AUGUST EDITION, VOLUME 2018, NO. 8
IS YOUR PRACTICE BREAKING THE LAW? JULY 9, 2018 By Pam Irwin, CMS Executive Director On July 1, HB 21, the new Opioid Prescribing Law went into effect. And based on the number of calls and feedback we are receiving at the office, a number of practices may not be in full compliance with the law. Here’s a quick eight question checklist.
breaking the law. You’ll want to familiarize yourself and your practice quickly.
• Are you checking E-FORCSE for every Schedule drug prescription? • Are you limiting opioid prescriptions to a 3-day supply? • If you are writing opioid prescriptions up to 7 days, are you writing “Acute Pain Exception” on the script? • Are you documenting the specific reason for the Acute Pain Exception in the script and chart? • Does every member of your staff who accesses E-FORCSE have their own individual login? • When prescribing Schedule II drugs for traumatic injury with Injury Severity Scores greater than or equal to 9, are you prescribing an opioid antagonist? • Are you seeing patients in your office and checking E-FORCSE for every prescription for Schedule drugs (including chronic pain)? • If you have experienced down time with E-FORCSE, are you documenting the event and limiting that script to a 3-day supply, regardless of the Schedule of the drug? If you are able to say 100% YES to all of these questions, then congratulations, you are in compliance with the new law. If not, you might inadvertently be
BUT, why is it showing as a required course for my license renewal on CE Broker if I don’t have a DEA license? The reason that this course is listed on the physician’s CE Broker account as possibly being a requirement is that FL law now requires FL-licensed prescribers who are DEA-authorized to prescribe scheduled drugs to take this course as part of their CME required for renewal. At this point, Dept. of Health (DOH) does not know which physicians have DEA registrations and which do not. DOH will soon be sending an email to all licensees who can potentially have a DEA registration and asking them to indicate on their profile if they are DEA-registered or not. For those who indicate that they are not registered with the DEA and authorized to prescribe scheduled drugs, CE Broker will remove this from their list of courses required for renewal. CONTINUED ON PAGE 3
CAPITAL MEDICAL SOCIETY 2018 MEETINGS CALENDAR August 25, 2018 Connect the Docs CMS/CMSA Family Picnic 11:00 am – 2:00 pm Maclay Gardens ($6 per car entrance fee)
September 18, 2018 CMS Membership & CME Meeting Addressing the Opioid Epidemic (2-Hour CME) Panel: Justin French, Tallahassee Police Department; E. Victoria “Tori” Penny, J.D., Henry Buchanan, P.A.; Celeste Philip, M.D., Florida Surgeon General; Matthew Standridge, M.D., TMH Physician Partners; and Sam Ashoo, M.D., Tallahassee Memorial Hospital, Bixler Emergency Center, Moderator 6:00 pm - Maguire Center for Lifelong Learning at Westminster Oaks CONTINUED ON PAGE 11
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
Practice Management.................................................................1 CMS/CMSA Connect the Docs Family Picnic......................5 Announcements..........................................................................6 Professional Notes......................................................................7 Physician Wellness......................................................................9 CMS News.................................................................................... 11 CMS Lunch and Learn.............................................................. 12 Viewpoint.................................................................................... 14 Medical/Legal............................................................................ 15 CMS Foundation........................................................................ 17
Kenneth Whithaus, M.D., Secretary/Treasurer
CMS Foundation: We Care Network.................................... 18
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.
