APRIL EDITION, VOLUME 2018, NO. 4
EARLY DETECTION CAN SAVE MORE THAN THE PATIENT By Pam Irwin, CMS Executive Director March was National Colorectal Cancer Awareness Month. Colon cancer doesn’t care how old you are. Colorectal cancer affects young and old and is intertwined in my own personal story. Colon cancer essentially changed my family forever and has taken the lives of two of my dear friends. This is my story. In 1967, my Mother was diagnosed with Stage 3 colon cancer during emergency exploratory surgery. She had been ill for months and in severe pain. My Dad was in the Air Force, and we were stationed at Ramstein AFB in Germany. I know now that they had recommended a colonoscopy, but she didn’t want to have it. That decision haunts me; this could have ended differently. I remember listening to her crying out in pain from my bedroom and multiple trips to the ER. I remember feeling helpless as a child to relieve her pain. By the time they operated, the tumor had perforated her colon. Her biggest fear was that she would have to have a colostomy for life. That didn’t happen. My biggest fear was that I would lose my mother. As a sixth grader, I remember believing my mother would die. I had nightmares about it. Due to a raging infection, she was placed in isolation. I didn’t see her for three weeks. We “lived” at Landstuhl Army Hospital after school each day while my Dad was trying to work, care for us, and figure out the future. My Dad made a pact with God that
he would stop smoking if He would just save my Mom. He stopped “cold turkey” and never smoked again. My Mother went from an average-sized, 5’8” woman of 155 pounds to a 105-pound skeleton resembling the photographs we had witnessed at the Dachau concentration camp. She could not digest food without medication for almost a year. When we returned to the States, my grandmother thought my mother was contagious and referred to her illness as the “Big C.” She refused to say the word. Later, I found out that my mother’s surgeon had told her and my Dad that she had a year to live. She believed it. We were enrolled in boarding school. However, that was not the hardest part. Because she believed her prognosis, sadly, she stopped living and lost her sense of hope and the future. She was unable to process that kind of prognosis and suffered from severe depression and anxiety for the rest of her life. She also was plagued with scar tissue adhesions and had multiple surgeries which created more scar tissue. At an early age, I became comfortable in hospitals, care-giving, and medical terms. She died at 52 of glioblastoma within six months of a brain tumor diagnosis. At 70, my Dad was diagnosed with Stage 1 colon cancer. He’d been tired. His primary care physician CONTINUED ON PAGE 3
CAPITAL MEDICAL SOCIETY 2018 MEETINGS CALENDAR Friday, April 13, 2018 CMS Membership & CME Meeting Stress In Medical Practice: Avoiding Risks of Burnout and Suicide Stefan A. Pasternack, M.D., Board Certified Psychiatrist and Psychoanalyst and Distinguished Life Fellow of the American Psychiatric Association, Boca Raton, Florida 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks CONTINUED ON PAGE 3 Spouses Welcome
BOARD OF GOVERNORS David Dixon, D.O., President
I N T H I S I SS U E :
MISSION: TO PROMOTE THE PRACTICE OF MEDICINE FOR THE ULTIMATE BENEFIT OF THE PATIENT. (850) 877-9018 Fax: (850) 878-0218 www.capmed.org
Maribel Lockwood, M.D., President-Elect
March - National Colorectal Cancer Awareness Month.....1 Connect the Docs Happy Hour........................................5 Professional Notes..............................................................6 CMS Lunch and Learn........................................................7 FMA Physician Leadership Academy.............................9 Physician Wellness...........................................................10 CMS Doctor/Daughter Event......................................... 12 Viewpoint............................................................................ 13 Medical/Legal.................................................................... 16 CMS Foundation................................................................ 18
Kenneth Whithaus, M.D., Secretary/Treasurer
CMS Foundation: We Care Network............................ 19
Tracey Hellgren, M.D., Immediate Past President Christie Alexander, M.D. Todd Hewitt, M.D. Sarah Ho, President, CMS Alliance Rohan Joseph, M.D.
HAPPY BIRTHDAY!
Sarah Ko, M.D. Narayanan Krishnamoorthy, M.D.
{APRIL BIRTHDAYS}
Paresh Patel, M.D. Laurence Rosenberg, M.D. Cody VanLandingham, M.D. Julia Weeks, M.D. Pam Irwin, Executive Director, Capital Medical Society Family Medicine Residents Meredith Maxwell, M.D./Alex Vanderby, M.D. Internal Medicine Residents Tahir Motiwala, M.D./Cristin Sampson, M.D. General Surgery Residents Aaron Hayson, M.D./Justin Lee, M.D.
PUBLICATION EDITOR Frank Skilling, M.D.
MANAGING EDITOR Shannon Boyle
GRAPHIC DESIGN Gandy Printers
EDITOR EMERITUS Charles E. Moore, M.D.
ARE YOU INTERESTED IN WRITING AN ARTICLE FOR CAP SCAN?
Please contact Shannon Boyle at sboyle@capmed.org. All articles submitted will be reviewed by your peers prior to publishing.
