Florida MD JulyAugust 2025

JULY/AUGUST 2025 • COVERING THE I-4 CORRIDOR

Orlando Health Lake Mary Hospital

Delivers World-Class Care To The Community

Minutes From Home.

A Lifetime of Healing.

You’re not just our patient. You’re our neighbor. For more than a century, Orlando Health Orlando Regional Medical Center has been honored to provide nationally recognized care for the Central Florida region we proudly call home. And because it’s your home, too, you deserve trusted healthcare within reach, so we can foster a partnership focused on health and wellness – together. Giving you more reasons to choose well. OrlandoHealth.com/ORMC

choose well.

contents

ON THE COVER: Orlando Health Lake Mary Hospital

18

SELECTING A REAL ESTATE BROKER FOR YOUR MEDICAL PRACTICE

21

HELPING VETERANS TREAT OBSTRUCTIVE SLEEP APNEA

COVERING THE I-4 CORRIDOR

 COVER STORY

The new hospital, which replaced Orlando Health South Seminole Hospital, spans 455,000 square feet and includes 124 beds, with room to grow to 240. “Residents can get world-class health care within our community,” said Shawn Molsberger, president of Orlando Health Lake Mary Hospital. “There are a lot of services we provide beyond most community hospitals.”

The wide range of services and equipment includes: • Comprehensive cardiovascular care • Labor and delivery services • Six state-of-the-art operating rooms • A full-service emergency department • Three catheterization labs One of the goals of the new hospital is to provide high level care that isn’t often available outside of a major city or downtown setting. While plans for the facility had been in the works for years, its importance became even more clear during the COVID-19 pandemic.

PHOTO: PROVIDED BY ORLANDO HEALTH

PHOTO: PROVIDED BY ORLANDO HEALTH

4

JULY/AUGUST 2025

DEPARTMENTS 2

FROM THE PUBLISHER

8

DERMATOLOGY

9

MARKETING YOUR PRACTICE

10

PULMONARY AND SLEEP DISORDERS

13

HEALTHCARE LAW

14

ORTHOPEDICS

16

PEDIATRICS FLORIDA MD - JULY/AUGUST 2025

1

FROM THE PUBLISHER

I

am pleased to bring you another issue of Florida MD. If any of your patients are immunocompromised please share the following important information about Think of me Please and the important work they do to help these individuals.

For immunocompromised individuals, reducing exposure to common infectious bacteria, viruses, molds, and other particles is a daily concern. Think of me Please® is a Florida-based 501(c)3 organization serving individuals with compromised immune systems through education, awareness, and community connections since 2019. It was founded after multiple community members became seriously ill over the holidays when family members came into their homes while sick and contagious.

Too often, immunocompromised patients must choose between staying healthy or participating in everyday activities others may take for granted.

Approximately 6.6% of Americans are immunosuppressed because of health conditions, treatments, or prescriptions. At Think of me Please®, the missing link in healthcare is protecting vulnerable patients from potentially life-threatening illness through precautions anyone can take. It encourages everyone, especially healthcare providers, to take simple steps to keep the immunocompromised individuals they interact with safe. This may include actions like wearing a mask while interacting with the patient or moving the patient to a private room instead of having the patient wait in a general public area. Think of me Please® also launched its Door Hanger Initiative to provide simple signage as a reminder to pause, think, and take any necessary precautions before entering an area where there is an immunocompromised person inside.

The organization also provides community connections through events for immunocompromised individuals, communication with healthcare providers, and its virtual peer support space for caregivers. Think of me Please® shares videos and stories from patients, loved ones, caregivers, and healthcare providers. It asks all people, immunocompromised or not, to think of immunocompromised patients they may interact with, please.

Think of me Please® is always grateful to connect with healthcare providers, share their stories, and accept donations to continue providing education, awareness, and support. Visit ThinkofmePlease.org for additional information or email info@thinkofmeplease. org to request your Think of me Please® Door Hanger today.

