To our Healthcare Heroes.....
MAY EDITION, VOLUME 2021, NO. 5
The Capital Medical Society and the We Care Network staff thank all physicians for their commitment to the practice of medicine for the ultimate benefit of patients. Despite increasing your own exposure to COVID-19, you continue to provide excellent healthcare to the patients of this community. Many of you are keeping the public informed of important medical updates. Others are engaged in vaccination distribution. Be well, and know that you are highly-valued and deeply respected. We celebrate you every day!
CAPITAL MEDICAL SOCIETY 2021 MEETINGS CALENDAR May 18, 2021 Virtual CME (1-Hour) Panel Discussion – Bringing it All Together: Expanding the Scope of Type 2 Diabetes Management 6:30 pm
September 14, 2021 Celebration Awards Dinner University Center Club at FSU 6:30 pm CONTINUED ON PAGE 3
BOARD OF GOVERNORS Rohan Joseph, M.D., 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
Paresh Patel, M.D., President-Elect Sarah Ko, M.D., Secretary/Treasurer
CMS News.................................................................................. 3 CMS Updates............................................................................. 5 Professional Notes...................................................................6 CMS Virtual Lunchtime Learning Seminars.......................8 CMS Foundation New Board Director................................9 Catch My Stride Activities................................................... 10 Viewpoint................................................................................. 13 COVID-19 Vaccine Update................................................... 14 Practice Management........................................................... 16 Medical/Legal......................................................................... 18 Reflections from the Editor................................................ 20 Simpler Times......................................................................... 21 Honor A Doctors’ Day...........................................................22 Community Partnership Through the We Care Network........ 23 Donate to the CMS Foundation..........................................24 CMS Foundation: We Care Network.................................26
Ken Whithaus, M.D., Immediate Past President Nicole Balmer, M.D. David Burns, M.D.
HAPPY BIRTHDAY!
Russell Cole, M.D.
{MAY BIRTHDAYS}
Amulya Konda, M.D. Helen Paulson, M.D. Shawn Ramsey, D.O. Andrea Stephens, CMS Alliance Cody VanLandingham, M.D. Julia Weeks, M.D. Graham Whitaker, M.D. Pam Irwin, Executive Director, CMS
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
B. David Robinson, M.D. – 1st Nancy Chorba, M.D. – 2nd Marc Fisher, M.D. – 2nd Shawn Ramsey, D.O. – 3rd William Comer Cherry, Jr., M.D. – 4th Joel Kramer, M.D. – 4th Charles Long, M.D. – 4th David Smith, M.D. – 4th Anthony Wright, M.D. – 5th Matthew Connor, M.D. – 6th Spencer Gilleon, M.D. – 6th H. Timothy Paulk, M.D. – 6th Jacob Hentges, M.D. – 7th Brett Howard, M.D. – 7th Nola Munasifi, M.D. – 7th Anthony Russell, M.D. – 7th Erin Carlquist, M.D. – 8th Vatsal Patel, M.D. – 9th Don Zorn, M.D. – 9th Shamil Castro, M.D. – 12th Kimberly Smith, M.D. – 12th John Bailey, D.O. – 13th Sam Ashoo, M.D. – 14th Hari Kolli, M.D. – 14th Floyd Jaggears, M.D. – 15th Chukwuma Okoroji, M.D. – 15th Amanda Stephens, D.O. – 15th Hugh VanLandingham, M.D. – 15th Mitchell Peabody, D.O. – 16th Mark Saunders, M.D. – 16th
Patricia Hogan, M.D. – 18th Cybelle Pfeifer, M.D. – 18th J. Alan Cox, JD – 19th Jayati Singh, M.D. – 19th Rex Williams, M.D. – 19th Sandya Jiandani, M.D. – 20th John Mahoney, M.D. – 20th Christopher Price, M.D. – 20th Kurt Luhmann, M.D. – 21st Amara Emenike, M.D. – 22nd Al McCully, M.D. – 22nd David Hood, M.D. – 23rd Stephen Medvid, M.D. – 23rd Sudha Ravilla, M.D. – 23rd Stephen Sandroni, M.D. – 23rd Aaron Appiah, M.D. – 25th Jerry Harris, M.D. – 26th Steven Currieo, M.D. – 27th Hong Gao, M.D. – 27th Gordon Low, M.D. – 27th Jeffrey Rawlings, M.D. – 27th Matthew Standridge, M.D. – 27th John Agens, M.D. – 28th Stephen LaRosa, M.D. – 29th David Oberste, M.D. – 29th Daniel Yang, M.D. – 29th Suzanne Harrison, M.D. – 30th Jayan Nair, M.D. – 31st Mehul Patel, M.D. – 31st
HAPPY BIRTHDAY! WE ARE SO GLAD YOU WERE BORN!
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
DID WE MISS YOUR BIRTHDAY? IF SO, PLEASE EMAIL ROSALIE CARLIN AT RCARLIN@CAPMED.ORG!
CMS NEWS
NEW DOCS ON THE BLOCK
IN MEMORIAM
Frank Andrew Kozel, M.D. Medical School: University of Virginia School of Medicine Internship: Wilford Hall Medical Center Residency: Medical University of South Carolina Practice: FSU BehavioralHealth at Apalachee Center Specialty: Psychiatry Robert L. Lott, M.D. Medical School: Mercer University Internship: Navicent Health (was Medical Center of Central GA) Residency: New York Medical College Practice: Dermatology Associates of Tallahassee, PA Specialty: Dermatology
Remelda T. Saunders-Jones, M.D. Medical School: Meharry Medical College Internship/Residency: Meharry Medical College Practice: Remelda Saunders-Jones, M.D., PA Specialty: Family Medicine
JOHN ROSS PURVIS, M.D. 1952 - 2021
CAPITAL MEDICAL SOCIETY 2021 MEETINGS CALENDAR CONTINUED FROM COVER
September 21, 2021 CME Panel Discussion – Updates and Debates in Cancer Screening 6:30 pm Location TBA
November 16, 2021 CME Health Disparities and Social Determinants 6:30 pm Location TBA
October 19, 2021 CME (2-Hours) Prevention of Medical Errors 6:30 pm Location TBA
December 2, 2021 CMS Foundation Holiday Auction Time and Location TBA
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
CMS UPDATES
MEDICAL LICENSURE EXTENDED UNTIL JUNE 30, 2021 On March 31, 2021, as part of the response efforts to the Novel Coronavirus 2019 (COVID-19), FL State Surgeon General Dr. Scott A. Rivkees issued Emergency Order 21-001 extending the licensure renewal expiration date for any professional license issued by the Department or a Department board or council until June 30, 2021. The license expiration date for Medical Doctors expiring January 31, 2021 is further extended to June 30, 2021. The full version of the State Surgeon General’s Emergency Order may be found at https://www.flhealthsource.gov/pdf/DOH-EO-21-001.pdf.
THE CAPITAL MEDICAL SOCIETY TAKES LEAD IN PUBLIC SERVICE ANNOUNCEMENT The Capital Medical Society partners with local hospitals and physicians to encourage patients to seek needed healthcare through the Public Service Announcement, "Don't Put It Off!" To view the “Don’t Put It Off!” PSA, visit: https://drive.google.com/file/d/1f32WFxsO3 3ot__1FsfCn0LIdfKQpGWBs/view.
Serving the needs of our patients in Tallahassee. Tallahassee Cancer Center 2351 Phillips Road, Tallahassee, FL 32308
R (850) 877-8166 FLCancer.com/TLC
R 888-GynOnc1 GynOncofTally.com CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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PROFESSIONAL NOTES
PROFESSIONAL NOTES On April 2, 2021, Dr. Alan Chen was commissioned as an officer in the United States Army Reserve Medical Corps. This day was a culmination of his personal development over the last few years. He is grateful for the many opportunities to succeed in his life in the United States. “This vow is my way of giving back to the greatest country on Earth, utilizing all my strengths and skills that I have gained to this point,” said Dr. Chen. Congratulations, Dr. Chen!
Dr. William Dixon, an interventional cardiologist at TMH, is the first physician in the Southeast to use a coronary intravascular lithotripsy system, or IVL — a breakthrough in treating patients with severe heart disease. In the treatment of heart disease, the IVL technology allows doctors to break up calcium using sonic pressure waves, or tiny shockwaves, through soft arterial tissue. Once the calcium has been cracked, the artery can be expanded at low pressure and a stent can be implanted to improve blood flow. Tallahassee Memorial HealthCare is now the only hospital in the Southeast and the fifth in the nation to use a coronary intravascular lithotripsy system. “This is one of the first major innovations for treating coronary artery disease in 30 years,” Dixon said in a statement. “It’s exciting to be starting a new chapter in the treatment of heart disease in some of our most complex patient cases, especially with technology that improves the safety of the procedure.”