Cap Scan is published during the first week of each month and is the official publication of the Capital Medical Society. Advertising in Cap Scan does not imply approval or endorsement by the Capital Medical Society. The opinions expressed are those of the individual authors and do not necessarily reflect the official policies of the Capital Medical Society. 2
Amy Reimer Neal, M.D. – 3rd
Stephanie Cruz Lee, M.D. – 18th
Amanda Shearer, M.D. – 3rd
Wendy Somerset, M.D. – 18th
Duncan Postma, M.D. – 4th
Luba Muaddi, M.D. – 19th
Michael Ford, M.D. – 5th
Lisa Cook, M.D. – 20th
Maria Andrews, M.D. – 7th
William Placilla, M.D. – 20th
Randy Reese, M.D. – 7th
R. James Mabry, M.D. – 21st
Barbara Jaeger, M.D. – 8th
Jana Bures-Forsthoefel, M.D. – 24th
Jana Cua, M.D. – 9th
Kenneth DeLay, M.D. – 24th
Jesse Judelle, M.D. – 9th
Sachin Patel, M.D. – 24th
Vikki McKinnie, M.D. – 10th
James Davenport, M.D. – 25th
Adanna Amanze, M.D. – 12th
Mary Swain, M.D. – 25th
Mansukhlal Padalia, M.D. – 12th
Whitney Whitfield, M.D. – 25th
Charles Cooper, M.D. – 13th
Clifton Bailey, M.D. – 27th
J. Anthony Giralt, M.D. – 13th
Farhat Khairallah, M.D. – 29th
Louis St. Petery, M.D. – 14th
Julian Hurt, M.D. – 30th
Edward Forster, M.D. – 15th
Jennifer Sanderson-Smith, M.D. – 30th
Stephen Mnookin, M.D. – 15th Christopher Myrtil, M.D. – 15th
HAPPY BIRTHDAY! WE ARE SO GLAD YOU WERE BORN!
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
MARCH - NATIONAL COLORECTAL CANCER AWARENESS MONTH
CONTINUED FROM COVER
checked his iron, found him to be anemic, and ordered a colonoscopy. Except for two hernia repairs following the abdominal surgery, he has recovered well. He was religious about getting his follow-up colonoscopies. They are no longer recommended at his age. At 88, he is about to join me for a trip back to Germany in May. Fast forward. After thanking my Dad for helping bump me to colonoscopies every three years, I have become diligent about getting my colonoscopies. My gastroenterologist recommended two different genetic tests. So far, so good. I remember arguing with him that I really didn’t want the test. If it turned out that I had a marker for colon cancer, I was concerned I might not be able to get life insurance. He responded, “Would you rather have insurance, or be dead?” I did the tests. I’m now on the five-year cycle. I’ve had two friends, both in their 50’s, die of colon cancer. They had not had their colonoscopies. Both had seemed healthy and were very active.
I remember visiting with one and us deciding that we would make it our cause to encourage our friends and family to get tested and to follow their physician’s recommendations in order to prevent colon cancer. Colon cancer is one of the most preventable cancers with screening and treatable when caught early. I spend my time encouraging those in the general population, family and friends to get tested after age 50 or if they have ANY symptoms. I’ve taken off work to take single friends for their colonoscopy. But what about if you are under 50? Adult children need to be talking to their parents to find out if they had pre-cancerous polyps and at what age. Share that information with your primary care physician to see whether you need to be screened earlier than the norm. We’ve all heard about the prep. I admit that it’s not my favorite pastime or preferred method to lose weight quickly. However, your life might just depend on getting tested for colon cancer and your children will thank you.
CAPITAL MEDICAL SOCIETY 2018 MEETINGS CALENDAR CONT. FROM COVER
May 15, 2018 CMS Membership & CME Meeting Advances in Minimally-Invasive Neurosurgery Narlin Beaty, M.D., Tallahassee Neurological Clinic, PA 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks June 7, 2018 Doctor/Daughter Event 6:00 pm Golden Eagle Country Club September 18, 2018 CMS Membership & CME Meeting Addressing the Opioid Epidemic (2-Hour CME) Panel: Sam Ashoo, M.D., Emergency Management; Victoria Penny, Attorney; Celeste Phillip, M.D., Florida Surgeon General; and Justin French, Tallahassee Police Department 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks
October 16, 2018 CMS Membership & CME Meeting Domestic Violence & Human Trafficking (2-Hour CME) Suzanne Harrison, M.D., FSU College of Medicine and Terry Coonan, J.D., Center for the Advancement of Human Rights 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks November 13, 2018 CMS Membership & CME Meeting Health Impact of Common Electronic Devices Alice Pomidor, M.D. 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks December 6, 2018 CMS Foundation Holiday Auction 6:30 pm FSU University Center Club
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 3
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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PROFESSIONAL NOTES
PROFESSIONAL NOTES FMA President, John N. Katopodis, M.D. has accepted the invitation from the Florida Academy of Pain Medicine to be the “Keynote Speaker” at the Opioid Summit on Saturday, April 28th at the Hyatt Regency Hotel on Clearwater Beach. In a recent special report from Dr. Katopodis, he noted that a deadly epidemic has engulfed our state and the country as a whole. According to CDC, more than 500,000 people have died from drug overdoses between 2000 and 2015. Ninety-one Americans die every day from an opioid overdose. He further noted that, “our profession is uniquely positioned to proactively confront the is grim reality”. At the Opioid Summit, Dr. Katopodis plans to share information about the current state of the opioid crisis, potential solutions, and what the FMA is doing. Other Summit topics include pharmacology updates, prescription limits, legal aspects, alternative treatments, interventional pain management and much more. Online registration is available at www.fapmmed.net.
In April 2018, Dr. Joedrecka Brown Speights will become interim chair of Family Medicine and Rural Health at the Florida State University College of Medicine. Dr. Brown Speights currently is associate chair and associate professor in the department.
