DECEMBER EDITION, VOLUME 2014, NO. 12
To our members and their families, our sponsors, and our friends‌ Happy Holidays from the Capital Medical Society and Capital Medical Society Foundation Staff
CAPITAL MEDICAL SOCIETY 2015 MEETINGS CALENDAR January 22, 2015 Installation of New CMS President, Dr. Joshua Somerset 6:00 pm FSU Alumni Center
CONTINUED ON PAGE 3
March 26, 2015 Celebration Awards Dinner 6:30 pm FSU University Center Club
April 21, 2015 CMS Membership & CME Meeting 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 1
MISSION: TO PROMOTE THE PRACTICE OF MEDICINE FOR THE ULTIMATE BENEFIT OF THE PATIENT. (850) 877-9018 Fax: (850) 878-0218 www.capmed.org
BOARD OF GOVERNORS Alfredo Paredes, M.D., President Joshua Somerset, M.D., President Elect J. Daniell Rackley, M.D., Secretary/Treasurer Nancy Loeffler, M.D., Immediate Past-President Robert Chapman, M.D. Garrett Chumney, M.D. Tracey Hellgren, M.D. Zan Batchelor, CMS Alliance President Vikki McKinnie, M.D. Hector Mejia, M.D. Margaret Havens Neal, M.D. Philip Sharp, M.D. Timothy Sweeney, M.D. Ernesto Umaña, M.D. Pam Wilson, Executive Director Family Medicine Residents William Carlson, M.D./Anna Hackenberg, M.D. Internal Medicine Residents Chris Rosadzinski, M.D./Prerna Satyanarayana, M.D.
PUBLICATION EDITOR Charles E. Moore, M.D.,
MANAGING EDITOR Shannon Boyle
GRAPHIC DESIGN Young Design
ARE YOU INTERESTED IN WRITING AN ARTICLE FOR CAP SCAN? Please contact Dr. Charles Moore at cmoore5186@aol.com and 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. If you are a member of the Capital Medical Society and would like a copy of the Minutes from the Board of Governors meeting, please call the CMS office. Thank you. 2
I N T H I S I SS U E :
CMS FAMILY FUN NIGHT
CMS Lunch & Learn 3 2015 Presidential Installation 4 2014 CMS Meeting/Event Sponsors 6 CMS Membership Meeting Minutes 7 Reflections from the Editor 9 Medical/Legal 12 Philanthropist of the Year 13 Viewpoint 14 POLST 16 CMS Allliance Corner 19 CMS Foundation 22 CMS Foundation: We Care Network 23
HAPPY BIRTHDAY! {DECEMBER BIRTHDAYS}
Stephen Duncan, M.D. – 1st
Milagros Pescador, M.D. – 15th
Terry Sherraden, M.D. – 1st
Gary Winchester, M.D. – 15th
J. Orson Smith, Jr., M.D. – 3rd
Michele Hoggatt, M.D. – 16th
Dorothy White, M.D. – 3rd
Praful Patel, M.D. – 17th
Raul Fernandez, M.D. – 4th
Cristina Rodriguez, M.D. – 18th
Clarence Applegate, M.D. – 5th
Arthur Clements, M.D. – 20th
Jonathan Appelbaum, M.D. – 8th
Cynthia Tie, M.D. – 20th
Arjun Kaji, M.D. – 8th
David Jones, M.D. – 21st
Kendall Campbell, M.D. – 9th
Dale Wickstrum, M.D. – 23rd
Garrett Chumney, M.D. – 9th
Isaac Moore, M.D. – 25th
Elizabeth Curci, M.D. – 9th
Baxter Byerly, M.D. – 26th
Joshua Somerset, M.D. – 9th
Efren Baltazar, M.D. – 28th
Larry Taylor, M.D. – 9th
Robert Watson, M.D. – 28th
Nighat Ahmed, M.D. – 11th
Bobby Abraham, M.D. – 29th
Charles Kent, M.D. – 11th
R. Scott Hanson, M.D. – 30th
Thomas Lawrence, M.D. – 11th
Tim Broeseker, M.D. – 31st
William F. Lindsey, M.D. – 11th
Iman Imanirad, M.D. – 31st
W. Brad Stephens, M.D. – 13th
Matthew Lee, M.D. – 31st
Julie Kelch, M.D. – 14th
Gregory Todd, 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 LUNCH AND LEARN
S
CAPITAL MEDICAL SOCIETY LUNCH & LEARN Capital Health Plan, 1491 Governors Square Boulevard On October 22nd, Allison Dudley, J.D., Florida Board of Medicine Executive Director, and Lontejuana Cooper, PhD, RHIA, CPM, FAMU Health Informatics and Information Management Program, gave an excellent program on “Medical Records: Handling Subpoenas; Charging for Copies”. You can reach Ms. Dudley at (850) 245-4130 and Ms. Cooper at (850) 561-2025. Centennial Bank sponsored the October 22nd Lunch and Learn. Patricia Griffin and Steve Mitchell were in attendance as representatives of Centennial Bank. You can reach Ms. Griffin at (850) 894-7124 or pgriffin@my100bank.com or Mr. Mitchell at (850) 894-7132 or smitchell@my100bank.com.
2015 MEETINGS CALENDAR January 22, 2015 Installation of New CMS President, Dr. Joshua Somerset 6:00 pm FSU Alumni Center
March 26, 2015 Celebration Awards Dinner 6:30 pm FSU University Center Club
April 21, 2015 CMS Membership & CME Meeting 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks
May 19, 2015 CMS Membership & CME Meeting 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks
June 4, 2015
Mark Your Calendars for the Spring 2015 Lunch and Learn Seminars: February 18, 2015 • March 18, 2015 April 15, 2015 • May 20, 2015 Be on the lookout for more information from us on topics and sponsors! seminarS ARE held at the Capital Health Plan on Governor’s Square Blvd – and we thank them for providing this lovely venue.