Dr. Amy Neal recently joined the Capital Medical Society Membership Committee. Dr. Neal is on staff at Capital Health Plan. The CMS 2021 Membership Committee includes Kenneth Whithaus, M.D., Co-Chair; Amulya Konda, M.D., Co-Chair; Anthony Clark, M.D.; Jerry Ford, M.D.; Tracey Hellgren, M.D.; Nancy Loeffler, M.D.; xKenneth McAlpine, M.D.; Amy Neal, M.D.; David Robinson, M.D.; Andres Rodriguez, M.D.; and Hugh VanLandingham, M.D. Thank you, Dr. Neal!
Dr. Brence Sell served as Doctor of the Day in the Florida Legislature on March 30, 2021. His sponsor was Senator Loranne Ausley pictured here. She presented a Bill she has sponsored that will help disadvantaged children receive better early education. 6
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
PROFESSIONAL NOTES
The 2022 U.S. News & World Report medical school rankings include new categories for diversity and health profession shortage areas. FSU’s College of Medicine debuted in the top 20 in both categories and earned a top 50 ranking for primary-care production. The College of Medicine tied for No. 13 in diversity with 26 percent of students identifying as an underrepresented minority. The college also came in at No. 42 in primarycare production, with Nova Southeastern being the only Florida school producing more primary-care physicians during the time period measured. The college, founded on a mission to serve underserved populations with a focus on primary care, ranked No. 13 for percent of graduates practicing direct patient care in health professional shortage areas. The latest U.S. News data is based on 2012-2014 graduates, and more than 50 percent of the college’s M.D. graduates in that span are practicing in health professional shortage areas. “As the first new medical school of the 21st century, the college takes great pride in our mission of serving our communities, particularly for rural and underrepresented patients,” said College of Medicine Dean John P. Fogarty. “As a young medical school, it takes time to receive recognition of our 20-year effort to recruit students from these areas and produce graduates committed to service. Our pipeline is producing the results we expected and we’re hopeful this survey will continue to reflect that even more in the coming years.” Excerpt from Florida State University News 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.
Dr. Kishor Muniyappa 4012 Kelcey Ct Ste 103| Tallahassee, FL 32308
Phone 850.297.0351 | Fax 850.297.0352
Inspiring Good Health
www.TALLYGASTROHEALTH.com CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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CMS VIRTUAL LUNCHTIME LEARNING SEMINARS
CAPITAL MEDICAL SOCIETY VIRTUAL LUNCHTIME LEARNING SEMINARS ~ These seminars will be virtual until further notice ~ MARK YOUR CALENDARS FOR THE REMAINING SPRING 2021 LUNCH AND LEARN SEMINAR: May 19, 2021 Take Your Practice’s Revenues to the Max Think you’re getting the most money out of your practice? According to The Medical Group Management Association (MGMA), American medical practices lose $125 billion every year in unpaid and underpaid claims. So how do you stop the bleeding? During this webinar, we’ll show how you could discover thousands of dollars in lost practice revenues by analyzing scheduling gaps, copays collected, proactive billing, follow up, past-due collection efforts and more. Through case studies, you’ll see how a walk-through of your processes in each phase of your revenue cycle (including patient intake, mid-revenue cycle, and collections improvement) will help you find missed opportunities.
Learning Objectives: After our presentation, you’ll be able to: • Learn how to conduct a walk-through of the administrative and financial functions of each phase of their revenue cycle • Find missed opportunities for capturing more revenue • Determine better ways to fill the schedule • Evaluate the requirements for each third-party payors • Identify inconsistencies in coding and billing by practitioners Speakers: Nadia Batey, CPA and Jay Hutto, CPA, James Moore CPAs and Consultants Sponsor: Liz Thiele, TMH Federal Credit Union (https://www.tmhfcu.org/)
For more information or to RSVP, please contact Rosalie Carlin at (850) 877-9018 or rcarlin@capmed.org.
Registration Required Time: 12:30 PM to 1:30 PM No Cost for these virtual seminars.
On March 24th, Julie Overstreet, MBA, CPHRM, Risk and Patient Safety Consultant with MagMutual, gave an excellent program on Clinical Best Practices in Patient Documentation and Their Role in Avoiding Medical Liability.
We thank TMH Federal Credit Union for sponsoring the March 24th Virtual Lunchtime Learning Seminar. Liz Thiele attended as a representative from TMH Federal Credit Union (https://www.tmhfcu.org/).
We help your
practice
thrive…
so you can help your
patients thrive.
Healthcare Accounting and Business Solutions Nadia Batey, CPA, Partner Nadia.Batey@jmco.com (850) 386-6184
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
Tallahassee | Gainesville Daytona Beach | DeLand
jmco.com
CMS FOUNDATION NEW BOARD DIRECTOR
THE CAPITAL MEDICAL SOCIETY FOUNDATION BOARD OF DIRECTORS WELCOMES NEW BOARD DIRECTOR Patricia G. Holliday, MSW was elected to the Capital Medical Society Foundation Board of Directors on April 1, 2021. Welcoming her are continuing board members, John P. Mahoney, M.D., President; Walt Colón, D.M.D., Vice President; Nancy Loeffler, M.D., Secretary; David Stewart, M.D., Treasurer; J. Alan Cox, Esq.; H. Avon Doll, M.D.; Marlisha Edwards, M.D.; Paula S. Fortunas, M.A.; Terreze Gamble, M.D.; Tracey Hellgren, M.D.; David Jones, M.D.; Rohan Joseph, M.D.; Maribel U. Lockwood, M.D.; Al McCully, M.D., Emeritus; Faisal Munasifi, M.D.; Paresh Patel, M.D.; J. Brian Sheedy, M.D.; Joedrecka Brown Speights, M.D.; Jay Walton, D.D.S.; Barbara Williams, M.D.; and Charles Williams, M.D., Emeritus. Mrs. Holliday follows her passion by investing in the human services sector of the community in many areas. Her experience includes designing community-wide programs and initiatives to address pressing needs, writing the needs analysis for Florida A&M University to obtain its accreditation for the Master of Social Work degree, teaching grant-writing and grant management at the Florida State University, and serving as a member of the Community Advisory Board at Florida State University’s Institute for Family Violence Studies. Mrs. Holliday recently retired from the City of Tallahassee. As their Human Services Administrator, she coordinated the Community Human Service Partnership grant process. Mrs. Holliday was a strong advocate for local human service agencies and their clients. She has garnered the respect and gratitude of the human services agencies of Leon County for her many years of advocacy on their behalf. Mrs. Holliday earned a Master of Social Work degree from the Florida State University, specializing in indirect services, including program design and development and program evaluation. “Mrs. Holliday’s extensive background and passion for providing healthcare to all align with the CMS Foundation’s mission to improve healthcare access,” said Dr. John P. Mahoney, President, CMS Foundation. “We are grateful for her commitment to serve on the CMS Foundation Board of Directors and for her advocacy on behalf of the We Care Network.”
Wolfson Children’s and Nemours Children’s specialists are here for Leon County kids and providers. Our Wolfson Children’s Specialty Centers at Tallahassee Memorial HealthCare bring doctors from two nationally recognized children’s health organizations close to home. Specialties we provide in Tallahassee include: Pediatric cardiology to diagnose, treat and manage congenital heart conditions; on-site testing Appts: 850.629.4861 • Fax: 850.629.4859 Pediatric gastroenterology for diseases of the digestive tract
Pediatric urology for complex urinary and genital conditions
Pediatric pulmonology for common and complex lung conditions
Pediatric hematology for all types of acute and chronic blood disorders
Appts: 904.697.3600 • Fax: 904.697.3927 To learn more, contact Wolfson Children’s Business Development Specialist Faithe Galloway Zoda at 850.559.3072 or Faithe.Zoda@bmcjax.com. TMH.org/Wolfson ©2021 Baptist Health
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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CATCH MY STRIDE ACTIVITIES
March marked the launch of “Catch My Stride” walks and other outdoor activities to help keep Capital Medical Society members and their families connected safely. Using CMS member survey results, the CMS Social Events Committee chaired by Dr. Sarah Ko, scheduled three Saturday walks at local greenways and Cascades Park. Survey results showed increased interest in walks, dog park meet-ups, and organized kayaking excursions. Although the first walk at the Miccosukee Greenway experienced rainy conditions, those who attended still had a great time. Other walks included the J.R. Alford Greenway and Cascades Park. The walkers included practicing physicians, retired physicians, spouses, children, and pooches. Florida Blue donated bottled waters for this wellness initiative. Thank you to Dr. Sarah Ko, Dr. Russell Cole, Dr. Rohan Joseph, CMSA President Andrea Stephens, Shannon Boyle, and Pam Irwin for leading the walks. The CMS Social Events Committee has planned two May activities. Stay tuned and spread the word!