Dr. Daniel Van Durme will transition from chair of the FSU College of Medicine's Department of Family Medicine and Rural Health to become the college’s chief medical officer and focus on duties as senior associate dean for clinical and community affairs. Dr. Van Durme has served as chair of the Department of Family Medicine and Rural Health since 2004.
Charles D. Williams, M.D. was honored as the 2018 Colquitt County Career Achievement Award recipient on March 8, 2018 at the Colquitt County Arts Center in Moultrie, Georgia. The purpose of this award is to recognize an individual with strong ties to Colquitt County who has excelled in business, academia, the arts, or some other field and must have attended school in Colquitt County for a substantial number of years.
CMS Members: If you receive accolades, please let us know so we can include you in this section! Email the details to Shannon Boyle at sboyle@capmed.org.
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
CMS LUNCH AND LEARN
CAPITAL MEDICAL SOCIETY LUNCH AND LEARN SEMINARS
On February 21st, Diane Gaddis and April Zehms-Payne from The Center for the Advancement of Health IT, gave an excellent program on the Quality Payment Program.
We thank Medical AR Revenue Solutions, LLC for sponsoring the February 21st Lunch and Learn. J.R. Blue and Sheila Erwin attended as representatives from Medical AR Revenue Solutions, LLC.
MARK YOUR CALENDARS FOR THE REMAINING SPRING 2018 LUNCH AND LEARN SEMINARS April 18, 2018 Keeping The Good Ones What does it take to create a culture of retaining good employees? Is examining the work environment a high priority for your company? At some point your employees will ponder a simple yet profound question based on the 80’s pop song, “Should I stay or should I go?” What can you do to keep the good ones? Speaker: Bert Mitchell Sponsor: Medical AR Revenue Solutions, LLC
May 16, 2018 Updates on Health Care Reform Representatives from the Government Relations team at Florida Blue will provide updates on how recent activity at the federal and state levels will impact health care policy. Speaker: Kelly James, Florida Blue Center for Health Policy Sponsor: Hancock Bank
Time: 12 Noon to 1:30 PM (Seminars start at 12:30 PM) Place: CHP Auditorium, 2nd Floor, 1491 Governors Square Blvd. Cost: $10 per person, per seminar Seminars are held at the Capital Health Plan on Governors Square Blvd – and we thank them for providing this venue to us. For more information or to RSVP, please contact Rosalie Carlin at (850) 877-9018 or rcarlin@capmed.org.
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 7
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FMA PHYSICIAN LEADERSHIP ACADEMY
APPLY FOR THE FMA PHYSICIAN LEADERSHIP ACADEMY Take the next step in your medical career by applying for the FMA's 2018-19 Karl M. Altenburger, M.D. Physician Leadership Academy. Funded by a generous grant from The Physicians Foundation, the Academy is an intensive, 10-month program designed to help young doctors develop skills they need to be effective, strategic leaders and advocates for the medical profession. Participants attend five full-day educational sessions led by nationally recognized experts and University of Florida Leadership Development Institute personnel. The FMA's Foundation for Healthy Floridians covers the cost of materials, speaker fees, lodging and sponsored meal expenses. To learn more about the program, visit http://www.fma-leadership.org/about-2/. To apply, visit http://www.fma-leadership.org/applications/. The deadline to apply is June 8, 2018. Applicants must be FMA members. Contributed by the FMA
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 9
PHYSICIAN WELLNESS
PHYSICIAN WELLNESS BURNOUT INVENTORY This is an adapted version of the Oldenburg Burnout Inventory, one of several such validated instruments used to assess the presence of burnout in many occupations. Each of these instruments, including this one, has its own unique advantages and limitations. This sample is provided not as a definitive measure of the presence or absence of burnout, but merely as one potential piece of data for you to consider as you explore issues related to physician wellness and resilience. By answering the questions and tallying your score, you will be able to determine your score. Scores range from 16-64. Scores above 35 have been correlated with higher rates of burnout. If you are an Active or Associate member of Capital Medical Society and would like to seek free wellness coaching services, please visit https://capmed.org/members-only/physician-wellness/. If you need help with your CMS login information, please email rcarlin@capmed.org. 1. I always find new and interesting aspects in my work. Strongly Agree (+1) Agree (+2) Disagree (+3) Strongly Disagree (+4)
4. After work, I tend to need more time than in the past in order to relax and feel better. Strongly Agree (+4) Agree (+3) Disagree (+2) Strongly Disagree (+1)
2. There are days when I feel tired before I arrive at work. Strongly Agree (+4) Agree (+3) Disagree (+2) Strongly Disagree (+1)
5. I can tolerate the pressure of my work well. Strongly Agree (+1) Agree (+2) Disagree (+3) Strongly Disagree (+4)
3. It happens more and more often that I talk about my work in a negative way. Strongly Agree (+4) Agree (+3) Disagree (+2) Strongly Disagree (+1) 10 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
6. Lately, I tend to think less at work and do my job almost mechanically. Strongly Agree (+4) Agree (+3) Disagree (+2) Strongly Disagree (+1)
PHYSICIAN WELLNESS
7. I find my work to be a positive challenge. Strongly Agree (+1) Agree (+2) Disagree (+3) Strongly Disagree (+4) 8. During my work, I often feel emotionally drained. Strongly Agree (+4) Agree (+3) Disagree (+2) Strongly Disagree (+1) 9. Over time, one can become disconnected from this type of work. Strongly Agree (+4) Agree (+3) Disagree (+2) Strongly Disagree (+1)