{AUGUST 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 Tristan Brooks, D.O./Alex Vanderby, M.D. Internal Medicine Residents Joshua Hickman, D.O./Luba Muaddi, M.D. General Surgery Residents Shlermine Aupont, M.D./Blake Davis, 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
Oliver Reyes, D.O. – 1st Cielo Rose, D.O. – 1st Katherine Mackenzie, M.D. – 1st Michael Douso, M.D. – 2nd Christopher Rumana, M.D. – 3rd Ronald Ray, M.D. – 4th Stacia Groll, M.D. – 5th William Paul Sawyer, M.D. – 5th Bob Soni, M.D. – 6th Emily Ashmore, M.D. – 7th T. Adam Oliver, M.D. – 7th John L. Williams, Jr., M.D. – 7th T. Dean Dalrymple, M.D. – 8th Lisa Flannagan, M.D. – 8th Stanley Gwock, M.D. – 8th David Pascoe, M.D. – 8th Nancy VanVessem, M.D. – 8th Akash Ghai, M.D. – 9th Simon Lopez, M.D. – 9th Eugene Wang, M.D. – 9th Marc Inglese, M.D. – 11th Sergio Ginaldi, M.D. – 13th Alice Pomidor, M.D. – 13th David Craig, M.D. – 15th Gadi Silberman, M.D. – 17th
Joshua Fuhrmeister, M.D. – 18th Joan Meek, M.D. – 18th Dung Nguyen, M.D. – 18th Terence Reisman, M.D. – 18th Rachel Vanderby, M.D. – 19th Marie Becker, M.D. – 20th William Morse, M.D. – 20th Frank Walker, M.D. – 20th Eric Bouchard, M.D. – 22nd Michael Forsthoefel, M.D. – 22nd Shayla Gray, M.D. – 22nd Claras Ellis, M.D. – 23rd Tracy Graham, M.D. – 25th P.S. Krishnamurthy, M.D. – 25th Joshua Hickman, D.O. – 26th James Thomas, M.D. – 26th Charles Yowell, M.D. – 26th Richard Dozier, M.D. – 27th Jeffrey Ferraro, M.D. – 27th Richard Thacker, D.O. – 28th Stan Whitney, M.D. – 28th Camille Blake, D.O. – 29th Rick Damron, M.D. – 29th Ashton Byington, M.D. – 30th
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!
PRACTICE MANAGEMENT
CONTINUED FROM COVER
The DEA does not have a specific educational requirement for people who are registered with them to prescribe controlled substances. There are not two different controlled substance prescribing requirements for MDs.
To read the statute, New Prescribing RegulationsSchedule II Controlled Substances – July 1, 2018, go to: www.flsenate.gov/Session/Bill/2018/21/BillText/er/ PDF.
There is a still a little confusing issue for DOs because they were already required to complete a 1-hour course on the state and federal laws related to the prescribing of controlled substances. I have been told by FL Osteopathic Medical Association that they are hoping that the Board of Osteopathic Medicine will rescind this 1-hour course since all DO DEA-authorized prescribers will have to take the new 2-hour requirement.
For Patients: http://www.flhealthsource.gov/ FloridaTakeControl/faqs
Bottom line, the only physicians who are required to take this new 2-hour controlled substance prescribing course (again, which is a FL requirement, not a DEA requirement) are those who are “registered with the United States Drug Enforcement Administration and authorized to prescribe controlled substances pursuant to 21 U.S.C. s. 822”. I have included a link to House Bill 21 so you can see the specific language that passed during the last legislative session. So a physician who is NOT registered with the United States Drug Enforcement Administration and authorized to prescribe controlled substances pursuant to 21 U.S.C. s. 822, but prescribes unscheduled drugs (no controlled substances) would NOT be required to fulfill this FL requirement.
As always, if you have questions, feel free to contact Pam Irwin at 850-877-9018.
For Patient Education Handouts-
For Spanish-speaking patients: https://capmed.org/wpcontent/uploads/2018/07/Instrucciones-para-pacientesHB-21-Spanish.pdf For English-speaking patients: https://capmed.org/wpcontent/uploads/2018/07/Patient-Instructions-for-HB21-English.pdf
RESOURCES For a CMS Quick Start guide for your practice, go to: https://capmed.org/wp-content/uploads/2018/07/ Opioid-Prescribing.pdf. For a comprehensive guide prepared by the Florida Medical Association, go to: http://flmedical.org/ Florida/Florida_Public/Docs/FMA-Opioid-HB21.pdf. To access the E-FORCSE website to register a provider or extender, go to: https://florida.pmpaware.net/login.