Sources:https://thinkofmeplease.org/

Best regards,

Donald B. Rauhofer Publisher

ADVERTISE IN FLORIDA MD

PREMIUM REPRINTS

For more information on advertising in Florida MD, call Publisher Donald Rauhofer at (407) 417-7400, fax (407) 977-7773 or info@floridamd www.floridamd.com

Reprints of cover articles or feature stories in Florida MD are ideal for promoting your company, practice, services and medical products. Increase your brand exposure with high quality, 4-color reprints to use as brochure inserts, promotional flyers, direct mail pieces, and trade show handouts. Call Florida MD for printing estimates.

Email press releases and all other related information to: info@floridamd.com

2 FLORIDA MD - JULY/AUGUST 2025

Publisher: Donald Rauhofer Photographer: Donald Rauhofer / Florida MD Contributing Writers: John “Lucky” Meisenheimer, MD ,Tara Griffin, DMD Sonda Eunus, MHA, John Meisenheimer, VII, MD;B.S., Tabarak Qureshi, MD FCCP, Tara Griffin, DMD, Frank Ricci, Julie A. Tyk, JD, Jaivir S. Rathore, M.D, F.A.E.S & Idha Sood, M.B;B.S Art Director/Designer: Ana Espinosa Florida MD is published by Sea Notes Media,LLC, P.O. Box 621856, Oviedo, FL 32762. Call (407) 417-7400 for more information.

Advertising rates upon request. Postmaster: Please send notices on Form 3579 to P.O. Box 621856, Oviedo, FL 32762.

Although every precaution is taken to ensure accuracy of published materials, Florida MD cannot be held responsible for opinions expressed or facts expressed by its authors. Copyright 2025 Sea Notes Media. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Annual subscription rate $45.

JOIN US IN LAKE BUENA VISTA, FL

REGISTRATION OPEN

NETWORK, LEARN, GROW https://sls.org/mis2025/

JOIN LEADING EXPERTS IN THE FIELD! Attend Pre-conference Hands-on Master Courses Multispecialty Plenary Sessions Presentations by World-Renowned Experts Scientific Papers / Videos / e-Posters Global Perspectives in MIS Plus much more!

BECOME A MEMBER TODAY AND RECEIVE DISCOUNTS TO ATTEND MISWEEK 2025

ADDITIONAL MEMBER BENEFITS

World-Class Conferences and Resources Tools and Opportunities to Advance Your Career Publications to Keep You at the Forefront of MIS Exclusive Member Interactions

Where Disciplines Meet JOIN/RENEW ONLINE AT SLS.ORG/MEMBERSHIP Same Great Experience, Same Low Membership Fees FLORIDA MD - JULY/AUGUST 2025

3

COVER STORY

Orlando Health Lake Mary Hospital Delivers World-Class Care to the Community

By Staff Writer The new hospital, which replaced Orlando Health South Seminole Hospital, spans 455,000 square feet and includes 124 beds, with room to grow to 240.

PHOTO: PROVIDED BY ORLANDO HEALTH

“Residents can get world-class health care within our community,” said Shawn Molsberger, president of Orlando Health Lake Mary Hospital. “There are a lot of services we provide beyond most community hospitals.”

The wide range of services and equipment includes: • Comprehensive cardiovascular care • Labor and delivery services • Six state-of-the-art operating rooms • A full-service emergency department • Three catheterization labs

Front of Orlando Health Lake Mary Hospital spanning 455,000 square feet including 124 beds with potential expansion of up to 240 beds.

One of the goals of the new hospital is to provide high level care that isn’t often available outside of a major city or downtown setting. While plans for the facility had been in the works for years, its importance became even more clear during the COVID-19 pandemic.

“What we found after COVID is that people just don’t want to drive for healthcare. If you don’t have it locally, they’ll seek out other options,” Molsberger said. “Over the past several decades, health systems have traditionally concentrated advanced services

and technology in large metropolitan hospitals. But today, more patients want high-quality care closer to home—so we’re seeing comprehensive services increasingly brought into community hospitals.” The new facility brings many services and procedures to the backyards of Seminole County residents who previously were forced to drive to across Central Florida to find quality care.

That local availability can be a game-changer for the patients who don’t have access to transportation or don’t have family in the area.