12. After my work, I usually feel worn out and weary. Strongly agree (+4) Agree (+3) Disagree (+2) Strongly Disagree (+1) 13. This is the only type of work that I can imagine myself doing. Strongly Agree (+1) Agree (+2) Disagree (+3) Strongly Disagree (+4) 14. Usually, I can manage the amount of my work well. Strongly agree (+1) Agree (+2) Disagree (+3) Strongly Disagree (+4)
10. After working, I have enough energy for my leisure activities. Strongly agree (+1) Agree (+2) Disagree (+3) Strongly Disagree (+4)
15. I feel more and more engaged in my work. Strongly Agree (+1) Agree (+2) Disagree (+3) Strongly Disagree (+4)
11. Sometimes I feel sickened by my work tasks. Strongly agree (+4) Agree (+3) Disagree (+2) Strongly Disagree (+1)
16. When I work, I usually feel energized. Strongly Agree (+1) Agree (+2) Disagree (+3) Strongly Disagree (+4)
CALCULATE YOUR SCORE HERE:
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 11
CMS DOCTOR/DAUGHTER EVENT
Save the Date
Capital Medical Society PRESENTS
Doctor / Daughter Event THURSDAY, JUNE 7, 2018 AT 6:00 PM GOLDEN EAGLE COUNTRY CLUB - 3700 GOLDEN EAGLE DRIVE CMS MEMBERS: BRING YOUR DAUGHTERS AND/OR GRANDDAUGHTERS OF ANY AGE OUT FOR A FUN-FILLED EVENING! OUR SOCIAL EVENTS COMMITTEE IS HARD AT WORK SECURING SPONSORS AND ACTIVITIES. STAY TUNED FOR MORE INFORMATION! 12 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
VIEWPOINT
THE JOURNEY: FROM HIPPIE DOCTOR TO THE UNITED STATES MARINE CORPS By Frank Skilling, M.D. I was born in Miami Beach and raised in Miami by parents who met while on active duty in the Army Air Force in World War II. My father was a flight surgeon at Key Field in Meridian, Mississippi. He met my mother who had volunteered for the Army Nursing Corps and was training in Mississippi prior to being deployed overseas to the CBI (China Burma India) Theater. Since my mother had no civilian clothes, they were married in uniform as soon as the war was over. I grew up thinking that most mothers had an olive blouse for their wedding gowns. After high school in Miami, I went to Spring Hill College in Mobile, Alabama. Army ROTC was available in 1964, but not required. I spent two years in the unit, and I served as a flag bearer in the color guard. I learned how to march, salute and polish my boots. But the Vietnam War was looming, and I wanted to go to medical school, so I dropped out of the ROTC program and hung my chances on getting into med school and consequently a four-year deferral. At that time the Berry Plan was in effect, and it essentially granted a draft deferment to all medical students with the understanding that they would serve as medical officers after graduation. Fortunately, I was accepted at the University of Alabama School of Medicine and began classes in 1968. I decided that I didn’t want to slog through the jungles of Vietnam with the Army, so I joined the Naval Reserve during my sophomore year in medical school. To enhance my chances of acceptance into an ophthalmology residency I elected to go on active duty after I finished my internship. After graduation from UAB in June 1972, I started an internship in internal medicine at the University of Miami and submitted my request for my first duty station as a Navy medical officer. I thought that being a flight surgeon sounded like a pretty nifty way to spend a few years: hanging out with pilots and going to sea on an aircraft carrier. Was I surprised when I received my first orders from BuMed (Bureau of Medicine) and didn’t see an assignment to Pensacola for flight training! Instead I was commanded to report to “FMF 3rd MAR DIV.” When I called my contact in Washington and asked why I wasn’t going
to Pensacola, he replied, “Son, you’re going to the Fleet Marine Force of the Third Marine Division on Okinawa.” Up to that moment I had never considered that I would be going anywhere except a Navy billet. I was quickly disabused of that belief.
Dr. Skilling in 1971 in his senior year at UAB.
The military in the late 1960s and 1970s was perhaps the most reviled government institution in our country. While I wasn’t enthusiastic about going to war, and I certainly didn’t want to die in Vietnam, I was prepared to serve, especially on my terms as a medical officer. However, I hadn’t counted on being with the infantry, and especially the infantry of the United States Marine Corps. While in Miami I had taken on the appearance commonly known as a “hippie doctor” on the wards of Jackson Memorial Hospital. I had a full beard and hair that was never long and flowing, but thick and springy. (A nurse once told me, “You look just like Jesus!”) Once I resigned myself to spending a year overseas, I decided that I would look the part and not try to “buck the system” by asserting my individual right to remain hirsute and shaggy as some military doctors tried to do. I had my first haircut in a year, shaved off my beard and assumed a clean-cut appearance I hadn’t had in years. Fellow medical staffers at Jackson Memorial Hospital and even my then girlfriend didn’t recognize me. In July 1973, I reported to Camp Pendleton California for a very brief introduction to field medical services. One of the lectures I attended was given by a senior chief corpsman who had received the Congressional Medal of Honor for saving a Marine squad in Vietnam. I later learned that Navy corpsmen serving with the Marines have won more Medals of Honor than any other group, but most of them were awarded posthumously. CONTINUED ON NEXT PAGE
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
13
VIEWPOINT
Dr. Skilling in 1974 while on duty as a Navy medical officer.