IN MEMORIAM
As of May 31, 2018, these entities are approved to offer the state-mandated 2-hour CME course on opioid prescribing: Florida Academy of Family Physicians – http://www.fafp.org Florida College of Emergency Physicians – http://www.emlrc.org Florida Medical Association – http://flmedical.org/florida Florida Osteopathic Medical Association – http://www.foma.org
John Craig Peterson, M.D. 1947 - 2018 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 3
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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CMS/CMSA CONNECT THE DOCS FAMILY PICNIC
Capital Medical Society and Capital Medical Society Alliance invite you and your family to the
Family Picnic Saturday, August 25, 2018 11am - 2pm Maclay Gardens State Park 3540 Thomasville Road ($6.00 per car entrance fee)
“Stella” the Food Truck and Street Chefs will serve delicious food plus, we’ll have lots of family fun activities! Come on out and enjoy the day with your colleagues and their families! Please RSVP by August 17 to Rosalie Carlin at (850) 877-9018 or rcarlin@capmed.org.
Supporting Sponsor The Robinson Group at Merrill Lynch
Event Sponsors Maclay School
In-Kind Sponsor Seminole Sitters
The Naumann Group
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
5
ANNOUNCEMENTS
THE CAPITAL MEDICAL SOCIETY BOARD OF GOVERNORS WELCOMES RESIDENT BOARD MEMBERS
Tristan Brooks, D.O., Family Medicine
Blake Davis, M.D., General Surgery
Alex Vanderby, M.D., Family Medicine (Board Seat Renewal)
Shlermine Aupont, M.D., General Surgery
Joshua Hickman, D.O., Internal Medicine
Luba Muaddi, M.D., Internal Medicine
CMS MEETS INCOMING RESIDENTS Dr. Charles Williams and Pam Irwin welcomed new residents from the Family Medicine, General Surgery, and Internal Medicine Residency Programs during an orientation luncheon at TMH on June 20, 2018. Dr. Williams shared the benefit of residents becoming engaged in organized medicine through Capital Medical Society and the power of an organized voice in shaping legislation that will impact the practice of medicine. New residents will be introduced at the September 18 CMS Membership Meeting. Dr. Williams also encouraged residents to enjoy their residency experience, build friendships and memories, and to prioritize humor along the way.
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
PROFESSIONAL NOTES
PROFESSIONAL NOTES On July 11, 2018, Tim Broeseker, M.D. celebrated providing 30 years of excellent compassionate cancer care in Tallahassee.
Andrea Friall, M.D. received a Juneteenth Freedom Award for her contributions to the Tallahassee community by Della Walker Chapter #86, Order of the Eastern Star, PHA on June 19, 2018. Her fellow honorees were Mayor Andrew Gillum and Reverend Rudolph Ferguson.
Robert M. Snider, M.D. has practiced medicine in Tallahassee for 50 years. Prior to arriving in Tallahassee, he practiced for two years as a United States Air Force flight surgeon. (Dr. Snider is pictured with his colleague, Dr. Duncan Postma.)
Louis B. St. Petery, M.D., Tallahassee pediatric cardiologist received the 2018 Medal of Honor Award in the non-lawyer category at The Florida Bar Foundation’s 42nd Annual Reception and Dinner on June 14, 2018 in Orlando. His leadership and legislative advocacy on behalf of the children on Medicaid have led to funding increases and substantial changes to the system. “He has probably done more to help improve medical care for children on Medicaid in Florida over the last decade than anyone else,” said Ft. Lauderdale attorney Carl Goldfarb, who nominated St. Petery. St. Petery also played key roles in recruiting attorneys to block Florida DOH from using a screening tool with which they disenrolled over 13,000 special needs children from Florida CMS, in defeating the "Docs vs Glocks" legislation which sought to prevent physicians from counseling parents about gun safety, and in defeating an effort by Florida DOH to abolish a rule which had long established the standards of excellence for children's cardiac surgery in Florida.
Mary E. Swain, M.D., FACR received the Florida Radiological Society’s Gold Medal Award, their highest honor, at their annual meeting on July 14, 2018. Dr. Swain was recognized for outstanding meritorious achievements that have contributed significantly to the practice of radiology in Florida.