One of three catheter labs at Orlando Health Lake Mary Hospital where cardiologists can perform procedures like Pulsed Field Ablation.

“I’ve had patients ask family members to fly in from out of state just to transport them through these procedures,” said Dr. Mohamed Elshazly, a board-certified cardiologist with the Orlando Health Heart and Vascular Institute. “Having all of this here makes a huge difference in terms of patient satisfaction.”

PHOTO: PROVIDED BY ORLANDO HEALTH

While working to deliver care on par with some of the top options in the nation, Orlando Health sought to hire from among the best physicians available for the new hospital. One of the easiest sells was the location.

Lake Mary and the surrounding area are highly attractive both for living and for raising a family, helping to make that recruitment process easier.

“We were able to recruit best of the best when it comes to our medical staff and clinicians,” Molsberger said.

4 FLORIDA MD - JULY/AUGUST 2025

COVER STORY Another major attractor was a commitment to outfit Orlando Health Lake Mary Hospital with next-level technology and equipment.

“All of this technology is able to help diagnose things earlier, which minimizes how traumatic of an experience a person has and how long the care is,” Molsberger said. “It also provides a higher level and degree of accuracy in what treatment plan they’re recommending.”

PHOTO: PROVIDED BY ORLANDO HEALTH

COMPREHENSIVE CARDIOVASCULAR SERVICES A KEY BENEFIT One of the most important benefits offered by Orlando Health Lake Mary Hospital is its comprehensive cardiovascular care. A wide range of services under this umbrella is available to residents, including interventional cardiology, electrophysiology and advanced imaging.

“In this kind of community hospital, the services provided are equivalent to even the best academic centers in the country,” Dr. Elshazly said. “We’re also using state-of-the-art equipment and technology.”

Orlando Health Lake Mary Hospital continues to add to its bevy of technological updates. For example, the facility will soon debut cardiac MRI technology. The advanced imaging system offers a leading-edge way to examine the heart and its structures, aiding in the diagnosis of various cardiomyopathies.

The hospital also added a heart failure specialist, bringing a high level of care to a particularly vulnerable group of patients.

“It’s huge because a big component of cardiovascular care is heart failure patients,” Dr. Elshazly said. “They tend to be the sickest patients. They are the ones who get admitted to the hospital multiple times.” Now, those patients won’t have to trek to different parts of Central Florida to receive regular care.

Another useful and innovative addition for cardiovascular patients is the patient experience center. The cozy space includes

Patient Experience Center at Orlando Health Lake Mary Hospital where patients and visitors can access interactive screens to learn more about the hospital’s services or just relax, work and recharge their devices.

interactive touchscreen displays where patients and their family members can easily learn about what to expect from their time at the hospital.

“We wanted to build a patient experience center where patients can actually see what their cardiovascular care and journey in the hospital is going to be like,” Dr. Elshazly said.

Patients can learn about the steps likely to take place during their care and how many days they may be in the hospital, which can help them calculate potential expenses. They’ll learn more about their patient care team and see models of equipment that may be used, including pacemakers and catheters. It’s also a place to relax with comfortable seats and phone charging areas.

One of the suites for moms at Orlando Health Lake Mary Hospital Center for Women and Babies.

“It’s kind of a space for them to unwind and take the stress off,” Dr. Elshazly said.

PHOTO: PROVIDED BY ORLANDO HEALTH

LABOR AND DELIVERY BROUGHT TO SEMINOLE COUNTY A significant new benefit for the community is the Center for Women and Babies, which brings labor and delivery services to the area. This has long been considered a top need for residents in Seminole County.

“Way back in 2018, we went to our wonderful Mayor of the City of Lake Mary, David Mealor, and said we were going to build a hospital here in Lake Mary,” Molsberger said.

“He said ‘well that’s phenomenal, FLORIDA MD - JULY/AUGUST 2025

5

COVER STORY

The hospital has six private suites for labor and delivery, with each offering a shower, recliner and hydrotherapy tub. There are also 18 postpartum beds. The first six months of operation witnessed more than 500 deliveries, with these new parents coming from all across Central Florida. “ Bringing our nationally ranked labor and delivery and newborn expertise from our downtown campus to Seminole County is one of the highlights of what we’re able to offer our community.” said Rosemarie Palmer, Director of Women’s Services for Orlando Health Lake Mary Hospital. “Moms and families have access to these services without driving far from home or battling the horrendous traffic on I-4.”