Once on Okinawa I was assigned duty at Camp Hansen with the 3rd Battalion of the 4th Marine Regiment. Officially I was a Battalion Surgeon, which sounds impressive, but I was actually a general medical officer with responsibility for 1500 Marine officers and men. At our camp there were eight GMOs and two psychiatrists, but no general surgeon or orthopedist. In Miami I had become a pro at taking care of elderly patients with chronic medical problems: heart attacks, GI bleeds, pulmonary failure, diabetic coma, and hypertension. On Okinawa I had young patients who were in excellent physical shape but were prone to accidents, back aches, muscle strains, trauma, STDs, and colds. I was expected to evaluate and treat lacerations, fractures, burns, heat stroke, self-inflicted injuries, drug abuse and severe inebriation. The facility I worked in had minimal supplies, a makeshift OR, a tiny pharmacy, a small x-ray machine, and a few beds for admissions. Fortunately, I rarely had a serious injury or illness to care for because the nearest referral Army hospital was a two-hour drive by ambulance. At the time I felt that I wasn’t properly using my hard earned medical training, but I realized later that I had been given an opportunity to be around one of the most outstanding organizations that our country has produced: The United States Marine Corps. All of the officers I served with had been in Vietnam. When I graduated from college in 1968, I went on to medical school; these Marines had graduated and gone to war. They were mentally and physically tough, enthusiastic, reliable, ready to lead, and learned in the ways of the military. They were not bloodthirsty, although there was a sense of machismo present virtually all the time. They worked hard even in garrison; they partied hard when they were on liberty. I deduced that the Marines weren’t good fighters because they were mean or cruel; they were effective because they were disciplined, and I suppose many were “adrenaline junkies.” Marine officers took care of their enlisted men in garrison and combat: they were expected to take charge and be in charge at all times. I sometimes wondered why the young officers weren’t more introspective and disillusioned 14 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
about being in such an unpopular war, but self-doubt is not part of the survival instinct when you’re in combat, and a Marine never expresses self-doubt about his role in the universe. I had book smarts, but not life smarts. I had never been around a group of people who were so dedicated to “the mission.” When I tried to contradict one captain who told me that he’d stayed awake for two weeks while in Vietnam because the brain couldn’t take going that long without sleep, he simply said, “Doc, when people are trying to kill you it’s amazing what you can do!” He was right. Among the young officers there was no complaining, no whining, no sense of being victimized, even though many of them had been wounded. There was a sense of shared purpose that came down the chain of command. While there were sarcastic remarks and gallows humor, these men were wholly committed to the Corps. To this day I’ve not been associated with a finer group of people, and I often reflect on how few people I know could carry on for one day in the jobs that are required of Marine officers…and that doesn’t include being in combat. My assistants were Navy corpsmen who’d been assigned to medical duty with the Marines. In the field we wore Marine uniforms with Navy insignia. This was the first time I’d worked with “physician extenders,” and I was impressed with their training and knowledge. Marines took good care of their corpsmen because they realized that any day a corpsman might save their lives. One of my close friends was rescued by a corpsman in Vietnam after an artillery shell explosion severed his femoral artery. His leg was saved after the corpsman shoved a piece of IV tubing in the artery’s cut ends to continue sending blood down his leg. After a few months on Okinawa our battalion departed for a “float,” as the Marines liked to call it. We boarded Navy amphibious transports (LSTs, LPDs) and sailed to Japan for tank and artillery maneuvers at Camp Fuji. I spent two months living in a Quonset hut with eleven others officers. We had electricity, but no running water, and the only heat was from a freestanding metal stove that burned fuel oil. This was during the first Arab oil embargo in the fall of 1973, and fuel was rationed. I experienced my first Thanksgiving away from home at the base of Mount Fuji, and the mess cooks made sure everyone had plenty of turkey and dressing during the only day off we’d had that month. One unexpected bonus from being in Japan was that I learned to eat and like sushi. Raw seafood had never been part of my diet, but when I ended up in a fancy Tokyo restaurant
VIEWPOINT
with another officer we found out that it was the only thing on the menu. Our battalion then spent a month at Subic Bay Naval Base in the Philippines, which was then a major port for the US Navy. This was good duty after being in freezing Japan. I had a small dispensary where I held office hours in the morning, but there was plenty of time to run, swim, read and visit the “O” club at Cubi Point where I won thirty-five dollars in a slot machine that I pulled one night as I was heading out of the club to catch a taxi back to the base. The main officers club was in an idyllic setting from where we watched the spectacular Pacific sunsets, and one night at dinner there I learned the costs of being a Marine. I was the only medical officer at our table and the only person who had not been in Vietnam. My companions started talking about being in combat, which surprisingly was not a common topic, but one that came up after a few drinks. They related their injuries and what it took to go through surgery and rehabilitation. I asked them how long they had to remain in the hospital and tallied the numbers on the back of a napkin. The five of them had spent a combined thirty-three months in Navy hospitals being put back together. I am still shocked that they survived and wanted to go back to active duty. They were the embodiment of the Navy motto: Honor, Courage, Commitment. After leaving the balmy atmosphere of the Philippines, we sailed to Korea for joint operations with the South Korean navy and marines. I went ashore with my corpsmen, and we set up a large field medical tent which would have functioned as a receiving ward had we been in combat. Fortunately, we had a fuel oil space heater inside the tent that abated the temperature, but Korea was still the coldest place I’ve ever been. I wore every piece of clothing I had including regulation green underwear which I didn’t change for a week. When I got back aboard ship and took a shower, my skin was green. After completing my tour on Okinawa in July 1974, I was assigned to Pensacola Naval Air Station as a medical officer at one of the dispensaries on base. It was considered a good assignment, but when compared to the adventure of being with the Marines, it was primarily a day job. I roomed with another single medical officer in an apartment on Pensacola Beach, and we drove across town every morning to report for duty at 0700. Although we were usually finished by 1500, I found the routine much less stimulating. On Okinawa I was the battalion’s medical officer; at Pensacola I was a junior medical officer and my rank wasn’t senior enough