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.
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 7
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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)
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) CONTINUED ON NEXT PAGE
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 9
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:
10 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
CMS NEWS
THANK YOU, DR. JERNIGAN! As Dr. Jernigan transitions into retirement this year and makes North Carolina more home than vacation destination, her friends at Capital Medical Society and the We Care Network wished her well with a “gift drop” at her office at the TMH Family Medicine Residency Program. Included were two hammocks to help her get a bit more relaxation and a scone recipe book and baking pan so she can keep her famous scone-baking skills intact. Dr. Jernigan, a native of Tallahassee, completed her residency at TMH Family Medicine Residency Program from 1985 to 1988. After a very busy private practice with Dr. Bill Kepper, she returned to the TMH Family Residency Program in 1994 as a faculty member. She served as president of Capital Medical Society in 2009 and also served on Capital Medical Society Foundation’s Board of Directors, the We Care Network Advisory Committee, the We Care Dental Advisory Committee, and many other important committees addressing access to care. She was a popular author for the Cap Scan newsletter for her down-to-earth stories about the practice of medicine. She has been a constant advocate for her patients and those in the We Care Network and has been a long-standing referring provider to the program. She was awarded the 2006 I.B. Harrison, M.D. Humanitarian Award for her intense commitment to humanitarian values associated with the late Dr.
I.B. Harrison. We wish Dr. Jernigan the very best and know Capital Medical Society and the We Care Network will always have a special place in her heart. We are not saying good-bye!
Pam Irwin, CMS Executive Director delivered the “gift drop” to Dr. Lisa Jernigan on June 20, 2018.
CAPITAL MEDICAL SOCIETY 2018 MEETINGS CALENDAR CONT. FROM COVER
September 27, 2018 Connect the Docs Happy Hour sponsored by Capital City Bank 6:00 pm – 8:00 pm The Wine House (1355 Market Street, A1) 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 11
CMS LUNCH AND LEARN
CAPITAL MEDICAL SOCIETY LUNCH AND LEARN SEMINARS MARK YOUR CALENDARS FOR THE FALL 2018 LUNCH AND LEARN SEMINARS September 19, 2018 Patient Non-Adherence: A Pricey Problem It has been estimated by numerous studies that one-third to one-half of all patients are non-adherent with medical direction and present a challenge for healthcare providers. This program will discuss some of the reasons why non-adherence may occur, describe strategies to be considered to encourage adherence and discuss situations in which a provider might consider terminating the provider-patient relationship. Speaker: Teresa Phillips, MagMutual Senior Risk Management Consultant Sponsor: CAMPUS USA Credit Union October 17, 2018 Top 15 Employment Law Updates for 2018 With record litigation and a dramatic increase in governmental audits impacting local business, come join us for a fun interactive look at the areas that are most likely to create costly legal exposure at your company. Topics to be covered will include key points of risk throughout the employment life cycle, common mistakes involving employee leave, and preparing for coming changes to federal wage and hour laws. This is a cannot miss for small business owners, human resource professionals, and Chief Executive Officers alike! Speaker: Bill Krizner, The Krizner Group Sponsor: CopyFax, Inc. November 14, 2018 Patient Collections: Bringing Home the Bacon Sponsor: CAMPUS USA Credit Union
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 For more information or to RSVP, please contact Rosalie Carlin at (850) 877-9018 or rcarlin@capmed.org. Seminars are held at the Capital Health Plan on Governors Square Blvd – and we thank them for providing this venue to us.