MARCH 6, 2021 – MICCOSUKEE GREENWAY
10 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
CATCH MY STRIDE ACTIVITIES
MARCH 20, 2021 – J.R. ALFORD GREENWAY
MARCH 27, 2021 – CASCADES PARK
WE APPRECIATE FLORIDA BLUE SPONSORING WATER BOTTLES FOR THESE ACTIVITIES.
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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3411 Capital Medical Blvd., Tallahassee, FL 32308 850-702-0365 CentralisHealth.com
GUARANTEED 40 MIPS POINTS ON INTEROPERABILITY By Lisa K. Rawlins, Health Care Consultant Get ready to increase your income via the MIPS interoperability bucket – it’s as easy as one, two, three! The Centers for Medicare and Medicaid Services recently announced the changes to the 2021 Merit-Based Incentive Payment System (MIPS), specifically in the category Promoting Interoperability Performance Category Measure 2021 Performance Period, while using your current certified EHR platform.
2. The HIE that I participate in is capable of exchanging information across a broad network of unaffiliated exchange partners including those using disparate EHRs, and does not engage in exclusionary behavior when determining exchange partners.
Fortunately, Centralis Health operates an EHRneutral cloud-based electronic data exchange service that works for everyone! Late last year, Centralis Health (formerly known as HIE Networks) was the first vendor/service provider to join the national eHealth Exchange. This allows the medical providers served by the company to join the eHealth Exchange at a much lower cost than if they joined directly. By joining Centralis Health, you’ll meet the newly defined standards in the MIPS Interoperability bucket.
What all this means for you, as a Centralis Health participant, is that HIE Interoperability requires very little effort. Contact our office and we’ll help walk you through the process of connecting to the national eHealth Exchange. The national eHealth Exchange is recognized as a bi-directional exchange, exchanging information across a broad network of unaffiliated exchange partners including those using disparate EHRs, and does not engage in exclusionary behavior when determining exchange partners.
The Health Information Exchange Measure, known as PI_HIE5, specifies that the MIPSeligible clinician or group must attest that they engage in a bi-directional exchange with an HIE to support transitions of care. In working with your Certified EHR vendor, the reporting requirements mandate that the MIPS-eligible clinician simply must attest YES or TRUE to the following: 1. I participate in an HIE in order to enable secure, bi-directional exchange to occur for every patient encounter, transition or referral, and record stored or maintained in the EHR during the performance period in accordance with applicable law and policy.
3. I use the functions of CEHRT (certified EHR) to upport bi-directional exchange with an HIE.
For medical providers not yet on our system, let us help you connect to us via your certified electronic health record and then to the national eHealth Exchange. Unlike many other organizations, Centralis Health can accomplish this transition in weeks not months, with very little disruption to your existing workflows. Even if you’re faxing your patient referral information, we can digitize that process for you, allowing you to onboard into the national eHealth Exchange via Centralis Health’s local health exchange. That’s what makes it as easy as one, two, three!
PAID ADVERTISEMENT 12
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
VIEWPOINT
I WAS WAITING FOR YOU TO VISIT By Jimmy L. Moss, M.D., FSUCOM Class of 2010, Anesthesiologist, Carle Foundation Hospital, Urbana, IL She never met me before, never spoke with me, but she knew. While she is in the hospital fighting for her life, her husband is in my ICU fighting for his. Same story. Same virus. Same me. Same us. Same shhhh...it does something to you. We talked and she echoed how throughout the day she was waiting for “someone” to come talk to her about what I was aiming to discuss. Not “his life,” but “his death.” She made peace before my arrival, and planned to maintain that same peace after I left. A peace...that she and him discussed multiple times; a peace that has carried them for nearly 40+ years as a couple. A peace that will never fade because their physical beings have been conquered, but rather one that will forever champion a smile that only their love can induce. We talked. No hugs. No warm embraces. Just words...and a request: “Can you call his sister?” ——————————— Cross Cover/PM Rounds -Pt is still severely hypoxemic; Acute Respiratory Failure 2/2 COVID-19 Pneumonia -We have been unable to safely transition to the supine position for > 36hrs -Still in AFIB w/ RVR while on Amio gtt; sedation has been optimized -I personally reviewed his chart; he has been intubated for ~7 days w/ no signs of improvement -Other than arrhythmias, he has no other reversible signs of severe organ dysfunction -Again, proning > 36hrs has not demonstrated any appreciable benefit -I had a lengthy discussion w/ his wife, she noted that she understands the severity of his condition -She states that she and her husband spoke in detail prior to hospitalization and he noted that he did not want “aggressive measures” -Pt is not a candidate for ECMO; he has received the most updated course of therapy for COVID-19 Pneumonia, w/o improvement -I explained that my concern is that he is suffering and that we are crossing the threshold of doing more harm than good
-She did not want chaplain services; they have no children; she would like for me to contact his sister and inform her as well -I noted that we will make arrangements for her to call into his room and say her goodbyes; she did not want to “see him like this” -I extended my condolences and assured her that we will continue to provide care and comfort. -Discussed plan with Nursing teammate and will update the pm Hospitalist attending Jimmy L Moss, MD ———————————— Prior to transitioning him to comfort care, I kept my word and spoke to his sister. Before I could offer my condolences, she started to endlessly thank me for all that we have done. In a moment when I was supposed to be extending my support, she was supporting...me. Me, the bearer of bad news was being told good things; good words...replacing heartfelt goodbyes. I asked if she would mind me having her share these same sentiments with our ICU team, and she agreed. Team gathered. Speakerphone. Number dialed. More good words. Words many of us haven’t heard since last summer; words that were lost during election drama and Capitol Hill invasion. Words that carried a sense of gratitude so deeply that all we could do...was stand around a landline device... designed for audible communication and tearfully be silent. His sister told me, “I wish you could have met him; wish you had a chance to know him before this. He wasn’t rich and didn’t have a lot of things...but he was a great man. He wasn’t just my brother; he was my mentor...my friend. My sister-in-law, his wife, is my second favorite person in the world...and he is my first. He was always helping others, always a people person and I’m thankful for his life and that you all will be with him during his death. Like my brother...you all are my heroes.” Thank you, Barb...a part of me, and I’m quite sure, a part of my team, was waiting for your words. Good words. Note: This patient story was shared with permission from the family.
-She voiced her understanding and wished to transition to comfort measures only CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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COVID-19 VACCINE UPDATE
Important Updates for Health Care Providers Regarding COVID-19 Vaccines April 5, 2021
Providers Authorized to Administer the COVID-19 Vaccine The list below contains health care professions whose governing practice act or federal guidance authorizes the administration of vaccines, including COVID-19 vaccines. If you have specific questions regarding a profession, please contact the respective regulatory board office at MedicalQualityAssurance@flhealth.gov. Profession
Legal Authority
Medical Doctors (includes all license types)
Section 458.305(3), Florida Statutes
Osteopathic Physicians (includes all license types)
Section 459.003(3), Florida Statutes
Physician Assistants
Section 459.022(4)(e), Florida Statutes Section 458.347(4)(e), Florida Statutes
Registered Nurses
Section 464.003(19), Florida Statutes
Advanced Practice Registered Nurses
Section 464.003(2), Florida Statutes
Licensed Practical Nurses
Section 464.003(18), Florida Statutes
Certified Nursing Assistants with Registered Nurse Delegation
Section 464.201(5), Florida Statutes
Paramedics
Section 401.272(2)(b), Florida Statutes
Pharmacists
Section 465.189, Florida Statutes, and Health and Human Services Guidance Memorandum Dated 9/9/2020
Registered Pharmacy Interns
Section 465.189, Florida Statutes, and Health and Human Services Guidance Memorandum Dated 9/9/2020
Registered Pharmacy Technicians
Health and Human Services Guidance Memorandum Dated 10/21/2020
Emergency Medical Technicians
Emergency Rule 64JER21-1 and Health and Human Services Guidance Memorandum Dated 3/12/2021
Dentists Licensed Midwives Optometrists Paramedics Physician Assistants Podiatric Physicians Respiratory Therapists Veterinarians
Health and Human Services Guidance Memorandum Dated 3/12/2021
The U.S. Department of Health and Human Services (HHS) issued new guidance on March 12, 2021, to expand the pool of qualified professionals able to serve as COVID-19 vaccinators. HHS has used its authority under the Public Readiness and Emergency Preparedness Act (PREP Act) to add additional categories of qualified people authorized to prescribe, dispense, and administer COVID-19 vaccines authorized by the U.S. Food and Drug Administration, including dentists, emergency medical technicians, midwives, optometrists, paramedics, physician assistants, podiatrists, respiratory therapists, and veterinarians. This action also authorizes medical students, nursing students, and other health care students in the professions listed under the PREP Act with proper training and professional supervision to serve as additional COVID-19 vaccinators under an established COVID-19 vaccine enrolled provider. More information about the PREP Act and
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COVID-19 VACCINE UPDATE