CMS Doctor/Daughter Banquet 6:00 pm Location: TBA
September 15, 2015 CMS Membership & CME Meeting 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks
October 20, 2015 CMS Membership & CME Meeting 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks
November 17, 2015 CMS Membership & CME Meeting 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks
December 3, 2015 CMS Foundation Holiday Auction 6:30 pm Location: TBA
Capital Medical Society is pleased to welcome the following New Member: Save the Date Come Eat at Uptown Cafe Saturday, January 10, 2015 1325 Miccosukee Road For Breakfast or Lunch from 7 a.m. – 3 p.m. A portion of sales will benefit We Care Network And a “Famous Smoked Salmon” will be raffled
D.D. Raj Bendre, M.D. Medical School: Rutgers University Internship: Hackensack Medical Center Residency: California Pacific Medical Center Specialty: Radiation Oncology Practice: TMH Physician Partners, Radiation Oncology Specialists
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 3
2015 Presidential Installation
FMA President Alan B. Pillersdorf, M.D. Slated for Keynote Address at CMS Installation Dinner Joshua Somerset, M.D. will be installed as Capital Medical Society’s next President on January 22, 2015 during the Installation Dinner at the FSU Alumni Center. We hope you will make plans to attend. Dr. Somerset has been fully engaged as this year’s President-Elect and has wonderful enthusiasm and ideas to move CMS forward for its members. The keynote speaker for the event will be the newly-elected Florida Medical Association President Alan B. Pillersdorf, M.D. He and his wife Rhona look forward to meeting more of the CMS membership that evening. The CMS Delegation to the 2014 FMA Annual Meeting had the opportunity to hear Dr. Pillersdorf ’s acceptance speech in which he shared his near-death experience and ongoing recovery and rehabilitation from viral encephalitis. He believed the experience would make him a better doctor
and a better FMA President. His compassion for those in need is reflected in his community activities including Project Access, a program for patients unable to maintain insurance. In 1991, that compassion also led him to serve as a kidney donor to his only brother Gary, who he admires. Dr. Pillersdorf is the founder and President of Plastic Surgery of Palm Beach, P.A. Dr. Pillersdorf has served the FMA in many leadership roles, including Secretary, Speaker of the House of Delegates and Delegate — Florida AMA Delegation. Board certified in plastic surgery and general surgery, Dr. Pillersdorf is a graduate of the Georgetown University School of Medicine in Washington, D.C. He completed his residency training in general surgery at Georgetown University and his plastic surgery residency at Nassau County Medical Center in New York. Please mark your calendars and plan to register for another wonderful evening which will launch a new year for Capital Medical Society and its leadership. CMS
Focus on your patients while we focus on you.
When you join the FMA, you get a professional staff dedicated to easing your burdens. The FMA will focus on your needs so that you can focus on patients. Reimbursement help, free and discounted CME, billing and coding assistance, advocacy and access to in-house health care experts are just a few benefits of membership. Join us so that we can help you practice medicine. Visit www.FLmedical.org or call (800) 762-0233.
FLORIDA MEDICAL ASSOCIATION
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
2015 Presidential Installation
Save the Date 2015 CMS Presidential Installation Honoring Joshua Somerset, M.D. Thursday, January 22, 2015 at 6:00 pm FSU Alumni Center - 1030 West Tennessee Street CMS Members and their Spouse/Guest are invited
Keynote Speaker
Alan B. Pillersdorf, M.D., Florida Medical Association President Also honoring Outgoing CMS President – Alfredo Paredes, M.D., Outgoing CMS Board Members, and Outgoing CMS Foundation Board Members Invitations will be mailed in mid-December.
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
5
2014 CMS MEETING/EVENT SPONSORS
We thank the following businesses and organizations for sponsoring CMS Meetings/Events in 2014: Aargus Facility Services Assurance Health Care
Mentor Corporation
Clinic
Worldwide
Financial Services, Inc. Boehringer-Ingelheim
Tallahassee Plastic Surgery
Tallahassee Primary Care
Patients First
Associates
Pfizer
Pharmaceuticals, Inc.
Southeastern Center for
Bristol-Myers Squibb
Southern Cardiac and
Capital Health Plan
Tallahassee State Bank/ Synovus
Infectious Diseases, P.A.
Capital City Bank
Vascular Associates
Thompson Bassett Team of Prudential Shimmering Sands Realty
Capital Regional Medical Center
SunTrust
Centennial Bank
Tallahassee Memorial Healthcare
TMH Federal Credit Union
Danna-Gracey
Tallahassee Orthopedic Clinic
Wadsworth, Humphress, Hollar
Eli Lilly and Company
(Diabetes Division) Florida Blue Florida Doctors Insurance Company FMA PAC FSU College of Medicine Hancock Bank HealthSouth Rehabilitation Hospital of Tallahassee Holy Comforter Episcopal School James Moore Certified Public Accountants and Consultants Janssen Pharmaceuticals The Krizner Group MagMutual MedAffinity
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
& Konrad, P.A.
CMS MEMBERSHIP MEETING MINUTES
Minutes CMS Membership Meeting October 21, 2014
D. Introduction of Monica Demott, R.N., Jean McCully We Care Network R.N. Program Coordinator Dr. Paredes shared that Ms. Demott most recently worked at the Jefferson County Health Department where she referred patients to the We Care Network. She has already begun to identify ways to streamline services and update the Patient Tracking System. Ms. Demott thanked the volunteer specialists for donating their time to We Care patients. Pam Wilson encouraged the volunteers to complete new commitment cards, so the We Care Network can update their records.
The mission of the Capital Medical Society is to promote the practice of medicine for the ultimate benefit of the patient. I.
Business Meeting – Capital Medical Society A. Welcome – Dr. Alfredo Paredes, President, called the meeting to order at 6:35 pm. Dr. Paredes thanked Westminster Oaks for use of their incredible facility and Ms. Sheri Whigham, Sales and Marketing Director at Westminster Oaks, spoke to the members about their facility.