to be the MOD (medical officer of the day) when I had duty in the base’s emergency department. I was the Assistant MOD, and therefore I had to screen all patients before referring to the MOD those I couldn’t handle myself. (I usually stayed in the ER while he stayed in the on call room.) While I was offered the possibility of a flight surgeon assignment if I stayed on for a few more years, I was ready to get out of the Navy by then. I’d been accepted to the University of Texas Medical Branch’s ophthalmology residency, and I was anxious to get started with training in my chosen specialty. I stayed in the inactive Naval Reserve for four more years, but I never put on the uniform again. All in all, my military service was a positive experience, although I wasn’t always sure of it at the time. Going from the intense, but somewhat disorganized, experience of being an intern at Jackson Memorial Hospital to a Marine Corps base with battle-hardened veterans was disorienting. Being around men who are ready to lead others into combat at a moment’s notice and are ready to sacrifice themselves to complete their mission was bracing but puzzling to someone not used to the heritage of the Marines. The price for being in combat is high, even for the survivors, and I cringe to think of how poorly our veterans are treated by our country. My major dissatisfaction now is that I don’t think most Americans appreciate how much the military does for us; and since the draft has been rescinded, fewer of us have firsthand experience of the demands placed on the men and women who volunteer. We are engaged in another unpopular war, but at least the armed services aren’t vilified, as they were when I served. I was in the Navy and served with the Marines when they were at their nadir in the twentieth century, but incontrovertibly they were the best group of people I’ve ever associated with. The Marine Corps motto is: SEMPER FIDELIS, Always Faithful. Those who have served with them usually shorten it to: Semper Fi! Unlike many of my generation who started out being against the War and ended up being against the military, I was raised with a favorable impression of being in the service. My parents didn’t think that their service was in any way remarkable, but I know that had they not heeded their country’s call to serve, I would certainly not be writing this today because there’s no chance they would have met in civilian life. Thank God for World War II!
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MEDICAL/LEGAL
Florida Medicaid Health Care Alert February 13, 2018 Provider Type(s): All Substance Use Disorder Treatment Options and Prevention Governor Rick Scott has declared the opioid epidemic a state of emergency in Florida (see Executive Order 17-146). In response to the opioid crisis, the Agency for Health Care Administration (Agency) is implementing provisions under the Florida Medicaid program to assist in the prevention and treatment of substance use disorders. Medication-assisted treatment combines behavioral health therapy and medications to treat substance use disorders. Florida Medicaid covers an array of behavioral health therapies and prescribed drugs (e.g., Naltrexone, Buprenorphine, Methadone, etc.) to treat substance use disorders and does not limit the length of time recipients may receive treatment. Medication-Assisted Treatment: 1. The Agency has eliminated all prior authorization requirements for the following medication-assisted treatment options under Florida Medicaid: · Naltrexone tablets · Vivitrol (naltrexone) injectable – for recipients ages 18 years of age and older diagnosed with alcohol and/or opioid dependence. 2. Effective February 5, 2018, Florida Medicaid will reimburse for a 7-day supply of Suboxone (buprenorphine/naloxone) film or buprenorphine tablets (for pregnant or nursing mothers) without prior authorization. This will allow induction therapy to start immediately. Providers will be required to request prior 16
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
MEDICAL/LEGAL
authorization for continued therapy after the initial 7-day induction period. All prior authorization forms and criteria for prescribed drugs may be found here: http://ahca.myflorida.com/medicaid/Prescribed_Drug/preferred_drug.shtml Additional Changes Related to Prescribed Drugs: Florida Medicaid has or will implement the following additional changes to prescribed drugs benefit: 1. Systems modifications: a. Prevent Florida Medicaid reimbursement for two or more long acting opioids prescribed simultaneously. b. Alert pharmacists when an opioid and a benzodiazepine are prescribed in combination (this applies in the fee-for-service delivery system) c. Require prescribers order a short acting opioid prior to consideration of a prescription for a long acting opioid 2. Created a prior authorization form consistent with the guidelines and recommendations from the Centers for Disease Control and Prevention. 3. Effective February 26, 2018, prescriptions for short acting narcotics, for the treatment of acute pain, will be limited to a maximum of 7-day supply. Prescribers may request an increase in the 7-day supply through the prior authorization process when medically necessary. 4. Effective March 26, 2018, prescriptions for opioids for patients who are new to opioid treatment will be limited to a maximum dose equivalent to 90 milligrams of morphine per day. For recipients enrolled in a Medicaid health plan, services are reimbursed by the plan in accordance with their established agreements/contracts with network providers. In no instance may the health plan impose limitations or exclusions more stringent than those specified in Florida Medicaid coverage policies. In any instance when compliance with provisions in the Florida Medicaid promulgated rules in Chapter 59G, F.A.C. conflicts with the terms of the health plan contract, the contract prevails. For additional information, please contact the plan directly. Questions? Send an email to: FLMedicaidManagedCare@ahca.myflorida.com If you have complaints or other issues: • Visit https://apps.ahca.myflorida.com/smmc_cirts/ • Call (877) 254-1055
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17
CMS FOUNDATION
The Impact of Private Support: Capital Medical Society Foundation’s community of donors strategically help fulfill its mission “to support the charitable efforts of physicians and others, increase access to healthcare, promote education and serve the community’s health needs through innovative projects that are exemplary, affordable and dignified.”