requirements to administer the COVID-19 vaccine for health care practitioners authorized under this guidance can be found at PHE.gov. Some of the requirements include: Documentation of completion of the Centers for Disease Control and Prevention COVID-19 Vaccine Training Modules, Documentation of an observation period by a currently practicing health care professional experienced in administering intramuscular injections, and Current certificate in basic cardiopulmonary resuscitation. HHS has also authorized physicians, advanced practice registered nurses, registered nurses, practical nurses, pharmacists, pharmacy interns, midwives, paramedics, emergency medical technicians, respiratory therapists, dentists, physician assistants, podiatrists, optometrists who have held an active license within the last five years, which is inactive, expired, or retired, to serve as COVID-19 vaccinator under an established COVID-19 vaccine enrolled provider. Employers can view the licensure status and disciplinary history for retired and inactive health care practitioners on the Department of Health’s website located here. COVID-19 Vaccine Reporting Requirements Florida Department of Health, Emergency Rule 64DER21-4, Florida Administrative Code, requires all enrolled COVID-19 vaccine providers to report vaccination data in Florida SHOTS within 24 hours of administration. This emergency rule follows Emergency Rule 64DER20-43, Florida Administrative Code, which expired March 14, 2021. The following data elements are required when reporting: (1) Administered at location: facility name/ID
(12) MVX (manufacturer)
(2) Administered at location: type
(13) Recipient address
(3) Administration address (including county)
(14) Recipient date of birth
(4) Administration date
(15) Recipient name
(5) CVX (Product)
(16) Recipient sex
(6) Dose number
(17) Sending organization
(7) IIS recipient ID
(18) Vaccine administering provider suffix
(8) Recipient race
(19) Vaccine administering site (on the body)
(9) Recipient ethnicity
(20) Vaccine expiration date
(10) IIS vaccination event ID
(21) Vaccine route of administration
(11) Lot number: unit of use and/or unit of sale (22) Vaccination series complete How Can I Become a COVID-19 Vaccine Provider? To become a COVID-19 vaccine provider, your practice or organization must be enrolled in the Florida State Health Online Tracking System (Florida SHOTS) and the Vaccines for Children/Adults Program (VFC/VFA). For questions or additional information, please contact the COVID-19 Vaccine Enrollment Desk at 833-701- 1397, or email CovidVaccineProgram@flhealth.gov. Click here to view the flyer with enrollment instructions: http://www.floridahealth.gov/programs-andservices/immunization/COVID-19VaccineInfo/_documents/covid-vaccine-provider-flowchart.pdf Florida SHOTS has a number of trainings available to help providers. These trainings can be accessed by visiting http://flshotsusers.com/. Florida COVID-19 Vaccine Weekly Pre-Book Request Opens The Florida COVID-19 vaccine weekly pre-book request is now open in Florida SHOTS. Weekly pre-book requests allow COVID-19 vaccine enrolled providers to share their ability and desire to receive COVID-19 vaccines. Requests do not guarantee an allocation will be made. This information will be used to assist leadership with planning activities throughout the state. For more detailed information, please click here. Helpful Resources Health care provider notifications - www.flhealthsource.gov/covid19 Florida Department of Health Immunization Section COVID-19 vaccine webpage http://www.floridahealth.gov/programs-and-services/immunization/COVID-19VaccineInfo/index.html Florida Department of Health COVID-19 webpage - www.floridahealthcovid19.gov
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PRACTICE MANAGEMENT
THE INFORMATION BLOCKING PROVISION OF THE 21ST CENTURY CURES ACT: WHAT DOES THE NEW RULE MEAN FOR PHYSICIAN PRACTICES By Jarrod Fowler, MHA, Director of Health Care Policy and Innovation, Florida Medical Association As if the byzantine laws and regulations regarding patient medical records and access thereto were not complicated enough, in 2016 Congress passed the 21st Century Cures Act, a 312-page piece of legislation that contains numerous unrelated provisions regulating healthcare. Including in this omnibus act is an “information blocking” provision that imposes penalties for interfering with the lawful sharing of electronic health records. Any physician that maintains an electronic health record system is subject to the prohibition on
ONC webinars https://www.healthit.gov/curesrule/resources/webinars ONC fact sheets https://www.healthit.gov/curesrule/resources/fact-sheets Information Blocking Resource Center for physicians and other providers https://infoblockingcenter.org/ Information on how to file a complaint on information blocking Actors—EHR vendors or otherwise (Report Information Blocking)
information blocking.
http://www.healthIT.gov/healthITcomplaints
“Information blocking” is defined as a practice that is likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information. If the practice is engaged in by a physician1, it is considered information blocking if the physician knows that such practice is unreasonable and is likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information.
Additionally, the FMA will soon be providing an additional webinar to its members, featuring live subject-matter experts that will both discuss the requirements at length and make themselves available to take questions.
This definition is extremely broad and without any guidance it would be virtually impossible for physicians to know what actions (or inactions) would constitute information blocking. To provide guidance, Congress conferred rulemaking authority on the Department of Health and Human Services (HHS) to “identify reasonable and necessary activities that do not constitute information blocking.” Pursuant to this rulemaking authority, the Office of the National Coordinator for Health Information Technology (ONC) published a final rule on May 1, 2020 implementing provisions of the 21st Century Cures Act related to electronic health information blocking, interoperability and the ONC Health IT Certification Program. Physicians and other “Actors” to whom the bill applies were required to comply with the information blocking requirements of this rule April 5, 2021. Penalties for violation of the information blocking provisions by physicians have not yet been determined by HHS. While HIE/HINs can receive up to $1 million in civil monetary penalties (CMPs) per violation, the only “disincentives” for physicians currently consist of a potential impact on the Merit-based Incentive Payment System (MIPS) payments for those physicians participating in the Promoting Interoperability Program. Enforcement of information blocking civil monetary penalties will not begin until established by future notice and comment rulemaking by the Office of the Inspector General. Physicians will not be subject to penalties until CMP rules are final. As for the content of the information blocking rules, there is a lot to digest. Rather than attempt to create a single treatise, this piece is meant to provide a brief 30,000-foot summary of the rule. Meanwhile, for practices ready to delve into additional detail, the AMA has created a two-part educational resource to help physicians and their medical practices understand develop an information blocking compliance program. Part 1 outlines what information blocking is, key terms to know, examples of information blocking practices and a summary of exceptions for when physicians may restrict the access, exchange or use of EHI. Part 2 will help physicians start down the path of compliance, including questions to consider, considerations for maintaining a compliance program and next steps. The AMA has stated that it will add additional resources to its webpage as the federal government releases new guidance. Below are several additional resources to help navigate the regulations:
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WHY DID CONGRESS ENACT THE INFORMATION BLOCKING PROVISION? The information blocking provision was enacted in response to concerns that some individuals and entities are engaging in practices that unreasonably limit the availability and use of electronic health information (EHI) for authorized and permitted purposes. As stated in the March 4th proposed rule, “these practices undermine public and private sector investments in the nation’s health IT infrastructure and frustrate efforts to use modern technologies to improve health care quality and efficiency, accelerate research and innovation, and provide greater value and choice to health care consumers. This provision will benefit physicians by prohibiting some of the practices engaged in by a number of EHR vendors and hospital systems that made it virtually impossible for some physician practices to switch from one EHR to another. Unfortunately, the provision will also add complicated new regulatory requirements that already overburdened physicians will have to navigate. EXACTLY WHAT INFORMATION DOES THE INFORMATION BLOCKING PROVISION APPLY TO? The definition of information blocking applies to electronic health information (EHI). Since EHI is not specifically defined in the Cures Act, ONC defined it to mean: •
Electronic protected health information; and
•
Any other information that: • is transmitted by or maintained in electronic media, as defined in 45 CRR 160.103; • identifies the individual, or with respect to which there is a reasonable basis to believe the information can be used to identify the individual; and • relates to the past, present, or future health or condition of an individua, the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual.
The ONC stressed that EHI is not limited to information that is created or received by a health care provider, rather the definition provides for an expansive set of EHI, which could include information on an individual’s health insurance eligibility and benefits, billing for health
PRACTICE MANAGEMENT
care services, and payment information for services to be provided or already provided, which may include price information.
2. Privacy Exception. It will not be information blocking if a physician does not fulfill a request to access, exchange or use EHI to protect an individual’s privacy, provided certain conditions are met.
De-identified data is excluded from the definition of EHI. EHI also does not include psychotherapy notes, or information compiled in reasonable anticipation of, or for use in, civil, criminal or administrative actions or proceedings.
3. Security Exception. It will not be information blocking for a physician to interfere with the access, exchange or use of EHI to protect the security of EHI, provided certain condition are met.