E. Announcements and Mark Your Calendars Dr. Paredes made a few announcements and reminded members to mark their calendars for upcoming meetings/events.
B. Dr. Paredes welcomed and thanked our sponsors for the evening: Presenting Sponsor Hancock Bank – Diana Cureton, Deborah McClellan, and Abby Smith Supporting Sponsor Aargus Facility Services – Tom McHaffie Meeting Sponsors Bristol-Myers Squibb/Pfizer – Cynara Miller and Debra Placilla MagMutual – Staige Hoffman Southeastern Center for Infectious Diseases, P.A. – Patricia Ballantine Tallahassee State Bank/Synovus – Mary Colonese and Sharon Weeden
Dr. Paredes introduced new CMS Members in attendance:
Dr. Barbara Demby Abrams, Social Security Disability Dr. Michael Allison, TMH Family Medicine Residency Program Dr. Wade Douglas, TMH Physician Partners, Surgical Specialists Dr. Stacia Groll, Tallahassee Primary Care Associates Dr. Gizatchew Ketsela, Southeastern Center for Infectious Diseases, P.A. b.
2.
The beginning stages of the 2015 pictorial directory of CMS members is underway. Please let CMS know ASAP if you want to update your headshot or information.
3.
The upcoming meetings/events are:
December 4, 2014 CMS Foundation Holiday Auction 6:30 pm University Center Club at Florida State University II.
Dr. Paredes announced new members approved since the last membership meeting:
Dr. Scott Asher, Tallahassee Ear, Nose & Throat Dr. George Cohen, Dermatology Associates Dr. Rohan Joseph, Capital Regional Surgical Associates Dr. Ovidiu Marina, M.D., TMH Physician Partners, Radiation Oncology Specialists Dr. Michael Sweeney, FSU College of Medicine
We Care Network continues to be a certified United Way Agency through Capital Medical Society Foundation.
November 18, 2014 Annual CMS Membership & CME Meeting – to vote on our 2015 slate of officers, board members and FMA delegates “The Evolution of Cervical Cancer Screening” David Dixon, D.O. and Stephanie Lee, M.D. 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks
C. New Members a.
1.
Tonight’s CME Program – this is a 2 Hour Category One Program Topic: Caring for Patients Impacted by Interpersonal Violence Speaker: Suzanne Harrison, M.D. Dr. Harrison gave an excellent and informative program on domestic violence and human trafficking.
Physician CME Proof of Attendance Forms will be sent to participants who attend the entire CME program. III.
Adjourn – Dr. Paredes adjourned the meeting at 8:00 pm. CONTINUED ON PAGE 8
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 7
CMS MEMBERSHIP MEETING MINUTES
Presenting Sponsor, Hancock Bank: (l-r) Deborah McClellan, Abby Smith, and Diana Cureton.
Our speaker for the evening, Suzanne Harrison, M.D.
Supporting Sponsor, Aargus Facility Services: Tom McHaffie.
Meeting Sponsor, Bristol-Myers Squibb/ Pfizer: (l-r) Debra Placilla and Cynara Miller.
Meeting Sponsor, Tallahassee State Bank/Synovus: (l-r) Mary Colonese and Sharon Weeden.
Meeting Sponsor, MagMutual: Staige Hoffman.
Meeting Sponsor, Southeastern Center for Infectious Diseases, P.A.: Patricia Ballantine.
Please Thank Our Sponsors for the OCTOBER 21st CMS Membership Meeting Presenting Sponsor
Supporting Sponsor Aargus Facility Services
Meeting Sponsors Bristol-Myers Squibb/Pfizer MagMutual Southeastern Center for Infectious Diseases, P.A. Tallahassee State Bank/Synovus 8
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
REFLECTIONS FROM THE EDITOR
TECHNO-SHAZAAM: OR SOMETHING, MAYBE, FOR CHRISTMAS By Charles Moore, M.D.
Having just fluffed together my CME points required for license renewal this January coming, I have two questions. First, why is it that every single medical practitioner in the world does not have in his or her office a Cherin-Boswinkel “Bio-Photon” machine? And second, how is it that anybody whomsoever can purchase, if at some considerable expense, this device and set oneself up as a “biontologist,” despite no medical training whatsoever, claiming that you can cure everything from cancer to acne to loss of libido? And, by the way, charge the public money for your “expertise.” But you will ask, understandably, who is Johan Boswinkel, inventor of the Chiren, a machine that detects light emissions, and whether they are “coherent” or not, from various acupuncture points on the hands. If “incoherent,” the machine coheres your…what shall I say?...cellular “light,” and there it is. You are restored to what is described as “perfect health.” Your lymphoma is gone. Your libido aflame. All right…all right…so Mr. Boswinkel has been knocking about with biophotons for 20 years, we are told, and lives in Rotterdam, where he is Director of the Health Angel Academy. Having watched a few of his presentations on YouTube, I can tell you that he looks like an elderly German scientist, speaking English with an accent that is perfectly gauged to comfort us with a kind of casual, old-world verisimilitude. He wears an off-white sport coat that has seen better times, loosely draped, and with just the right amount of shoulder stuffing dislodged to create the look of an regular, old, ordinary, brilliant scientist who has risen above concerns regarding how he might dress. He is modestly diffident, but twinkles every now and then when he describes how he makes cells happy, and therefore healthy, by rendering their light emissions coherent. It was all very pleasant and easy-going, and I recommend that you Google-up “Cherin Boswinkel BioPhoton,” and see for yourself. Have a modest glass of mediocre wine brought up from your wine cellar by your butler, and by all means remain calm.
