MD, Pathology (B, N, S, W) Zhigao Huang, MD, Neurology Karen A. Hubbard, DDS, Pediatric Dentistry (W) David M. Imbt, MD, Emergency Medicine (B, S) Samuel P. Jacks, MD, Cardiothoracic Surgery (S) Saundra A. Jackson, MD, Emergency Medicine (B, N, S) Larry S. Janoff, DO, Teleneurology Amy Jarvis, MD, Neurology (S) Dhiraj R. Jeyanandarajan, MD, Teleneurology (S) Takaya L. Jones, MD, Family Medicine Hospitalist (S) Arun Kachroo, MD, Teleneurology Lalit Kanaparthi, MD, Pulmonary Diseases, Critical Care Medicine (B, S)
Arezo J. Karmand, MD, Internal Medicine Hospitalist (S) Michael J. Katsnelson, MD, Teleneurology Fawad Khawaja, MD, Cardiothoracic Surgery (S) Howard L. Kim, MD, Teleneurology (S) Craig A. Kornick, MD, Pain Medicine (S) Semaan G. Kosseifi, MD, Pulmonary Diseases (B, N, S) Stephen S. Kramarich, MD, Pain Medicine (S) Susan H. Krieger, MD, Palliative Medicine, General Pediatrics (W) Prasanth Krish, MD, Nephrology (B, S) Paresh Lalcheta, MD, Internal Medicine Hospitalist (S) Loren Leshan, MD, Family Medicine Hospitalist (B, S) Gregory M. Lewis, MD, Ophthalmology Catherine E. Lindsay, MD, Family Medicine Heather M. Linn, MD, Teleneurology Benjamin J. Ludwig, MD, Radiology (B, N, S) Reuben K. Maggard, MD, Nephrology (B, S) Steven A. Mantegari, DDS, Oral & Maxillofacial Surgery (B, S, W) Andrew D. McBride, MD, Radiology (B, N, S, W) Charles Milton, DDS, MD, Oral & Maxillofacial Surgery (S, W) Raghavendra Mishra, MD, Internal Medicine Hospitalist (S) Ali Moghani Lankarani, MD, Gastroenterology Bashar A. Mohsen, MD, Neurology Thomas Moon, Jr., MD, Pediatric Cardiology (W) Muhammad Munir, MD, Teleneurology Simone Nader, MD, Cardiology (N, S) Brieanna J. Nation-Howard, DO, Palliative Medicine (S) Daniela L. Neagu, MD, Pediatric Cardiology (W) Nikhil D. Nihalani, MD, Psychiatry Gustavo A. Ortiz, MD, Teleneurology Jonathan I. Orwitz, MD, Teleneurology Omeni N. Osian, MD, Cardiothoracic Surgery (S) Eduardo Oyola Torres, MD, Radiology (B, N, S) Niraj H. Pahlajani, MD, Radiation Oncology (B, S, W) Soe Paing, MD, Internal Medicine Hospitalist (S) Ravi U. Pande, MD, Neurology (S) Ronak A. Patel, DO, Pain Medicine (S) Cherie Perales, DO, Obstetrics and Gynecology (S) Eric D. Pinnar, MD, General Surgery (B) Iulia R. Platte, MD, Internal Medicine (S) Marcela I. Pop, MD, Internal Medicine Hospitalist (B, S) Kiersten L. Prince, DO, Family Medicine Juliana Raymaker, MD, Family Medicine (S) Francois R. Roche, MD, Internal Medicine Hospitalist (S) Gerson Rodriguez-Baez, MD, Internal Medicine Hospitalist (B, S) Christopher M. Rossilli, PsyD, Psychology (S) Saswata Roy, MD, Pediatric Otolaryngology Mitchell J. Rubin, MD, Teleneurology Jamal S. Salameh, MD, Nephrology (B, N, S) Leslie J. Salomone, MD, Endocrinology (S) Todd L. Samuels, MD, Teleneurology Marisol S. Sanchez-Lance, DO, Family Medicine Aristides A. Sastre, MD, Family Medicine (S) Jean-Raphael Schneider, MD, Teleneurology Jeffrey A. Schoen, DPM, Podiatry (B, S) Hillard C. Sharf, MD, Teleneurology Sunil K. Sharma, MD, General Surgery (W) Andrew R. Simonsen, DO, Pediatric Otolaryngology (S, W)
Harpreet Singh, MD, Emergency Medicine (FastTrack) (B, S, W) Flavio M. Soares, DDS, Pediatric Dentistry Terrence L. Soldo, DO, Family Medicine (W) Jason A. Soriano, MD, Teleneurology (S) Bakkiam Subbiah, MD, Neurology (B, S) Ali Tutar, MD, Cardiology (S) Carlos E. Villar, MD, Teleneurology Gonzalo A. Wallis, MD, Pediatric Cardiology (W) Benjamin W. Webster, MD, Emergency Medicine (B, N, S) Nikita L. Wilkes, MD, Obstetrics and Gynecology (S) Michal J. Wolski, MD, Radiation Oncology (B, S, W) Tahir M. Yunus, MD, Internal Medicine Hospitalist (B, N, S) Steven M. Zak, MD, Teleneurology (S) Allen C. Zechowy, MD, Teleneurology