Initially, ONC will define EHI as the data elements in the United States Core Data for Interoperability (USCDI) standard. Almost all USCDI data elements are already captured in 2015 Edition certified EHRs today – which means that the information blocking policies will apply to the information that is likely available on a physician practice’s system. However, under ONC's rule, the definition of EHI will eventually expand beyond the USCDI. Starting May 2022, the EHI definition will include the full HIPAA electronic designated data set.
4. Infeasibility Exception. It will not be information blocking if a physician does not fulfill a request to access, exchange or use EHI due to the infeasibility of the request, provided certain conditions are met.
WHAT PRACTICES IMPLICATE THE INFORMATION BLOCKING PROVISION? To meet the definition of information blocking under the Cures Act, a practice must be likely to interfere with, prevent or materially discourage the access, exchange, or use of EHI. The ONC noted in the final rule because information blocking may take many forms, it is not possible to anticipate or catalog all potential types of practices that may raise information blocking concerns. The ONC emphasized that any analysis of information blocking necessarily requires a careful consideration of the individual facts and circumstances, including whether the practice was required by law, whether the actor had the requisite knowledge, and whether an exception applies. The ONC also pointed out that to implicate the information blocking provision is not necessarily to violate it.
5. Health IT Performance Exception. It will not be information blocking for a physician to take reasonable and necessary measures to make health IT temporarily unavailable or to degrade the health IT’s performance for the benefit of the overall performance of the health IT, provided certain conditions are met. •
There are a number of examples in the proposed rule as to what would be considered information blocking. To give one example, the information blocking provision would be implicated if a physician’s practice has the capability to provide same-day access to EHI in a form and format requested by a patient or a patient’s health care provider, but takes several days to respond to the request.
Exceptions that involve procedures for fulfilling requests to access, exchange or use EHI: 6.
Content and Manner Exception. It will not be information blocking for a physician to limit the content of its response to a request to access, exchange or use EHI or how it fulfills a request to access, exchange or use EHI, provided certain conditions are met.
7.
Fees Exception. It will not be information blocking for a physician to charge fees, including fees that result in a reasonable profit margin, for accessing, exchanging, or using EHI, provided certain conditions are met.
8.
Licensing Exception. It will not be information blocking for an actor to license interoperability elements for EHI to be accessed, exchanged, or used, provided certain conditions are met.
This subject will be dealt with extensively in the next few weeks. WHAT DOES THE INFORMATION BLOCKING RULE DO? Section 4004 of the Cures Act added language to the Public Health Services Act that defined practices that constitute information blocking when engaged in by a health care provider. The Act gave the HHS Secretary the authority to identify, through rulemaking, reasonable and necessary activities that do not constitute information blocking as defined in the Act. The ONC’s final rule does exactly that – it establishes 8 exceptions to the information blocking provision that define certain activities that would not constitute information blocking as defined in the Cures Act. WHAT ARE THE 8 EXCEPTIONS TO THE INFORMATION BLOCKING PROVISION? The ONC maintains that their 8 exceptions will support seamless and secure access, exchange, and use of EHI and offer physicians certainty that practices that meet the conditions of an exception will not be considered information blocking. The 8 exceptions are divided into two classes as set forth below: •
Exceptions that involve not fulfilling requests to access, exchange or use EHI:
WHO CAN I CONTACT FOR ADDITIONAL HELP OR INFORMATION? Please contact us at membership@flmedical.org with any additional questions you may have. __________________________________ The information blocking provisions are applicable to health information technology developers (HITs), health information exchanges (HIEs), health information networks (HINs) and health care providers. Physicians are included in the definition of “health care provider.” Physicians, if they engage in certain practices, can be considered HITs, HIEs or HINs for purpose of the Act. For purposes of this article, the focus will be on the effects of the information blocking provisions on physician practices and not on the requirements applicable to HITs, HIEs or HINs. 1
__________________________________ 1. Preventing Harm Exception. It will not be information blocking for a physician to engage in practices that are reasonable and necessary to prevent harm to a patient or another person, provided certain conditions are met.
Reprinted with permission from the Florida Medical Association
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MEDICAL/LEGAL
SCOPE BATTLES - NON-PHYSICIANS AREN’T SURRENDERING. ARE YOU? By Mary Thomas, Esq., Assistant General Counsel, Florida Medical Association, MThomas@flmedical.org The year 2020 was unkind to the practice of medicine, and I am not just talking about the unprecedented global pandemic. The Florida Legislature passed two massive scope bills that were then signed by the Governor almost immediately on the same day – an expedited timeline not often seen. House Bill 607 (2020) granted nurse practitioners an entryway to practice autonomously in the areas of primary care, family medicine, pediatrics, and internal medicine. While pharmacists had been pushing for years to have the ability to test and treat for the flu, the breadth of House Bill 389 (2020) was shocking, allowing pharmacists to manage chronic health conditions under a collaborative practice agreement with a physician and to test and treat for minor, non-chronic conditions under a physician protocol. “How did this happen?” is a question I have been asked many times. It is true that 2020 turned out to be a perfect political storm. In his last year as House Speaker, Rep. Jose Oliva made it no secret that his top priority was to expand scope of practice and, with no known future political aspirations, hard deals were his to broker. His aspirations were made more easily attainable after years of zealous advocacy from certain legislators and pharmacists, nurse anesthetists, and others packing the Florida Capitol’s halls wearing white coats session after session. But there is also a more painful truth: Physicians have become passive participants in their own profession. Out of over 25,000 Florida Medical Association members, only 879 are also members of the FMA Political Action Committee. I promise you that is not a typo, I did not leave off a zero. This is a problem. The sole mission of the FMA PAC is to elect medicine-friendly candidates. To truly understand what those 879 are up against, let us look a little more into the scope landscape at the national, state, and regulatory levels. National nurse practitioner associations drive the policies for their respective state organizations and further promote the idea of independent practice within nursing school programs. Upon completion of the program, regardless of whether it is operated by a credible institution or an online diploma mill, students emerge falsely confident that they can practice free of any supervisory safety measures. These national groups also conduct and publish their own studies about how unsupervised nurse practitioners will solve all the problems in modern medicine and subsequently cite their own studies when lobbying for expanded scope.
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
This sequence is not unique to nursing – plug in any other healthcare profession and you will see the same pattern. If you are still dismayed by the passage of HB 607 and 389, I understand. But frankly, there is no time to live in the past. Here is what the FMA is defending against in 2021: Legislation that would allow full independent practice for nurse practitioners in every “specialty” already has been filed. There is no doubt that the physician assistants will try to gain independent practice through this bill as well. Keep an eye on Senate Bill 160, which would give psychologists full prescriptive authority, including controlled substances. The CRNAs would like to replace “anesthetist” with “anesthesiologist” for no logical reason other than that is what the national associations are peddling. We also expect the “Eye Wars” to resume as optometrists will once again attempt to expand their prescriptive authority and perform ophthalmic procedures such as laser eye surgery. This is by no means an exhaustive list as the 2021 Session has yet to commence. Once a scope bill has passed, it is typically subject to rulemaking through one of the regulatory boards – and this typically further complicates advocacy efforts. Depending on the way the legislation is written, control of rulemaking may solely lie with the mid-level board or require some type of input from the Boards of Medicine and Osteopathic Medicine. HB 607 (2020), for example, created the Council on APRN Autonomous Practice, which is responsible for recommending to the Board of Nursing standards of practice for autonomous APRNs. There are four physicians, two from each medical board, who sit on this Council. However, the Board of Nursing has the authority to reject Council recommendations and, therefore, a method to silence physician voices. While the FMA and other physician groups lobby and actively participate in these meetings, it is not the same as lobbying members of the Legislature. Board members are Governor-appointed volunteers who, aside from the consumer members, are active participants in their healthcare profession. While some boards may be more friendly than others, at the end of the day, to vote the way physicians want is viewed as a vote against their own profession. In fact, members of these mid-level boards actively advocate for expanded scope, despite the fact their main charge is to protect the health, safety, and welfare of Florida’s patients. In this sense, it is much more difficult to get a favorable outcome at the regulatory level and further illustrates why it is critical to stop scope expansion at the legislative level.
MEDICAL/LEGAL
A fact that is underappreciated, or perhaps just unknown, is the broader support for scope expansion. This isn’t “physicians against nurses” or “physicians against optometrists” – this is physicians against all mid-levels, hospitals, insurance companies, consumer advocacy groups and so on. And that is just regarding scope battles. Constantly focusing on defense diverts a great deal of time and attention from initiatives that would benefit all healthcare providers and patients, such as legislation that would simplify prior authorizations and step therapy protocols. Unsurprisingly, mid-level providers are silent when it comes to advancing legislation that would directly benefit patient care.
The landscape may be bleak, but the opportunity to close ranks is present. It is more important than ever to develop personal relationships with your local legislators outside of session. Physicians are in the best position to explain the importance of medical training and share firsthand the hardships faced during daily practice. Never underestimate the value of personal relationships and participation in the FMA PAC. Help us help you practice medicine. ___________________ Reprinted with permission of Hillsborough County Medical Association publication, The Bulletin, Vol. 66, No. 4, Spring 2021.