So far, so good. My bit of a problem is related to how just any old regular ordinary person of any age whatsoever can buy this device, go to California for a week learning how to plug it in to a wall socket, and then come back to Whereverfrom and advertise yourself as a “Healer.” Yes, a “Healer.” Is there not some magic to the word? It sounds so much more comforting to go to a “Healer” instead of a “Doctor” or a “Physician” or an “Internist” or an “Oncologist,” and God forbid a surgeon covered in bludy blood. Healing is what we want, not a bunch of high-fallutin’ titles that state you have wasted ten years of your life studying such stuff as biology, biochemistry, pathology, and so on, and then “practiced” at medicine or surgery for a couple dozen years including your residency in some unspellable (Ophthalmology) or unpronounceable (Anesthesiology) specialty. After all, the sick and afflicted may well mutter to themselves, all that stuffing just gives them big egos that charge too much, when I can so easily be cured, and all of my lights made coherent, by GrandPa Boswinkel, who seems such a sweet man on YouTube. Of course, as Cap Scan’s roving reporter, I wondered if Bio Photon therapy had reached Tallahassee all the way from Rotterdam, and find that it indeed has done so. Let me implicate no one, but here in the delightful backwoods of Tallahassee itself we have a “Healer-presenter,” whose lecture is quite free and thoroughly, surely, engaging. We are quite up to Rotterdam and all that “The Angel Academy” may have to offer. And don’t overlook the point that this is not only the ONLY bio-photonic cohering device in our area, but it is also “an FDA approved biofeedback instrument that can be used to read the energy meridians of the body and correct these electromagnetic information pathways to return the body to a healthy functioning state.” Hurrah for the good old FDA, too, I say.
CONTINUED ON PAGE 10
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 9
REFLECTIONS FROM THE EDITOR
But otherwise, it has further crossed my mind to wonder why and how, with all the credentials we MDs must possess, and the CME standards we must continually meet lest we lose our license, to what standard, if any, does the Florida Department of Professional Regulation insist that a “Healer,” and more specifically a practitioner of BioPhotonic Therapy, be held? I gave the Florida Department of Professional Regulation a call, just out of curiosity, and no hard feelings. This proved an interesting experience in its own right. If you are ever bored, and want to spend 45 minutes testing your patience, give the FDPR a ring. You will begin with high hopes, generously forgiving the inevitable “listen carefully, for our options have changed…” You confidently push the anticipated menu of buttons you choose to push, and doing so be led to a new menu of choices, and then yet again to a further, culminating finally in a highly detailed set of ultimate options, these so bewilderingly full of jargon that you will have no idea what you were calling about in the first place since your question appears to fit none of them. You hold out, of course, with the hope that in the end you will be granted the final salvation of hitting “0” to speak to an actual human. But no, never, despite the fact that at the very beginning you had been informed that from 9-5 Monday through Friday breathing people were available who spoke English, unless you had hit “2” por hablar espanol. No wonder attempts to enroll in “ObamaCare” caused so many suicides! So I called the FMA. Hurrah! A voice! “Happy Thanksgiving,” I gobbled. “Happy Gobble-gobble,” replied the nice voice. The FMA lives, working for us. I also called Rosalie at CMS. “Happy Turkey-Day, gobble-gobble,” we said to one another. I explained to her what I was up to, the
10 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
bit of research involved, and just as you would expect she dove right in: “We will sleuth it out together,” she said. And so, in due course, I have the lowdown. Practitioners of the Cherin-Boswinkel Bio-Photonic Device, once they have taken their gobble-de-gobble course, do not ever again have to be recertified, take a CME course, or be in any way troubled by keeping any sort of reckoning of their proficiency. After all, it is simply a matter of getting those silly, confused, and incoherent light waves coherent. Get on Dr. Boswinkel’s Website! See the video! Gobble it up! You, also, can heal everything including yourself, and with very little trouble to it, too. You can be, yes!, finally, a “healer.” Look! It may well be that in my previous life when Copernicus came out with his theory, I stuck with Ptolemy. I am, after all, old enough to be stodgy. But I still must wonder why, as noted at the outset of these remarks, if Mr. Boswinkel’s device works so wonderfully there is not one in every physician’s office? You can do so much, and never have to bother with CME ever again. Let me be frank. I did, I must admit, enjoy Mr. Boswinkel’s remark to the effect that (Part 9) “Horses and children have one thing in common: they don’t think.” It is so brilliantly coherent. Nor to forget…although this disclaimer may be a cowardly act of fence-walking…there was a time, almost in living memory, when wise men actually said that this new-fangled horseless carriage idea was poppycock, and you had better keep your assets in buggy whips. Which is to say that, while doing everything else you must do as a physician, by all means, at least a little bit, keep your light waves coherent. But wait! Hey! I’ve got a great idea for all you spouses of physicians, etcetera, or for that matter anyone who otherwise appears to have everything. Give him/her a Cherin-Boswinkel Bio-Photonic machine for Christmas! Every kitchen needs one. And, by the way, have a Merry Christmas season yourself, so hope all of us coherent light waves at Cap Scan. CMS
professionals the confidence to comply with those orders. If Florida truly values the principle of self-determination, especially for its most vulnerable medical populations like
adoption and implementation of the POLST within Florida law as a significant marker in the development of more ethical and humane care for each of us.