➢ Access to healthcare is increased through gifts to We Care Network and the We
Donate to the CMS Foundation We Thank Our Donors We thank the following organizations who made a donation to the CMS Foundation this past month: We Care Network St. Elizabeth Ann Seton Catholic Church – for Medical Assistance
Care Network Endowment Fund. More than $90 million in donated specialty medical and dental care has been provided to low-income, uninsured patients since the program was created in 1992. In fiscal year 2016-17, which ended June 30, 2017, more than $10.9 million in health care was donated. Gifts support the salaries and benefits of the case management team who coordinate donated care. ➢ To provide incentives to keep medical students trained at FSU College of Medicine in the Big Bend after completion of their residencies and help meet the growing demand for physicians in Florida, gifts to the Scholarship Fund provide scholarships to FSU College of Medicine students who have expressed an interest in returning to the Big Bend to practice after completion of their residencies. $47,000 was distributed to eight medical students in 2017. ➢ Gifts to Capital Medical Society Foundation help provide operation resources for Capital Medical Society Foundation. In addition, modest grants to area non-profits whose programs improve access to health care for the underserved. In 2017, CMSF awarded $10,000 in grants to Elder Care for their In-Home Services Program and to CMSF’s Physician Wellness Program. Gifts to Honor and In Memoriam: You can make a donation to the CMS Foundation in memory of someone who has passed away or in honor of someone, such as a fellow physician, you hold in high esteem or has taken care of you or your family. CMS Foundation will send an acknowledgement letter to those you memorialize and honor. How to Give: Through the generosity of donors, funds have been created in order to establish financial stability to meet our mission. You can donate at any time to one of CMS Foundation’s current funds: 1) Capital Medical Society Foundation-area of greatest need 2) The Capital Medical Society Foundation Endowment 3) We Care Network 4) We Care Network Endowment 5) Scholarship Fund 6) The Ronald G. Pickett Endowment 7) Physician Wellness Fund Checks should be made payable to the CMS Foundation and indicate on the memo line of your check to which designation you would like to donate. Bring your check to the CMS Office or mail it: Capital Medical Society ~ 1204 Miccosukee Road ~ Tallahassee, FL 32308. Donations may be made by credit card from the CMS website.
Your gifts to Capital Medical Society Foundation transform lives in the Big Bend.
If you would like to discuss a gift of appreciated securities, an insurance policy, designation of retirement plan assets, estate gift, or multi-year pledge, please contact: Pam Irwin Executive Director pirwin@capmed.org or (850) 877-9018
CMS FOUNDATION: WE CARE NETWORK
FOUNDATION
We Care Network
THANK YOU To our CMS members and We Care partners who saw new patients for the We Care Network in February 2018. Your generosity and support of the We Care Network makes a difference. Physicians Emily Ashmore, M.D. Arvind Bakhru, M.D. Dhananjay Bendre, M.D. Robert Bradford, M.D. Alexander Brickler III, M.D. Tim Broeseker, M.D. Logan Brooks, M.D. Viet Bui, M.D. David Burns, M.D. Carlos Campo, M.D. Joseph Camps, M.D. Stephen Carr, M.D. Michael Cavallaro, M.D. Raymond Cottrell, M.D. Jeffrey Crooms, M.D. Narlito Cruz, M.D. David Dixon, D.O. David Durden, M.D. Alberto Fernandez, M.D. Jerry Ford, M.D. Hong Gao, M.D. Akash Ghai, M.D. Sergio Ginaldi, M.D. Gian-Carlo Giove, M.D. Aaron Guyer, M.D. Gregory Hartlage, M.D. Muhanad Hasan, M.D. Amit Jain, M.D. Lisa Jernigan, M.D. Arjun Kaji, M.D. John Katopodis, M.D. Farhat Khairallah, M.D James Killius, M.D. Hari Kolli, M.D. Matthew Lawson, M.D. Carey Linker, M.D. Deanna Louie, M.D. Kurt Luhmann, M.D. Charles Maitland, M.D. Michael Mangan, M.D. Ovidiu Marina, M.D. Laura Martin, M.D. Jonathan Melquist, M.D. Jayan Nair, M.D. Paresh Patel, M.D. Timothy Paulk, M.D. Mitchell Peabody, D.O. Michael Pentaleri, M.D. Jorge Perez de Armas, M.D. Alexander Ramirez, M.D. James Renehan, M.D. Adrian Roberts, M.D. Laurence Rosenberg, M.D. Tim Ruark, M.D. Jeannine Silberman, M.D. Hardeep Singh, M.D. Robert Snider, M.D. Joshua Somerset, M.D. Bhavik Soni, M.D. Christopher Sundstrom, M.D. Timothy Sweeney, M.D.