12 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
1 IN 3 RATIO OF U.S. ADULTS WHO HAVE HIGH BLOOD PRESSURE. ONLY HALF KNOW IT.
SOURCE: CDC
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
13
VIEWPOINT
TRIAGE AND TREATMENT AT 36,000 FEET By Julian Hurt, M.D. My wife Myra and I were returning from our Ruby Anniversary celebration trip of a week to Washington’s Olympic Peninsula. We boarded the Seattle to Atlanta flight with several king salmon I had caught on the Sol Duc River. They were riding frozen in the 737’s baggage compartment. About an hour into our flight I heard the query that all physicians hate to hear: “Is there a doctor on board?” Since the message was a bit garbled, I decided not to reply initially, but I noticed a lot of activity by the flight attendants in the first class cabin. When I saw the head attendant on the intercom, probably with the captain, I knew this was serious so Myra pushed the call button, and I talked with the attendant who walked back to our seats. The emergency was an unconscious woman; I went forward to see what was happening. She was an older woman who was slumped against her husband. I immediately checked the pulse in her carotid artery. Based on decades of experience as a cardio-vascular surgeon, I knew her systolic blood pressure was well below one hundred. Her respirations of eight to ten breaths per minute were insufficient. Her husband told me that she had previous cardiac bypass surgery and had a defibrillator implanted. She carried nitroglycerin in her purse. Because she wore a brace on her leg, she didn’t want to get up to use the restroom on the plane, so she hadn’t eaten or had liquids recently. I told her husband that I needed to stimulate her, and then I slapped her face. She ultimately responded when I pinched her finger really hard. After I gave her a dose of nitroglycerin in the mouth, she woke up, but looked addled. I gave her another dose, and the flight attendant arrived with the emergency kit. With the cuff I found a blood pressure of 80/50: way too low! I knew she was suffering from severe hypotension and was extremely dehydrated. While I waited beside her, the attendant asked me if the pilot should divert the aircraft to a nearby airport. I responded no, but they brought me headphones to patch me into the Delta medical consultant who was on the ground. After I reviewed her history with him, he said that he thought things sounded okay, but I was to call him back if necessary. Once I was back in my own seat I requested the emergency medical kit so I could see what was in it. There were cardiac drugs, needles, syringes, IV bags with tubing, and a ventilator bag. A portable defibrillator was also on board. As I reclined and tried to relax, I opened a novel by 14 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
Elizabeth George ironically titled, “Payment in Blood”. As the plane reached the halfway point of our trip, the flight attendant returned to tell me that the passenger was again showing symptoms. I went forward. I had already decided that if more treatment was needed I would go to a full court press (whatever that means in a passenger jet at 36,000 feet). Her eyes had a glazed look, but she wasn’t unconscious, and she suddenly vomited a large amount of fluid. I felt for carotid and brachial pulses: there were none! The attendant handed me an IV bag, but there was no tourniquet in the kit, so I used a rubber glove to compress the arm and put the needle into an antecubital vein. I asked the attendant to find out if there was a nurse on board, and he said there was a recent medical school graduate in the back. I asked for him to be sent up to help. After I hooked up the tubing and the IV bag I began to slowly squeeze saline into her arm, but I still couldn’t feel a pulse, so I began to give her small dose of atropine through a syringe. By this time the new doctor from Michigan State University joined us; he was on his way to begin a general surgery residency at Morehouse University in Atlanta. After 500 milliliters of fluid and a full syringe of atropine, I began to feel a pulse. She started to wake up as I started the second bag of saline solution. The other doctor measured her blood pressure at 150/90, and suddenly she became alert and was able to answer questions. She said she felt good. Again I was asked if the pilot should divert the plane, but I responded no. After I removed the needle I requested that paramedics meet our plane in Atlanta so I could safely transfer her care. With my permission the attendant told the woman and her husband my name. She then asked for our email addresses so each of us could receive a flight voucher on Delta for one-hundred-fifty dollars. In Atlanta the paramedics met the plane to take off the woman ahead of the other passengers. All the flight attendants and the woman’s husband waited at the gate to thank me for my help. Myra and I got home on time after a stressful end to an otherwise idyllic vacation. Most importantly, the fish were in good shape too! Postscript: I received a very nice thank you note from my airborne patient. She had seen her physicians in Alabama and was recovering well. Apparently she had a viral infection while on vacation which obviously compounded her serious health issues. I sincerely believe that she would have died without my help. I’m thankful that Myra strongly encouraged me to respond to the emergency call at 36,000 feet.