THE FRACTIONAL GENERAL COUNSEL QUESTION OF THE WEEK: IS YOUR MEDICAL SOFTWARE PROVIDER USING THE CLOUD TO STORE DATA? By Steven Boyne, Esq., Florida Healthcare Law Firm These days everyone is migrating to the Cloud. This exodus away from servers to the cloud is driven by the flexibility, security and pricing that Cloud services such as AWS (Amazon Web Services), Microsoft’s Azure, Google Cloud and IBM offer software developers. It is a pretty safe assumption that most healthcare software vendors are currently using the Cloud, or they plan on using the Cloud. So, why do you want to ask that question? Because, believe it or not, most major cloud service providers do not offer HIPAA compliance by default. They can all be configured to be HIPAA compliant, and as far as the regulators are concerned it is up to the Covered Entity (i.e. the Healthcare provider) to enforce the compliance. If AWS or Azure has a data breach and your patient’s data is involved, then you can be held liable. To close this loophole, you should ask your software vendor (1) do they store data on the Cloud; and (2) if so, to provide evidence that they are configuring their interface and services with the Cloud provider to ensure HIPAA compliance. If the
vendor doesn’t know the answer, or is unwilling to discuss how they utilize the tools available by the Cloud providers to make the Cloud HIPAA compliant, then it may be time to find another vendor. ___________________ The Florida Healthcare Law Firm serves as an HCMA Benefit Provider providing legal services to members. FHLF offers a complimentary hotline, an “Online Store,” and free webinars for HCMA members. Visit the innovative resource center at www.FloridaHealthcareLawFirm.com or contact Jeff Cohen at JCohen@floridahealthcarelawfirm.com. ___________________ Reprinted with permission of Hillsborough County Medical Association publication, The Bulletin, Vol. 66, No. 4, Spring 2021.
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REFLECTIONS FROM THE EDITOR
ONE YEAR INTO RETIREMENT By Frank Skilling, M.D. “You’re telling me that you’re not nostalgic, so give me another word for it…” - Joan Baez to Bob Dylan in “Diamonds and Rust” A year ago, I saw my last patient in private practice. It was on March 19th, and I left the office thinking that I would be returning again…sometime. Because of COVID-19, our practice was forced to shut down entirely for over two weeks. Emergency appointments were made, of course, but routine exams and all outpatient surgeries were cancelled. As the practice re-opened, we were restricted to how many physicians, staff, and patients could be inside the building at one time. By the beginning of June, it was obvious that our practice wouldn’t be able to schedule me, even part-time, for several more months. I decided that it was time to retire. I then wondered how I was going to feel being without a profession that I’d devoted over a half century of my life to. Surprisingly for me, it wasn’t as hard as I conceived it would be. I had already reduced my schedule to a part-time office practice four years ago. Fortunately, my wife Karen and I immediately became quite busy supervising two grandchildren who arrived for an extended stay because their pre-school in Atlanta had shut down. Our son Bennett is a firefighter with DeKalb County, and his department was swamped with calls related to COVID emergencies. He felt it was safest to have his wife and children stay with his in-laws and us in Tallahassee till things quieted down. That stay lasted for three and a half months. We live in an old neighborhood that’s excellent for strolling, so I started taking a daily walkabout for at least an hour. When the City of Tallahassee re-opened the pools, I started alternating my walk with an hour’s swim. I have been a fitness swimmer for twenty years, so I was happy to resume lap swimming. Since my wife had grown tired of grocery shopping, I became habituated to going to Publix several times a week, once I got used to wearing the mask that Karen had made. With a mask on, I wasn’t concerned about contracting COVID since I used hand sanitizer frequently and tried to social distance. I am also now familiar with the layouts of Fresh Market and Whole Foods, but I still like Publix best. Between supervising the grandkids, scooting around Publix, and exercising, I didn’t have time to think about what I was missing. I stopped by the office to check on mail and messages, but the word that I was retired got out quickly, and I received several nice notes from former patients. It took a few more months to dispose of my personal desk and bookcases, which were heirlooms I’d inherited from my father. The desk was burled walnut and probably 130 years old. He purchased it at a second-hand shop in Washington, DC in 1935, and he used it 20 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
for his personal desk in his private medical practice. I inherited it from him and used it in my office. It now belongs to my son and daughter-in-law in Atlanta. I was an English major at Spring Hill College, a Jesuit liberal arts school, in the 1960s, and I read many of the classics in the literary canon of the time. However, as I got older, I realized that I had been looking at them with the mind of a twentyyear-old, and I felt that some of them deserved re-reading. At that time, I had been fascinated with the 19th century Russian novelists, but I had no frame of reference to go by. I didn’t know much about Russian history, except that the October 1917 revolution brought the downfall of the tsar and put the communists in charge. So, I took an online OLLI class through FSU on Romanov Russia, which opened my eyes to the complex story of the country and its peoples. This spring, I’m taking another OLLI course on Putin’s Russia. I read a cultural history that explained what I wanted to know about the novelists who were trying to change the traditions of the country before the fall of the empire. Now I’m embarking on a trip with Dostoevsky in Crime and Punishment. His Brothers Karamazov is next, and I’d like to re-read Tolstoy’s War and Peace and Anna Karenina. My fear now is that I’ll die before I get through them again. So, you ask, do I miss practicing medicine? Am I nostalgic? Yes, in a way. I miss the contact with patients and being able to help people navigate the problems that life throws at all of us medically. I miss the encounters and stories of some patients that stretched out over decades. I read the obituaries to see who has passed away. I’m heartened when someone tells me that I was able to help their child many years ago, and now that child is a productive member of society. But, and this is a BIG BUT, I definitely don’t miss the morass of the electronic health records that controls every aspect of practice; I don’t miss compliance with all the managed care rules that govern physicians’ ability to prescribe medications; and I don’t miss the constraints that compliance with COVID restrictions has placed on all patients and providers. So, in response to Joan Baez’s query, I’m not nostalgic for medicine the way it’s currently practiced, and I don’t have another word for it. I have volunteered giving vaccinations at the TMH drivethrough facility. I’m inspired and truly impressed with the public health physicians, epidemiologists, laboratory scientists, vaccine manufacturers, nurses, ICU specialists and first responders who have taken up the mantle and waged into this desperate fight. In a way, I’d like to be back in the public health fight as a practitioner, but I know that I have to get through several more Russian novelists before I’ll feel I have accomplished something. One thing I’ve learned from reading them: Russian novels don’t have happy endings. I don’t think that the pandemic will have one either.
SIMPLER TIMES
A VISIT WITH MAMA AND GRANDMA By Charles D. Williams, M.D., FACR, FAAP (“Pedro”) It has been a tradition in South Georgia to periodically visit the burial plots of relatives who have passed on and to make sure the grounds were being kept up and to place some flowers at the grave site. With Mother’s Day coming up, Millard (my Dad) and Pedro decided to visit Mama’s and Grandma’s resting place and take some flowers. Mama loved daisies. When Pedro was a little boy, he’d bring flowers to Mama and say, “Flowers for Mama. Here’s you a bouquet” and she’d hold him close. They weren’t fancy and he’d picked ‘em himself, but over the years they became Mama’s favorite bouquet. Pedro picked up Millard early one Sunday morning and went over to Mama’s cemetery, which was located next to Colquitt Regional Medical Center on the south side of Moultrie. Pedro didn’t know why the hospital and the cemetery were located next to each other. Upon arrival Pedro started walking slowly over to where Mama was resting and looked down. As Pedro stood there he realized how much he missed Mama. He recalled one time when the well went dry, he heard Mama say, “You don’t miss the water until it’s gone” and now here on Mother’s Day, Pedro knew exactly what she meant. Pedro then bent over and placed the flowers and once again said, “Flowers for Mama. Here’s your favorite bouquet.” Millard and Pedro without speaking a word then left to go have a little talk with Grandma. She had been laid to rest next to Grandpa Williams at Big Creek Cemetery south of Coolidge, Georgia. While traveling south on 319, Pedro said to Millard, “We have a lot of relatives without problems, troubles or worries and all of ‘em are equal. Most of ‘em are resting at Hopewell Cemetery.” Millard then said, “When you think you have a lot of problems and troubles, you need to think about that.” Upon arrival at Big Creek Cemetery they started walking toward Grandma’s plot. They passed by one tombstone where the epitaph said “Devoted Family Man”. The epitaph was either lying or the wrong person was in the hole. They then got over to Grandma’s site and realized she still influenced their lives long after she had been gone. She had been a major character in their lives. At that moment Pedro remembered the words of Robert Orr:
Upon standing over Grandma’s grave, a peacefulness set in and it seemed to help Pedro and Millard more than it helped Grandma. Pedro remembered that Grandma turned to family, a higher power, and to humor. She poked fun at herself and at things beyond her control. She said not to make a joke out of life, but a sense of humor would help us tolerate the unpleasant and cope with the unexpected and that it would add balance to the tightrope of life. As he stood there Pedro felt that he could almost hear Grandma asking if he still had on a clean change of underwear. As Millard and Pedro continued to stand there, Pedro said, “Grandma, I made it. I’m a real doctor.” He didn’t have the heart to tell her that he was a Radiologist. He just continued and said, “Grandma, I can now write prescriptions.” Pedro kept thinking back and remembered Grandma telling him over and over to get his education. She pointed out that this would allow him to be himself without folks thinking that he was ignorant or illiterate. Then Pedro remembered that Oleen was told that her son was illiterate. Oleen replied, “That’s a dad-burned lie. My son ain’t illiterate. I was married almost two months before he was born.” Anyhow, Pedro silently thanked Grandma for inspiring, guiding, and prodding him to get his education. By now the sun started goin’ down and Millard and Pedro looked down at Grandmama’s grave and began singing, “In the sweet by and by, we shall meet on that beautiful shore.” Pedro took the low part and Millard took the high part. When it was all finished, Millard turned to Pedro and asked, “When I reach my journey’s end, will you come on Father’s Day and sing a song for me?” Pedro stood there lookin’ directly at Millard with a lump in his throat unable to answer, but Millard already knew the answer and the sun finished goin’ down. Reprinted with author permission from More Simpler Times.