CMS
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 11
Medical/Legal
Rising Number of Infectious Disease Cases Creates Patient Safety Issues By Debbie Hill, RN, MBA, LHRM, Patient Safety Risk Manager, The Doctors Company
Physicians are reporting communicable, or infectious, diseases that were thought to have been controlled in the United States. New cases of whooping cough (pertussis) and, most recently, measles (rubeola) are making headlines. During the first half of 2014, there were more than 288 reported cases of measles, the highest number for any one year since the disease was eliminated from the country in 2000.1 In addition, newly classified infectious diseases are emerging, like Middle East Respiratory Syndrome Coronavirus (MERS-CoV), a viral respiratory illness. Modern travel has been found to impact how far and fast infectious diseases spread.2 Outbreaks often occur when a disease is brought into the United States and spread to people who have not been vaccinated.1 Exposure to infectious diseases in a medical office or facility is a serious patient safety issue. To protect staff and patients, medical offices need to have established protocols that limit the exposure risk from individuals who come into the office with one of these debilitating, if not fatal, conditions. Medical malpractice liability risk may grow as reports of infectious diseases continue. Unlike hospitals, most medical offices are not equipped with negative pressure isolation units that protect staff and other patients from infectious diseases. Your practice, however, can reduce liability risks and promote patient safety by: Documenting all discussions with patients and parents of minors regarding infectious diseases, including the risks and benefits of inoculation. Documenting all discussions about serologic evaluations with patients who are unsure of their immunity status. Ensuring that all immunization tracking is up to date so that patients remain on a timely immunization schedule. When possible, allowing only staff members who have demonstrated evidence of immunity to work with patients suspected of having a communicable or infectious disease. Complying with state laws for the provision of vaccines to healthcare workers. For more information, go to http://www2a.cdc.gov/nip/statevaccapp/statevaccsapp/default.asp. 12
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
Notifying those who may have come in contact with an infected individual that they should see a physician. Ensuring that all office staff members are trained in the use of personal protective equipment and on proper isolation techniques when working with patients who present with symptoms of an infectious disease. Physicians should be prepared to evaluate patients for new and emerging infectious diseases.3 Staying current on the latest signs and symptoms, diagnostic testing, and case definitions, as well as infection control recommendations from the Centers for Disease Control and Prevention, is essential. Follow these tips if you or your staff suspects a patient has an infectious disease: Minimize risk of exposure by moving the patient from the waiting area and isolating him or her in an exam room. For airborne diseases, place a surgical mask on the patient and ensure that all office staff members wear protective equipment, including gloves, eye protection, masks, or an N-95 particulate respirator, if needed. Follow standard disinfection and sterilization procedures for exam rooms. Report suspected cases to the local health department and obtain specimens for disease testing. Consider making post-exposure prophylaxis available to those who have been exposed. Post-exposure vaccination can be effective in preventing infectious disease in some individuals; if the vaccine does not prevent contraction, it will likely lesson the severity of the disease. References 1 CDC: Highest number of U.S. measles cases since 2000. CNN Health. http://www.cnn.com/2014/05/29/health/cdc-measles/. Published May 30, 2014. Accessed June 5, 2014. 2 Measles. Travelers’ Health. Centers for Disease Control and Prevention. http://wwwnc.cdc.gov/travel/diseases/measles. Published May 9, 2013. Updated December 13, 2013. Accessed June 5, 2014. 3 Middle East Respiratory Syndrome (MERS): Healthcare Provider Preparedness Checklist for MERS-CoV. Center for Disease Control and Prevention. http://www.cdc.gov/coronavirus/mers/preparedness/checklist-providerpreparedness.html. Published July 15, 2013. Accessed June 5, 2014. 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 health care 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. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety. CMS
PHILANTHROPIST OF THE YEAR
Dr. Maguire said, “Improving medical care and accessibility, along with building medical education in the state of Florida continues to be just the right thing to do.”
Charlotte E. Maguire, M.D. Recognized as Philanthropist of the Year
In 1999, Dr. Maguire donated $1 million to create the Charlotte Edwards Eminent Scholar Chair in the Program in Medical Sciences (PIMS). The program was the precursor for FSU College of Medicine, for which she was an outspoken advocate. In 2004 she donated enough to the medical school for two full-time scholarships to attract qualified prospective students to the fledgling program. In 2005, she surprised the guests attending a celebration in her honor to name the Charlotte E. Maguire, M.D. Virtual Library, by donating $1 million and $1 to FSU College of Medicine to increase the state’s match from 70% to 75%. Her gift to fund The Charlotte E. Maguire, M.D. and Tallahassee Memorial HealthCare Center for Clinical Simulation Lab makes it possible for medical students to hone their skills in patientfocused competent care. “Dr. Maguire’s gifts are totally consistent with the mission of the College of Medicine and have helped transform the college into the learning community it is today,” said Dr. John Fogarty, dean of FSU College of Medicine.
By Pam Wilson, CMS Executive Director
Dr. Charlotte Edwards Maguire was recognized as “Philanthropist of the Year” at the Association of Fundraising Professional’s National Philanthropy Day Celebration on November 13, 2014 in Tallahassee. In a room filled with many of those from organizations and institutions whom she has benefited through her philanthropy locally, the petite white-haired retired pediatrician born on September 1, 1918 received local recognition for her generous donation of time, talents, and resources to help others thrive. An internationally recognized physician and philanthropist, the latest recognition will add to her 61-line listing in Who’s Who in the World. Locally, her philanthropic endeavors have touched many local organizations including Tallahassee Memorial HealthCare, Florida State University College of Medicine, Westminster Oaks Active Living Community, Big Bend Hospice, and Capital Medical Society Foundation. Dr. Charlotte Maguire began practicing medicine in 1944 and opened a pediatric practice in Orlando in 1946, which she ran for 22 years. When asked about her philanthropic motivation,
Dr. Maguire, whose medical career was challenged by those who did not believe there was a place for women in medicine, has used her talents and treasures to shape the face of medicine and the quality of life for her community. She moved past being dismissed from her first medical school matriculation in Memphis to make room for a male student, not being white-coated at the University of Arkansas Medical School, and being referenced as the “first girl doctor” in Orlando headlines. She recalls she wasn’t even warmly received by Capital Medical Society when she first moved to Tallahassee. This year, she is a sponsor of the Capital Medical Society Foundation Holiday Auction that raises funds for FSU College of Medicine students and the We Care Network. She has a big heart. She understands times have changed, in large part because of the tenacity of pioneering women physicians who broke the barriers for future women. Today, we celebrate Charlotte E. Maguire, M.D., her generous spirit, her medical legacy, her transformative philanthropic endeavors, and the vision she has cast for others. Thank you, Dr. Maguire! CMS
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 13
VIEWPOINT
Ending the Silence By Suzanne Leonard Harrison, M.D.