MEDICAL/LEGAL
SEXUAL HARASSMENT ALLEGATIONS IN HEALTHCARE: RISING RISKS By Richard Cahill, JD, vice president and associate general counsel, The Doctors Company Healthcare providers are not immune from the growing number of reported incidents of alleged sexual harassment in the workplace. Accusers may be employees, patients, third-party vendors or visitors. Individuals alleged to have acted inappropriately may include co-workers, both supervisors and subordinates, professional staff— and even patients. Repercussions of Harassment Claims After complaints are filed, costly and potentially embarrassing investigations are often conducted by law enforcement, human resources departments, and administrative agencies. Depending on the nature and scope of the findings, serious adverse consequences and often irreparable harm to a person’s reputation may follow. Adopt and Enforce Zero Tolerance Healthcare practitioners and facilities are strongly encouraged to develop and consistently enforce a zero-tolerance policy. Protocols must be written, periodically reviewed, and updated as necessary, detailing:
provider or facility to comply with federal and state requirements. Be Sure You’re Covered Healthcare providers are also strongly encouraged to consult with their personal or corporate attorney to understand the potential financial risks of claims involving allegations of sexual harassment or misconduct. They should then confer with their insurance agent or broker to determine pro-actively what coverages might be available in their respective states to protect the provider in the event of such a claim. Most practitioners carry professional liability coverage in the event of a claim for medical malpractice. Not uncommonly, however, medical professional liability policies specifically exclude coverage for acts of sexual misconduct committed by a physician against a patient.
It’s also prudent to consult with insurance brokers and agents about the availability of Employment Practices Liability Insurance (EPLI). EPLI may provide coverage for certain types of workplace • The types of conduct that will not be harassment, which may include sexual misconduct tolerated, regardless of the identity of the involving the policy holder and an employee. alleged perpetrator. • A clear methodology for reporting claimed And finally, claims of inappropriate sexual behavior instances of wrongdoing. against a physician or other licensed healthcare • The process to be followed in investigating practitioner may result in administrative proceedings complaints, and rules that should be by a state medical board, or the privileges committee observed to help insure that confidentiality of a hospital or other facility regulated by The Joint and due process are appropriately protected. Commission. Endorsements are widely available as • Documentation to be completed and part of medical professional liability policies to pay maintained. legal defense costs in the event of an investigation or • The range of sanctions, up to and including subsequent disciplinary hearing. termination, for both employees and patients, should the allegations ultimately ________________________________________ be determined to be true. Staff should receive proper training as part of the on-boarding process and on a regular basis thereafter. Offices should develop and retain attendance sign-in sheets of such training in the regular course of business to demonstrate, in the event of a subsequent problem, the good faith and due diligence as continuing efforts of the clinic,
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered. -------------------Contributed by The Doctors Company (thedoctors.com)
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 15
CAPITAL REGIONAL CARDIOLOGY ASSOCIATES WELCOME
RAJENDRA SOLANKI, DO
Capital Regional’s Physician Network-of-Care is committed to delivering high quality and compassionate care. At Capital Regional Cardiology Associates, our cardiologists diagnose and treat cardiovascular disease. We provide expert care and use the latest technology to help our patients improve their overall heart health.
Our Cardiology Services Include: • Cardiovascular Disease
• Echocardiography
• Clinical cardiology including management of high blood pressure and cholesterol • Cardiac Catheterization via femoral (leg) and radial (arm) approach • Interventional Cardiology
• Nuclear Cardiology • Stress Testing
Dr. Solanki, Cardiologist
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Scott Tetreault, M.D. Viral Bhanderi, M.D. Paresh Patel, M.D. (850) 219-5830 2626 Care Dr, Suite 200 1600 Phillips Rd, Suite 300
For more information visit: FLCANCER.COM 16
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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 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.
We Care Network patient, Mr. Jimmie Hardy has been boosting clean oxygen levels at Capital Medical Society by volunteering to repot neglected plants and bring fresh cuttings of pothos plants to green up the office. He shares his horticultural tips and tends to the plants with TLC. Thank you, Mr. Hardy for brightening our days and our offices!