Dr. Williams’ sequel book, More Simpler Times, can be purchased from the Capital Medical Society. All proceeds from the book are donated to the Capital Medical Society Foundation’s We Care Network program. The total sales from his books have raised over $39,000 for the CMS Foundation’s We Care Network.
“They are not dead who live in lives They leave behind In those whom they have blessed They live a life again And shall live through the years.” CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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HONOR A DOCTORS' DAY
HONOR A DOCTORS’ DAY, IN CELEBRATION OF NATIONAL DOCTORS’ DAY, ENCOURAGES PHYSICIANS AND DENTISTS AND PROVIDES ADDITIONAL GIFTS FOR THE CAPITAL MEDICAL SOCIETY FOUNDATION By Pam Irwin, Executive Director The COVID-19 pandemic has placed significant strain on physicians. Words of encouragement mean a lot to physicians at any time. When they are received during a pandemic, they can be the balm to a weary soul. In late February, and during the entire month of March, the Capital Medical Society Foundation received Honor A Doctors' Day tribute gifts to recognize National Doctors' Day. The tributes encouraged recipients and provided additional funding for the Capital Medical Society Foundation. Grateful patients, colleagues, family members, and friends participated and generously supported the CMSF's programs and initiatives, including the Area of Greatest Need, the We Care Network program, and the We Care Network Endowment. The COVID-19 pandemic creates ongoing challenges for physicians, medical students, medical practices, and hospitals. The CMSF is especially appreciative of all donors who gave to celebrate Honor A Doctors' Day. Patients, families, and colleagues are proud to support dedicated physicians working together to improve health. It is a pleasure to share a few of the many personal words of gratitude that will describe the positive impact these physicians have in the practice of medicine. We appreciate many of the donors allowing us to share their tributes publicly. Jill Bauer shared these encouraging words about her son, Jesse Blake Bauer, M.D.: “So proud of my son, Jesse Blake Bauer, M.D. He is an intelligent, caring, and overall excellent provider of quality care in Leon County!” Gavin Boone shared these kind words about Roy Forman, M.D.: “Dr. Roy Forman, Happy Doctors’ Day! Congratulations on a lifetime of caring for others as you would for yourself and better!!”
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Rosalie Carlin honored Maribel U. Lockwood, M.D. with the following comment: “Thank you for being my guardian angel in 2020. I can never thank you enough for all you did for me!” Pam Irwin honored Temple Robinson, M.D. with the following comment: “Thank you for your dedication to improving access to healthcare for all.” Pam Irwin honored Hugh VanLandingham, M.D. with the following comment: “Thank you for proactively taking care of my health. Keep singing too!” Temple Robinson, M.D. honored her colleague, Alma Littles, M.D. with these kind words: “I want to be like you when I grow up.” Thank you for the gifts and encouraging words to celebrate “Honor A Doctors’ Day” – National Doctors' Day. Please continue to celebrate and recognize the hard work of all doctors every day. Make a gift today, to support the CMS Foundation. Visit: https://capmed.org/donate/ or mail your gift check, payable to the CMS Foundation, 1204 Miccosukee Road, Tallahassee, FL 32308. HAPPY NATIONAL DOCTORS’ DAY
COMMUNITY PARTNERSHIP THROUGH THE WE CARE NETWORK
COMMUNITY PARTNERS IMPROVE ACCESS TO HEALTHCARE THROUGH THE WE CARE NETWORK The Rotary Club of Tallahassee Helps Improve Access to Healthcare Pam Griggs, Community Services Director for the Rotary Club of Tallahassee presented a $2,500 grant to Executive Director Pam Irwin and We Care Network Program Coordinator Diana Bixler on March 18, 2021 for the Capital Medical Society Foundation’s We Care Network program. “Rotary’s focus on disease prevention and treatment aligns perfectly with the program’s goal to improve access to specialty healthcare for low-income, uninsured adults in Leon, Gadsden, Jefferson, and Wakulla counties. The Rotary Club of Tallahassee has been a two-decade partner in improving community health outcomes. We are grateful for their support,” said Pam Irwin.
Florida Dental Association Foundation Awards Grant to Improve Access to Oral Healthcare The Florida Dental Association (FDA) Foundation and the We Care Network are longterm partners to increase access to better oral healthcare for the uninsured and underserved. Greg Gruber, Chief Financial Officer from the FDA, and Kristin Badeau, Foundation Coordinator from the FDA Foundation awarded a 2021 Project: Dentists Care grant to the Capital Medical Society Foundation, Inc.’s (CMSF) We Care Network Program Coordinator, Diana Bixler; Senior Case Manager and Dental Coordinator, Roshanda Dorsey; and CMSF Executive Director, Pam Irwin on April 7, 2021. The $5,000 grant for the CMSF’s We Care Dental Network program will provide funding for dentures, crowns, and transportation assistance for eligible We Care Network patients in 2021. “The CMSF’s We Care Network dental component provides a service to those in need that is unique and special. The FDA Foundation has been a consistent partner and contributor to the success of this program that benefits our community members in such a special way. Thank you FDA Foundation for your efforts and work with the We Care Network and us local dentists,” said Walter E. Colón, D.M.D., Vice President of the CMSF Board of Directors, Chair of the We Care Dental Network Committee, and a donating We Care Dental Network provider. CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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DONATE TO THE CMS FOUNDATION
Donate to the CMS Foundation – We Thank Our Donors We thank the following donors who made a gift to the CMS Foundation this past month: Honor a Doctor – Capital Medical Society Foundation – Area of Greatest Need Pam Irwin – In Honor of Dr. Temple Robinson and Dr. Hugh VanLandingham Debra Placilla – In Honor of Dr. William Placilla Gloria Rollins – In Honor of Dr. Hugh VanLandingham Honor a Doctor – We Care Network Rosalie Carlin – In Honor of Dr. Maribel U. Lockwood Gloria Rollins – In Honor of Dr. Andres Rodriguez Steve and Teresa Sarbeck – Through Their Donor-Advised Fund – In Honor of Al McCully M.D. Honor a Doctor – We Care Network Endowment Temple Robinson, M.D. – In Honor of Dr. Alma Littles Scholarship Fund David Bellamy, M.D. – In Memory of Stella Schmahl Cottrell David Bellamy, M.D. – In Memory of Meliton Morales David Bellamy, M.D. – In Memory of Jean Young Sieloff We Care Network Florida Dental Association Foundation – for dentures, crowns, and transportation assistance for We Care Dental Network patients Rotary Club of Tallahassee Your gifts to the Capital Medical Society Foundation transform lives in the Big Bend.
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DONATE TO THE CMS FOUNDATION
The Impact of Private Support: The 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 the We Care Network and the We Care Network Endowment Fund. More than $112.3 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 2019-20, which ended June 30, 2020, more than $6.9 million in health care was donated. Gifts support the operational expenses of the program including salaries and benefits of the case management team who coordinate the donated care. ➢ To provide incentives to keep medical students trained at the 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. $31,000 was awarded in 2020. ➢ Gifts to the Capital Medical Society Foundation help provide operational resources for the Capital Medical Society Foundation. In addition, modest grants are awarded to area non-profits whose programs improve access to healthcare for the underserved. In 2020, the CMSF awarded a total of $10,000 in grants to Elder Care Services for their In-Home Services Program and the Big Bend Hospice Foundation for bereavement services. Gifts to Honor and In Memoriam:
You can make a gift 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. The 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 make a gift at any time to one of the 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) The Anesthesiology Associates of Tallahassee Scholarship Endowment 6) Scholarship Fund 7) The Ronald G. Pickett Endowment 8) P hysician Wellness Fund Gifts should be made payable to the CMS Foundation and indicate on the memo line of your check to which designation you would like to give. Bring your check to the CMS Office or mail it: Capital Medical Society Foundation ~ 1204 Miccosukee Road ~ Tallahassee, FL 32308. Gifts may be made by credit card or direct debit from the CMS website. 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 or after hours at (850) 559-8611 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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CMS FOUNDATION: WE CARE NETWORK
FOUNDATION
We Care Network
THANK YOU To our CMS members and We Care Network partners who provided healthcare to new patients in March 2021. Your generosity and support of the We Care Network makes a difference.