People are talking about domestic violence. Finally. One good thing that has emerged from the media attention with domestic violence and the NFL is that people are talking about it. During the week following release of the Ray Rice video it was all over the national news, making it easy to engage both men and women in conversations about domestic violence. While the video was playing on a television in a Texas airport, I asked a young man what he thought about it. He looked directly at me and said, “I don’t think you want to know what I think.” After I assured him I did, he shared some very negative remarks about men who perpetrate violence against women. The significance for me was that it was easy to engage a man I had never met in a meaningful conversation about domestic violence. The National Domestic Violence Hotline experienced an 84% increase in calls in the days following release of the video. [1] Perhaps we finally entered an era when the silence has ended. I sincerely hope so. I wonder if the increased awareness has translated to patient care. Many of us ask about domestic violence as a part of routine screening, but do we ask during clinical encounters? Do we ask the right questions at the right time, and in a safe place? In the flow of a busy clinic day, it is so easy to get caught up in addressing a patient’s primary concern, so easy to not dig further to find the underlying cause. We have so many pressures with 30+ patients per day, insurance issues, malpractice concerns, pay for performance, learning a new electronic health record. Many physicians find it difficult to query patients because of a personal history of abuse or neglect. Some physicians are currently in abusive relationships. The barriers are numerous, and we are only human. I wonder how many of us actually ask about childhood trauma when caring for our patients. I wonder how many physicians really take the time to assess the abuse and
14 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
neglect inflicted on our patients when they were children, and consider it as a contributor to current medical conditions. We’ve known for several years the tremendous impact that abuse and neglect during childhood has on adult health. I know that I don’t do it often enough, and I’m one of those docs who spends a lot of time delving into social history. Do I ask the right questions? Do I ask at the right time? Am I doing everything I can to make my patients feel safe? Probably not. What now? I am certainly going to try harder to engage my patients – to encourage them to share the challenges they face now. I will ask specifically about current abuse in all forms. I will ask more often how past events may be affecting them now. I will revise my questions so that I can more effectively create a safe place for patients to share their struggles. And I will engage staff in assisting me with these efforts. After all, medicine is a team sport. Want to know how to engage domestic violence conversations with your patients and have resources for your learners? Join the STFM Group on Violence Education and Prevention at www.stfm. org/Groups/GroupPagesandDiscussionForums/ ViolenceEducationandPrevention.
Reference [1] National Domestic Violence Hotline receives long-term commitment of resources from National Football League. (September 19, 2014). http://www.thehotline.org/2014/09/ national-domestic-violence-hotline-receives-long-termcommitment-of-resources-from-national-football-league/. CMS
VIEWPOINT
Guardianship
By Barbara Demby Abrams, M.D., J.D.
Whether your patients are young or old, physicians regularly encounter situations where a patient’s ability to make decisions is compromised or questionable. Family members often ask questions such as: “Doctor, my mother is getting senile. In fact, I don’t think she can manage her affairs any more. What can I do?” “Doctor, my developmentally delayed child is about to turn 18. I know he can’t manage things for himself. How can I continue being his guardian in order to make health care decisions for him and continue to have access to his medical records?” Such questions normally arise from a family member’s recognition of the vulnerability created by their relative’s diminished capacity. What do you do when your adult patients aren’t able to manage their affairs, whether due to dementia, developmental delays, mental illness, or brain injury? Refer the concerned family member to an Elder Law attorney. Although it’s usually done by a family member, any adult may petition the court to determine another person’s incapacity. What will happen next? The court will appoint a committee of three members, one of whom must be a physician, but cannot be the person’s treating physician. The other two committee members are usually nurses, psychologists, and/or social workers. The committee members will gather information and will conduct an exam of the alleged incapacitated person. As the treating physician, you may be contacted to give your opinion as to your patient’s ability to function, particularly regarding abilities to handle financial affairs and to give informed consent for medical procedures. You will be provided with a court order, signed by a judge, authorizing you to provide medical records to the examining committee and to discuss with them your impressions of your patient, including diagnoses and prognosis.
If the majority of the examining committee concludes that the person is not incapacitated in any respect, the judge is required to dismiss the petition. However, if the examining committee finds the person is unable to exercise certain rights, a hearing will be scheduled to determine whether the person is totally or partially incapacitated. If a person is found to be incapacitated in any respect, a guardian is appointed at the end of the incapacity hearing, unless there are less restrictive alternatives to guardianship which adequately address the person’s needs. One such less restrictive alternative is the appointment of a guardian advocate, for people with developmental disabilities who are fairly high functioning. Depending on the person’s particular needs, a guardian of the property, a guardian of the person, or a plenary guardian may be appointed. This guardian may be a family member, but is not required to be. A guardian of the property is required to inventory the property, invest it prudently, use it for the ward’s support, and account for it by filing detailed annual reports with the court. A guardian of the person, who may or may not be the same person as the guardian of the property, may exercise those rights that the court has delegated to the guardian, such as providing medical and personal care services, and determining the place and kind of residential setting best suited for the ward. The guardian of the person must also present a detailed plan for the ward’s care and a physician’s report annually to the court. What if I have a brain-injured patient who had a guardian appointed while he was in a coma, but after a year of rehab he’s almost back to his baseline? If a person recovers in whole or part from the condition that caused him or her to be incapacitated, a petition can be filed with the court to restore the ward’s rights. This is called a Suggestion of Capacity and is usually filed by the guardian or by the ward. In these cases, the court will have the ward reexamined by a physician, and based upon the physician’s recommendations, the court can restore some or all of the ward’s rights. So when family members approach you with concerns that their relative is unable to manage his or her affairs, refer them to a local Elder Law attorney. If you become concerned about one of your patients no longer being able to care for him or herself and there is no friend or family member involved, you may contact DCF’s Department of Elder Affairs at 850-414-2000 for assistance. CMS
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 15
POLST
POLST—A Tool to Help Older Individuals Stay in Control By Marshall B. Kapp, J.D., M.P.H., Director, Florida State University Center for Innovative Collaboration in Medicine and Law
Older individuals and their families confront many
of physician orders and health care providers are culturally
different, important kinds of decisions. Some of those
and psychologically used to routinely following physician
decisions concern medical care. None are more complex
orders, studies such as the recent one in JAGS confirm
and emotion-laden, however, than choices about the
that a POLST is likely to receive more respect than patient
initiation, continuation, withholding, or withdrawal of
wishes expressed in other ways, such as current mechanisms
aggressive medical intervention when illness has advanced
authorized by Florida Statutes Chapter 765. Thus, POLST
to a point where it is critical and unlikely to be reversed.