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
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
17
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 June 2018. Your generosity and support of the We Care Network makes a difference.
Physicians Emily Ashmore, M.D. Marie Becker, M.D. David Bellamy, M.D. Dhananjay Bendre, M.D. Robert Bradford, M.D. Tim Broeseker, M.D. Robert Brumberg, D.O. Acquinonette Bryant, M.D. Viet Bui, M.D. David Burns, M.D. Joseph Camps, M.D. Stephen Carr, M.D. Michael Cavallaro, M.D. Gilbert Chandler, M.D. Armand Cognetta, Jr., M.D. George Cohen, M.D. Jeffrey Crooms, M.D. William Dixon IV, M.D. Avon Doll, M.D. Ray Dolly, M.D. David Durden, M.D. Margarett Ellison, M.D. Alberto Fernandez, M.D. Michael Ford, M.D. Edward Forster, M.D. Spencer Gilleon, M.D. Sergio Ginaldi, M.D. Gian-Carlo Giove, M.D. Aaron Guyer, M.D. Brett Howard, M.D. Marc Inglese, M.D. Barbara Jaeger, M.D. Floyd Jaggears, M.D. Amit Jain, M.D. Beverly Johnson, M.D. Rohan Joseph, M.D. Farhat Khairallah, M.D. Sayeed Khalillulah, M.D. James Killius, M.D. Carey Linker, M.D. Kurt Luhmann, M.D. Charles Maitland, M.D. Michael Mangan, M.D. Ovidiu Marina, M.D. Kenneth McAlpine, M.D. Jayan Nair, M.D. Chukwuma Okoroji, M.D. David Pascoe, M.D. Timothy Paulk, M.D. Mitchell Peabody, D.O.
Michael Pentaleri, M.D. Jorge Perez de Armas, M.D. J. Daniell Rackley, M.D. Alexander Ramirez, M.D. James Renehan, M.D. Adrian Roberts, M.D. Andres Rodriguez, M.D. Tim Ruark, M.D. Less Shrestha, M.D. Gadi Silberman, M.D. Hardeep Singh, M.D. Francis Skilling, M.D. Robert Snider, M.D. Joshua Somerset, M.D. Bhavik Soni, M.D. Joseph Soto, M.D. Matthew Standridge, M.D. Christopher Sundstrom, M.D. Timothy Sweeney, M.D. Scott Tetreault, M.D. John Thabes, M.D. Jean-Paul Tran, M.D. Ernesto Umana, M.D. Lucas Watkins, M.D. Graham Whitaker, M.D. William Yaakob, M.D. Charles Yowell, M.D. Samuel Yu, M.D. Brian Zirgibel, M.D. Dentists Walter Colon, D.M.D. William McFatter, D.D.S. James Sykes, D.M.D. Kirstin Walther, D.M.D. Russell Walther, D.D.S. Facilities Advanced Urology Institute Anesthesiology Associates Apalachee Primary Care Aspros, Badger, & Boyd Dental Associates Beachton Denture Clinic Bond Community Health Center Capital Periodontal Associates 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 Jasmine Women’s Center Jessie Furlow Medical Center Ketchum, Wood, & Burgert Pathology Associates Madison Medical Center Nature Coast Women’s Care, LLC Neighborhood Medical Center North Florida Nephrology Associates
North Florida Women’s Care Periodontal Associates Radiology Associates of Tallahassee Red Hills Oral & Facial Surgery Smile Connection at Bond Community Health Center Southeastern Dermatology Southern Medical Group, P.A. Southern Vitreoretinal Associates Tallahassee Diagnostic Imaging Tallahassee Ear, Nose, & 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 Physician Partners Urology Specialists TMH Rehabilitation TMH Transition Center Tallahassee Neurological Clinic, PA Tallahassee Orthopedic Clinic Tallahassee Surgical Associates Tallahassee VA Clinic Vascular Surgery Associates Wakulla County Health Department Wakulla Medical Center 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 June 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) 2010085 or mail to 1204 Miccosukee Road, Tallahassee, FL, 32308. Thank you!