John Thabes, M.D. Jean-Paul Tran, M.D. David Vermess, M.D. Lucas Watkins, M.D. Graham Whitaker, M.D. William Yaakob, M.D. Daniel Yang, M.D. Samuel Yu, M.D. Dentists William Baldock, D.D.S. Jean-Pierre Bastien, D.M.D. Brian Beck, D.M.D. Labon Bontrager, D.M.D. Steven Bryan, D.M.D. David Cardman, D.M.D. Walter Colon, D.M.D. William McFatter, D.D.S. Robert Murrell, D.M.D. Russell Rainey, D.M.D. Frank Swerdzewski, D.D.S. Facilities Abbey Eye Institute Advanced Urology Institute Anesthesiology Associates Apalachee Primary Care Beachton Denture Clinic Big Bend Oral Surgery Bond Community Health Center Bristol Dental Clinic Capital Periodontal Associates Capital Regional Cancer Center Capital Regional Medical Center Care Point Health & Wellness Center Dermatology Associates Desloge Home Oxygen Digestive Disease Clinic Eye Associates of Tallahassee Florida Cancer Specialists & Research Institute Gadsden County Health Department Jessie Furlow Medical Center Ketchum, Wood, & Burgert Pathology Associates Madison Medical Center Neighborhood Medical Center North Florida Nephrology Associates North Florida Women’s Care Periodontal Associates Radiology Associates of Tallahassee Smile Connection at Bond Community Health Center Southeastern Plastic Surgery Southern Medical Group, P.A. Southern Vitreoretinal Associates Tallahassee Diagnostic Imaging Tallahassee Ear, Nose, and Throat Tallahassee Memorial HealthCare TMH Family Medicine Residency Program TMH Physician Partners Cancer & Hematology TMH Physician Partners Cardiology and Internal Medicine TMH Physician Partners Gynecologic Oncology Specialists TMH Physician Partners Pulmonary, Critical Care, and Sleep Specialists TMH Physician Partners Radiation Oncology Specialists TMH Physician Partners Surgical Specialists TMH Physician Partners Quincy TMH Rehabilitation TMH Transition Center Tallahassee Orthopedic Clinic Tallahassee Neurological Clinic, P.A. Tallahassee VA Clinic Vascular Surgery Associates Wakulla Medical Center Walton & Cardman Dentistry Women’s Imaging Center
Please contact Diana Bixler at dbixler@capmed.org or 201-0130 if you are a We Care volunteer and you provided volunteer specialty care in the month of February 2018 and your name is omitted. The We Care Network strongly encourages our volunteer physicians and dentists to send their value of donated services to us. The value of donated services is important for us to share with our funders and the community. Also, up to five hours, per biennium, of CE credit may be fulfilled by performing pro bono medical and dental services to We Care Network patients, if we have received documentation of value of services. You can send your value of donated services via fax to Diana Bixler at (850) 201-0085 or mail to 1204 Miccosukee Road, Tallahassee, FL, 32308. Thank you!
We thank our referring providers from February 2018: Abbas Abbey, M.D. Ebonie Allen, ARNP Anne Ananga, ARNP Arvind Bakhru, M.D. Karen Bartley, M.D. Dhananjay Bendre, M.D. Jonna Bradley, ARNP Daniel Breivogel, ARNP Tim Broeseker, M.D. Logan Brooks, M.D. David Cardman, D.M.D. Lysmar Carrion-Dinguis, M.D. Jordan Cherkinsky, D.D.S. Raymond Cottrell, M.D. Jeffrey Crooms, M.D. Stephanie Derovin, ARNP William Dixon IV, M.D. Alberto Fernandez, M.D. Jerry Ford, M.D. Klive Forde, M.D. Sharron Foster, M.D. Hong Gao, M.D. Judy Griffin, ARNP Gregory Hartlage, M.D. Hantz Hercule, M.D. Dwight Hooper, M.D. Julian Hurt, M.D. Amit Jain, M.D. Hari Kolli, M.D. Elaine Larkins, ARNP Matthew Lawson, M.D. Michael Mangan, M.D. Ovidiu Marina, M.D. Laura Martin, M.D. Damon McMillan, M.D. Donald Michel, M.D. Kelly Miller, ARNP Marcia Morris, ARNP
Jayan Nair, M.D. Kathy Odham, ARNP Rose Origa, ARNP Dianne Pappachristou, D.O. Kyara Paulk, ARNP Timothy Paulk, M.D. Lisa Perkins, ARNP Andrea Plagge, D.O. Jessica Proxmire, ARNP Alexander Ramirez, M.D. James Renehan, M.D. Charlie Richardson, M.D. Adrian Roberts, M.D. Laurence Rosenberg, M.D. Tim Ruark, M.D. Lucilita Salvador, PA Less Shrestha, M.D. Abisoye Somorin, ARNP Alanna Steaple, ARNP Christopher Sundstrom, M.D. Scott Tetreault, M.D. Lacie Thompson, ARNP Faye Tinson, ARNP Barrett Tolley, D.D.S. Marianne Towler, ARNP Dwanna Ward-Boahen, ARNP Jeffrey Wasserman, D.O. Lucas Watkins, M.D. Eula Weaver, ARNP Graham Whitaker, M.D. Chien-Yi Williams, M.D. Dianna Willis, ARNP
DURING THE MONTH OF FEBRUARY, THE WE CARE NETWORK: RECEIVED 203 REFERRALS, WITH 110 PATIENTS NEW TO THE PROGRAM
SCHEDULED 216 APPOINTMENTS WITH VOLUNTEER PHYSICIANS AND DENTISTS
$570,804.63 IN DONATED CARE WAS REPORTED BY WE CARE VOLUNTEERS
Prsrt. Std. U.S. Postage
PAID Tallahassee, FL Permit 801
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