Baptist Medical Center Beaches
Kristin B. Caldow, MD, Obstetrics and Gynecology Shawn Chopra, MD, Internal Medicine Hospitalist Rachel A. Cook, MD, Anesthesiology Amalie F. Eid, MD, Gastroenterology Shilpa Goli, MD, Internal Medicine Hospitalist John D. Grigas, MD, Pulmonary Diseases (N) Zhen Hou, MD, Hematology/Oncology Jose F. Jimenez, MD, Anesthesiology (N) Rahul K. Kakkar, MD, Pulmonary Diseases Angelika Kharrazi, MD, Family Medicine Hospitalist, Emergency Medicine (FastTrack) Christopher W. Lipari, MD, Reproductive Endocrinology Bruce D. Lipsius, MD, Teleneurology Rajesh Mali, MD, Internal Medicine Hospitalist Hilaree B. Milliron, DPM, Podiatry Diwakar Nagula, DO, Pain Medicine Andrew M. Namen, MD, Pulmonary Diseases (N) Peter A. Nassar, MD, Pulmonary Diseases, Sleep Medicine Richard Reid, MD, Pulmonary Diseases (N) Brent E. Seibel, MD, Obstetrics and Gynecology Daniel S. Selbst, DPM, Podiatry (S) Mona J. Shah, MD, Cardiology Khawar M. Shaikh, MD, Cardiology (S) Mohammed Touheed, MD, Internal Medicine Hospitalist
Baptist Medical Center Nassau
Joseph A. Lonzetta, DO, Internal Medicine Hospitalist Venkata S. Sagi, MD, Cardiology Sunny Sandhu, MD, Pain Medicine William R. Vickers, MD, Ophthalmology George R. Woodward, DO, Emergency Medicine
Baptist Medical Center South Lauren W. Averill, MD, Pediatric Teleradiology (W) Steven L. Blumer, MD, Pediatric Teleradiology (W) Kerry A. Bron, MD, Pediatric Teleradiology (W) Harry J. Dâ€™Agostino, Jr., MD, Pediatric Cardiothoracic Surgery Stephen M. Meritt, DPM, Podiatry Deborah A. Rabinowitz, MD, Pediatric Teleradiology (W) Tessa M. Ricci, MD, Family Medicine Kerry V. Rifkin, MD, General Surgery Monica J. Sestopal Epelman, MD, Pediatric Teleneurology (W) Andrea Shah, MD, General Pediatrics (W) Chetan C. Shah, MD, Pediatric Radiology (W) Frank Trogolo, MD, Obstetrics and Gynecology
Wolfson Childrenâ€™s Hospital
Geoffrey A. Agrons, MD, Pediatric Teleradiology Alexandra D. Beier, DO, Pediatric Neurosurgery Ashley G. Bennett, MD, General Pediatrics Julie A. Bradley, MD, Radiation Oncology Amy E. Burns, MD, Pediatric Anesthesiology Anna Chong, MD, General Pediatrics Shamsur R. Chowdhury, MD, Pediatric Critical Care David Dinan, MD, Pediatric Teleradiology (S) Lane F. Donnelly, MD, Pediatric Teleradiology (S) Kurtis W. Dotson, MD, Pediatric Emergency Medicine Gohalem Felema, MD, Pediatric Anesthesiology Mark S. Finkelstein, DO, Pediatric Teleradiology (S) Sharon W. Gould, MD, Pediatric Teleradiology (S) Leslie E. Grissom, MD, Pediatric Teleradiology (S) Carolina V. Guimaraes, MD, Pediatric Teleradiology (S) Grace W. Guo, MD, Pediatric Teleradiology (S) Hans-David R. Hartwig, MD, Pediatric Teleradiology Mary P. Harty, MD, Pediatric Teleradiology (S) Craig M. Johnson, DO, Pediatric Teleradiology (S) Sassan Keshavarzi, MD, Neurosurgery Bevan P. Londergan, MD, Pediatric Anesthesiology Nathan J. Ranalli, MD, Pediatric Neurosurgery Gauravi K. Sabharwal, MD, Pediatric Teleradiology Asma N. Salahuddin, MD, General Pediatrics-Hospitalist Courtney E. Sherman, MD, Pediatric Orthopaedic Surgery Robert V. Weaver, DMD, Pediatric Dentistry
(B) Also on the Baptist Beaches medical staff (N) Also on the Baptist Nassau medical staff (S) Also on the Baptist South medical staff (W) Also on the Wolfson medical staff