CMS FOUNDATION: WE CARE NETWORK
We thank our referring providers from June 2018: Ebonie Allen, ARNP
Hantz Hercule, M.D.
James Renehan, M.D.
Mary Jane Bailey, ARNP
Sarah Hinson, ARNP
Charlie Richardson, M.D.
Kala Balan, D.M.D.
Dwight Hooper, M.D.
Andres Rodriguez, M.D.
William Baldock, D.D.S.
Brett Howard, M.D.
Tim Ruark, M.D.
Karen Bartley, M.D.
Amit Jain, M.D.
Karen Russell, M.D.
Megan Bassett, ARNP
Howard Kessler, M.D.
Lucilita Salvador, PA
Dhananjay Bendre, M.D.
Farhat Khairallah, M.D.
Philip Sharp, M.D.
Robert Bradford, M.D.
Amulya Konda, M.D.
Gadi Silberman, M.D.
Jonna Bradley, ARNP
Elaine Larkins, ARNP
Hardeep Singh, M.D.
Daniel Breivogel, ARNP
Matthew Lawson, M.D.
Joshua Somerset, M.D.
Alexander J. Brickler III, M.D.
Matthew Lee, M.D.
Abisoye Somorin, ARNP
Tim Broeseker, M.D.
Deanna Louie, M.D.
Bhavik Soni, M.D.
Robert Brumberg, D.O.
Michael Mangan, M.D.
Matthew Standridge, M.D.
Acquinonette Bryant, M.D.
Ashok Manocha, D.D.S.
Alanna Steaple, ARNP
Lysmar Carrion-Dinguis, M.D.
Ovidiu Marina, M.D.
Scott Tetreault, M.D.
David Castillo, M.D.
Kenneth McAlpine, M.D.
John Thabes, M.D.
Jordan Cherkinsky, D.D.S.
Damon McMillan, M.D.
Lacie Thompson, ARNP
Armand Cognetta, Jr., M.D.
Hector Mejia, M.D.
Faye Tinson, ARNP
David Dixon, D.O.
Kelly Miller, ARNP
Marianne Towler, ARNP
William Dixon IV, M.D.
Marcia Morris, ARNP
Mary Tucker, M.D.
Margarett Ellison, M.D.
Jayan Nair, M.D.
Jean-Paul Tran, M.D.
Mignon Emenike, M.D.
Chukwuma Okoroji, M.D.
Ernesto Umana, M.D.
Shirley English, ARNP
Rose Origa, ARNP
Dwanna Ward-Boahen, ARNP
Cynthia Evans, ARNP
Thomas Park, M.D.
Jeffrey Wasserman, D.O.
Alberto Fernandez, M.D.
Timothy Paulk, M.D.
Eula Weaver, ARNP
Michael Ford, M.D.
Mitchell Peabody, D.O.
Graham Whitaker, M.D.
Michael Forsthoefel, M.D.
Jorge Perez de Armas, M.D.
Dianna Willis, ARNP
Sharron Foster, M.D.
Lisa Perkins, ARNP
Charles Yowell, M.D.
Akash Ghai, M.D.
Jessica Proxmire, ARNP
Richard Zorn, M.D.
Gian-Carlo Giove, M.D.
Stephen Quintero, M.D.
Judy Griffin, ARNP
J. Daniell Rackley, M.D.
Muhanad Hasan, M.D.
Alexander Ramirez, M.D.
DURING THE MONTH OF JUNE, THE WE CARE NETWORK: RECEIVED 256 REFERRALS, WITH 141 PATIENTS NEW TO THE PROGRAM
SCHEDULED 197 APPOINTMENTS WITH VOLUNTEER PHYSICIANS AND DENTISTS
$401,797.59 IN DONATED CARE WAS REPORTED BY WE CARE VOLUNTEERS
Prsrt. Std. U.S. Postage
PAID Tallahassee, FL Permit 801
Cap Scan Newsletter 1204 Miccosukee Road Tallahassee, FL 32308 Return Service Requested
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