represents the next generation in the evolution of health
In those situations, the particular individual’s personal
care advance planning law and policy.
values and wishes should be respected by others and determine the course of medical action. Sadly, sometimes
A number of other states have already codified the POLST
such respect does not occur and people in this context,
option in their statutes and/or regulations, giving physicians
especially when they no longer are able to make and express
the confidence to write such orders in consultation with
their own present preferences, get subjected to intrusive
the patient or surrogate and giving other health care
and burdensome medical interventions that they would
professionals the confidence to comply with those orders.
not have wanted for themselves. The 1990 federal Patient
If Florida truly values the principle of self-determination,
Self-Determination Act (PSDA) and the first generation of
especially for its most vulnerable medical populations like
advance care planning mechanisms (living wills and durable
older, frail people nearing the end of their lives, it needs
powers of attorney) help in many cases to bring about a
to join the ranks of states enabling POLSTs to be written
humane, autonomy-respecting conclusion to an individual’s
and respected. For the past several years, the Florida State
life, but they provide no assurance of an optimal result.
University Center for Innovative Collaboration in Medicine and Law, working in close collaboration with the National
However, there does exist an effective mechanism for
POLST Paradigm Task Force, has acted as coordinator of
correcting this problem. A study produced by researchers
a statewide POLST effort involving a large group of health
at Oregon Health & Science University and published in
care, human service, religious, and legal professionals who
the June 9 online issue of the Journal of the American
are committed to protecting and promoting the rights of
Geriatrics Society (JAGS) provides yet more evidence that
individuals approaching the end of life. The time has come
individuals for whom a POLST (Physician Orders for Life-
for more Floridians to educate both themselves and others,
Sustaining Treatment) has been written are more likely to
including those who represent the citizenry in the public
receive the kind of medical care they wish near the end of
policy arena, about the Florida POLST initiative (https://
their lives, and to be provided with that care in the location
med.fsu.edu/medlaw/polst) and to advocate with local
of their choice. The POLST is a document that enables
officeholders, community leaders, and media outlets for
a willing patient (or the patient’s surrogate) to convert
adoption and implementation of the POLST within Florida
the patient’s medical treatment wishes into the physical
law as a significant marker in the development of more
form of medical orders written by the patient’s physician,
ethical and humane care for each of us.
instructing other health care providers such as members of an Emergency Medical Services squad about the future care of that patient. Because the POLST document is a set
16
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
CMS
L-R: Judith Lewis, MD, Marlisha Edwards, MD, Jeannette Iriye, ARNP-C, Camille Blake, DO
We Have Moved to Better Serve Our Patients Drs. Judith Lewis, Camille Blake, Marlisha Edwards and Jeannette Iriye, ARNP-C are pleased to announce that our practice is now conveniently located on the 3rd floor above the Tallahassee Memorial Emergency Center-Northeast. If you have any questions or concerns, please contact, 216-0100. Accepting New Patients
Tallahassee Memorial Physician Partners Cardiac and Internal Medicine Specialists Northeast
Tallahassee Memorial Emergency Center - Northeast
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
17
A belated Happy Veterans Day to those members of Capital Medical Society who have served: Isaac Moore, M.D. (Army) Captain Thomas Peele, M.D. (Army) Captain L. Steven Sarbeck, M.D. (Navy) Lt. Commander Robert M. Snider, M.D. (Air Force) Captain
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
CMS ALLIANCE CORNER
By Zaneta Batchelor, President, Capital Medical Society Alliance Under the full sunlight of beautiful Florida, Alliance members enjoyed the October Fall Fitness for Everybody Event at Winthrop Park. This event was led by Krista Killius. The fitness event was followed by the November Family Fun Picnic held in Maclay Gardens where our new Alliance members were introduced and our children enjoyed games and face painting.
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 19
Tallahassee Memorial Family Medicine Residency Program Welcomes Michael Allison, M.D. Board Certified: Family Medicine Medical School: Creighton University, Omaha NE Residency: University of South Florida/Morton Plant Mease Family Medicine Residency Fellowship: PCC Community Wellness Center Maternal Child Health Accepting New Patients.
Complete Medical Care. Here in Tallahassee. 1301 Hodges Drive | Tallahassee | 850-431-5430
20 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
21
CMS FOUNDATION
DONATE TO THE CMS FOUNDATION
We Thank Our Donors The mission of the Capital Medical Society Foundation is 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.
Reasons to Give: Funds raised by generous donors benefit the We Care Network. The We Care Network is a past
Blue Foundation Sapphire Award winner and its impact on the community is featured in the Sept/ Oct 2014 issue of the Tallahassee Magazine. The We Care Network provides over $5 million in donated specialty medical and dental care to the community’s low-income uninsured annually. In addition, donations support medical school scholarships for first and second year students at FSU College of Medicine committed to returning to NW Florida after completion of their residencies. In 2014, $40,000 in scholarships were awarded to nine FSU College of Medicine students.
We thank the following people/organizations who made a donation to the CMS Foundation last month: In Memory: Charles Williams, M.D. – in memory of Jack MacDonald, M.D., Millard Roberts, M.D., and Hollie Louise Skelton Sanders We Care Network: Anonymous – for the We Care Dental Network The Perkins Charitable Foundation Year-End Appeal for the We Care Network: Gary Brown, M.D. Dr. Susan Cross and Mr. Timothy Cross
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 will send an acknowledgement letter to those you memorialize and honor.
Azalea Women’s Healthcare Adrienne George, M.D.