Physicians Christopher Babl, M.D. Julia Barry, D.O. Venkata Bavikati, M.D. Marie Becker, M.D. Shelby Blank, M.D. Tim Broeseker, M.D. Robert Brumberg, D.O. Viet Bui, M.D. David Burns, M.D. Carlos Campo, M.D. Joseph Camps, M.D. Francisco Carpio, M.D. Stephen Carr, M.D. Raymond Cottrell, M.D. William Dixon IV, M.D. H. Avon Doll, M.D. Chesley Durgin, M.D. Amara Emenike, M.D. Jerry Ford, M.D. Hong Gao, M.D. Gian-Carlo Giove, M.D. Muhanad Hasan, M.D. Todd Hewitt, M.D. Marc Inglese, M.D. Okanta Jackson, M.D. Barbara Jaeger, M.D. Amit Jain, M.D. Beverly Johnson, M.D. Lawrence Kaelin, M.D. Arjun Kaji, M.D. John Katopodis, M.D. Farhat Khairallah, M.D. James Killius, M.D. Ben Kirbo, M.D. Jeffrey Kirk, M.D. Fang Sarah Ko, M.D. Maribel U. Lockwood, M.D. Deanna Louie, M.D. Robert Lott, M.D. Kurt Luhmann, M.D. Tod Morris, M.D. Manoela Mota, M.D. Christopher Murphy, D.O. Jayan Nair, M.D. Charles Newell, M.D. Michael Pentaleri, M.D. Jorge Perez de Armas, M.D. Cybelle Pfeifer, M.D. Ovidiu Popa, M.D. James Renehan, M.D. Allison Retzer, M.D.
Stephen Richardson, M.D. Adrian Roberts, M.D. Andres Rodriguez, M.D. Abel Romero-Corral, M.D. Tim Ruark, M.D. Eliot Sieloff, M.D. Gadi Silberman, M.D. Hardeep Singh, M.D. Joshua Somerset, M.D. Bhavik Soni, M.D. Joseph Soto, M.D. Amanda Stephens, D.O. Lucas Stowers, M.D. Christopher Sundstrom, M.D. Timothy Sweeney, M.D. Briana Thompson, M.D. Ernesto Umana, M.D. Alexander Ramirez Valderrama, M.D. Beatriz Cepeda Valery, M.D. Kaisa van der Kooi, M.D. Carl Vegas, M.D. Andrea Venturini, M.D. David Vermess, M.D. Robert Watson, M.D. Tony Weaver, M.D. William Yaakob, M.D. Samuel Yu, M.D. Dentists Walter Colón, D.M.D. John Dozier, D.M.D. Aixa Guzman, D.M.D. William McFatter, D.D.S. Lawrence Pijut, D.M.D. Facilities Advanced Urology Institute Airway Works, LLC Anesthesiology Associates Apalachee Primary Care Beachton Denture Clinic BioTelemetry, Inc. Bond Community Health Center Capital Premier Womens Health, PA Capital Regional Vascular Surgery Care Point Health & Wellness Center Centre Pointe Dental Group CESC Dental Clinic Deborah ZurSchmiede PhD LCSW Dermatology Associates Digestive Disease Clinic Eye Associates of Tallahassee Family First Wellness Center, LLC Florida Cancer Specialists & Research Institute FSU PrimaryHealth Gadsden County Health Department Jessie Furlow Medical Center Ketchum, Wood, & Burgert Pathology Associates Lawrence J. Pijut DMD PA Madison Medical Center Neighborhood Medical Center North Florida Nephrology Associates North Florida Women’s Care Periodontal Associates of North Florida
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Radiology Associates of Tallahassee Southeastern Surgery Center Southern Medical Group, P.A. Tallahassee Diagnostic Imaging Tallahassee Ear, Nose, and Throat Tallahassee Memorial Family Medicine Residency Program Tallahassee Memorial HealthCare TMH Physician Partners Cancer and Hematology TMH Physician Partners Cardiology and Internal Medicine TMH Physician Partners Cardiothoracic Surgery Specialists TMH Physician Partners Gynecologic Oncology Specialists TMH Physician Partners Pulmonary, Critical Care, and Sleep Specialists TMH Physician Partners Radiation Oncology Specialists TMH Physician Partners Heart Rhythm Clinic TMH Physician Partners Surgical Specialists TMH Physician Partners Urology Specialists TMH Physician Partners Wakulla TMH Rehabilitation TMH Transition Center Tallahassee Neurological Clinic, P.A. Tallahassee Plastic Surgery Clinic Tallahassee Orthopedic Clinic TOC Canopy Tallahassee VA Clinic Vascular Surgery Associates Wakulla County Health Department Wakulla Medical Center Womens Clinic Women’s Imaging Center
Please contact Diana Bixler at dbixler@capmed.org or 201-0130 if you are a We Care Network volunteer and you provided volunteer specialty care in the month of March 2021, 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. In addition, 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) 2010085 or mail to 1204 Miccosukee Road, Tallahassee, FL, 32308. Thank you!
CMS FOUNDATION: WE CARE NETWORK
We thank our referring providers from March 2021:
Ebonie Allen, APRN
David Keen, M.D.
Charlie Richardson, M.D.
Anne Ananga, APRN
Farhat Khairallah, M.D.
Carla Robertson, APRN
Katrina Ball, APRN
Fang Sarah Ko, M.D.
Tim Ruark, M.D.
Karen Bartley, M.D.
Amulya Konda, M.D.
Karen Russell, M.D.
Daniel Breivogel, APRN
Stefanie Kreamer, M.D.
Lucilita Salvador, P.A.
Fran Bridges, APRN
Elaine Larkins, APRN
Jamey Sarvis, M.D.
Frances Carney, APRN
Jessica Lea, APRN
Jeannine Silberman, M.D.
Stephanie Chandler, APRN
Ashok Manocha, D.D.S.
Hardeep Singh, M.D.
Victor Chou, D.M.D.
Damon McMillan, M.D.
Sharnjeet Singh, P.A.
Melba Colon-Renta, M.D.
Kelley Miller, APRN
Jon Soble, M.D.
Deborah Congdon, APRN
Marcia Morris, APRN
Abisoye Somorin, APRN
Easa Darwish, APRN
Manoela Mota, M.D.
Alanna Steaple, APRN
Elizabeth Dickens, M.D.
Christopher Murphy, D.O.
Frank Swerdzewski, D.D.S.
Nathalie Esellem, APRN
Charles Murrah, M.D.
Franckel Taylor, APRN
Cynthia Evans, APRN
Chukwuma Okoroji, M.D.
Briana Thompson, M.D.
Alberto Fernandez, M.D.
Rose Origa, APRN
Faye Tinson, APRN
Sharron Foster, M.D.
Jorge Perez de Armas, M.D.
Barrett Tolley, D.D.S.
Gabrielle Gardner, APRN
Lisa Perkins, APRN
Teresa Tullos, APRN
Charmaine Gilmore, APRN
Lawrence Pijut, D.M.D.
Kaisa van der Kooi, M.D.
Muhanad Hasan, M.D.
Fabiola Puga, M.D.
Dwanna Ward-Boahen, APRN
Hantz Hercule, M.D.
Stephen Quintero, M.D.
Jeffrey Wasserman, D.O.
Todd Hewitt, M.D.
Hussein Rayatzadeh, M.D.
Shana Wood, APRN
Okanta Jackson, M.D.
James Renehan, M.D.
Anneka Johnson, APRN
Brandi Richardson, APRN
DURING THE MONTH OF MARCH 2021, THE WE CARE NETWORK: RECEIVED 250 REFERRALS, WITH 132 PATIENTS NEW TO THE PROGRAM
SCHEDULED 136 APPOINTMENTS WITH VOLUNTEER PHYSICIANS AND DENTISTS
$472,685.90 IN DONATED CARE WAS REPORTED BY WE CARE VOLUNTEERS
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Cap Scan Newsletter 1204 Miccosukee Road Tallahassee, FL 32308
Your gifts to the Capital Medical Society Foundation transform lives in the Big Bend.