Debbie White, C.N.M.
How to Give: Capital Medical Society Foundation has created three board-designated funds in order to establish financial stability to meet our mission. You can donate at any time to one of CMS Foundation’s funds. 1) The CMSF Endowment 2) The We Care Network Endowment 3) The Scholarship Fund Checks should be made payable to the CMS Foundation and indicate on the memo line of your check to which fund you would like to donate. Bring your check to the CMS Office or mail it: Capital Medical Society ~ 1204 Miccosukee Road ~ Tallahassee, FL 32308.
22 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
Azalea Women’s Healthcare is pleased to announce our new addition Rebecca Harris ARNP/CNM Rebecca will be joining our practice as of December 1, 2014 and she is looking forward to providing gynecological and obstetrical care to the women of Tallahassee. For Referrals, please call 850-877-5767.
CMS FOUNDATION: WE CARE NETWORK
Thank you!
To our CMS members and We Care partners who saw new patients for the We Care Network in October 2014. Your generosity and support of the We Care Network makes a difference. Physicians Greg Albright, D.O. Emily Ashmore, M.D. Robert Bradford, M.D. Viet Bui, M.D. Carlos Campo, M.D. Joseph Camps, M.D. Ray Dolly, M.D. Michael Douso, M.D. Spencer Gilleon, M.D. Kristin Harmon, M.D. Celeste Hart, M.D. Muhanad Hasan, M.D. David Huang, M.D. Marc Inglese, M.D. Amit Jain, M.D. James Killius, M.D. Carey Linker, M.D. Maribel Lockwood, M.D. John Mahoney, M.D. Michael Mangan, M.D. Steven Ostrov, M.D. Praful Patel, M.D. James Renehan, M.D. Andres Rodriguez, M.D. William Sawyer, M.D. Scott Sellinger, M.D.
Hardeep Singh, M.D. Joshua Somerset, M.D. Joseph Soto, M.D. Mary Swain, M.D. Timothy Sweeney, M.D. John Thabes, M.D. David Vermess, M.D. Anthony Wright, M.D. William Yaakob, M.D. Dentists Eric Amundson, D.D.S. Brian Beck, D.M.D. Susan Byrne, D.M.D. Walter Colón, D.M.D. Eve James-Wilson, D.M.D. William McFatter, D.D.S. E. Lynn McLarty, D.D.S. Jim McSoley, D.M.D. Robert Murrell, D.M.D. Lawrence Pijut, D.M.D. Frank Swerdzewski, D.D.S. James Sykes, D.M.D. Jay Walton, D.D.S. Lawrence Weaver, D.D.S. Ed Zapert, D.M.D. Facilities Affordable Dentures Anesthesiology Associates Beachton Denture Clinic Capital Regional Medical Center Dermatology Associates Desloge Home Oxygen Leon County Dental Clinic Pathology Associates Radiology Associates Seven Hills Surgery Center Southeastern Surgery Center Tallahassee Diagnostic Imaging Tallahassee Endoscopy Center Tallahassee Health Imaging Tallahassee Memorial HealthCare Tallahassee Orthopedic and Sports Physical Therapy Tallahassee Outpatient Surgery Center TMH Family Medicine Residency Program Women’s Imaging Center
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. You can send your value of donated services via fax to Monica Demott, R.N. at (850) 201-0085 or mail to 1204 Miccosukee Road, Tallahassee, FL, 32308. Thank you! Please contact Monica Demott, R.N. at mdemott@capmed.org or 201-0130 if you are a We Care volunteer and you provided volunteer specialty care in the month of October 2014 and your name is omitted.
We thank our referring providers from October 2014: Eboni Allen, ARNP
Farhat Khairallah, M.D.
Anne Ananga, ARNP
Elaine Larkins, ARNP
Aaron Appiah, M.D.
Esaias Lee, M.D.
Dhananjay Bendre, M.D.
Matthew Lee, M.D.
Faith Blocker, ARNP
Chitra Mony, M.D.
Jonna Bradley, ARNP
William Necaise, ARNP
Sherry Bramblett, ARNP
David Oberste, M.D.
Daniel Breivogel, ARNP
Whit Oliver, M.D.
Tim Broeseker, M.D.
Rose Origa, ARNP
Acquinonette Bryant, M.D.
Lisa Perkins, ARNP
Joseph Camps, M.D.
Luz Prieto-Sanchez, M.D.
Lysmar Dinguis, M.D.
Stephen Quintero, M.D.
Michael Douso, M.D.
Marlaine Registe
Cynthia Evans, ARNP
Temple Robinson, M.D.
Tanya Evers, M.D.
Tim Ruark, M.D.
Michael Forsthoefel, M.D.
Prerna Satyanarayana, M.D.
Sharron Foster, M.D.
William Sawyer, M.D.
Anneka Gaffney, ARNP
Roy Schwartz, M.D.
Lynn Garner, M.D.
Thomas Serio, M.D.
Judy Griffin, ARNP
William Shaner, D.D.S.
Celeste Hart, M.D.
Philip Sharp, M.D.
Hantz Hercule, M.D.
Douglas Sherman, M.D.
Susan Horton, ARNP
Robert Snyder, M.D.
David Huang, M.D.
Alanna Steaple, ARNP
Iman Imanirad, M.D.
Frank Swerdzewski, D.D.S.
Amit Jain, M.D.
Tallahassee VA Clinic
Eve James-Wilson, D.M.D.
Scott Tetreault, M.D.
Rohan Joseph, M.D.
Jeffrey Wasserman, D.O.
Howard Kessler, M.D.
Quandra Whaley, ARNP
During the month of OCTOBER, the We Care Network: Received 124 referrals, with 54 patients new to the program
Scheduled 77 appointments with volunteer physicians and dentists
$86,432 in donated care was reported by We Care volunteers
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75% of healthcare professionals will answer this question incorrectly... Want to know how it can be done cheaper..? Find the answer and the referral partners waiting for you to join: HIEnetworks.com/Tallahassee