The Center for Women and Babies, a part of the Orlando Health Women’s Institute, is laid out to make transport and care as easy as possible for expecting mothers and families. The center is contained on a single floor, minimizing patient movement during visits.

“You can come to Lake Mary, park out front, go to the third floor, and you don’t have to leave that floor until you go home,” Palmer said. “It’s a huge win for the patients.”

As with the rest of the hospital, the Center for Women and Babies uses the latest technology to make things easier for patients as well as their doctors and nurses.

For example, there is a digital “smart” whiteboard in each private suite. These whiteboards connect directly to the patient’s electronic medical records, allowing for patient status to be updated in real time.

PHOTO: PROVIDED BY ORLANDO HEALTH

but don’t build a hospital unless you’re going to add labor and delivery services.’”

Hydrotherapy tub inside suite for laboring.

manually with a dry-erase pen. That relied on the nurse or someone being able to update it as the patient’s condition changed,” Palmer said. “With the new digital boards, nursing and physician satisfaction is great because everything is updated and there’s no guessing.”

Another new technology is the Certascan system, which creates digital footprints to identify newborns. This upgrade from the old ink and paper method offers better record keeping, while also providing long-lasting mementos for families.

A close partnership with Orlando Health Winnie Palmer Hospital for Women and Babies also offers seamless benefits for mothers and babies who are experiencing more serious health complications.

Orlando Health Lake Mary Hospital has a 24/7 triage area for patients who come in with symptoms of labor. If they present “Prior to digital whiteboards, those boards were updated with a high-risk delivery, they can quickly be transported to Orlando Health Winnie Palmer HospiDigital smartboard located inside every patient room at Orlando Health Lake Mary Hospital provides tal for Women and Babies. patient with real time updates on care.

This is also the case for babies – born at Orlando Health Lake Mary Hospital – who must be admitted to the neonatal intensive care unit, with both ground and air transport available.

PHOTO: PROVIDED BY ORLANDO HEALTH

“That is an extraordinary comfort not only to the nurses and doctors but for our patients and our community to know that if their baby needs that higher level of care, that Orlando Health Winnie Palmer is right there,” Palmer said.

ORTHOPEDICS, EXPANDED CARE AVAILABLE NEARBY Local residents also have access to other services through the sur6 FLORIDA MD - JULY/AUGUST 2025

COVER STORY rounding Orlando Health Medical Pavilion – Lake Mary. The 60,000-square-foot area serves as home to numerous outpatient specialties, including pediatrics, gynecology and urology. Within the pavilion is a state-of-the-art ambulatory surgery center and comprehensive imaging center.

Orlando Health Jewett Orthopedic Institute also opened a new Lake Mary facility, bringing a higher level of orthopedic care to the area. The 14,000-square-foot facility offers access to hand surgeons, spine surgeons and other specialties. The location opened in May, but that doesn’t mean it is a finished product.

“We have more and more orthopedics that we’re working on to consistently improve quick access when our patients need it, and it’s all in partnership with Orlando Health Jewett Orthopedic Institute,” Molsberger said.

IMPACT ON SEMINOLE COUNTY ALREADY FELT Despite only being up and running for a few months, it hasn’t taken long to see the positive impact that Orlando Health Lake Mary Hospital has made on the community.

One day not too long ago, Molsberger was in line for coffee (the facility partners with and has it’s own Foxtail Coffee for the community to enjoy) when he ran into a man whose baby had just been delivered at the Center for Women and Babies. The father was excited that his family had been able to stay in the area, unlike with his first baby.

“He said it was so nice to be able to deliver near home, with grandparents, aunts and uncles able to come see them,” Molsberger said.

The new hospital also is making a difference by bringing a wide range of world-class services directly to the community at a time when people are more reluctant to travel for care. For some residents, this means being closer to their families during critical health care moments.

Orlando Health understands that offering high-level care close to where people live can make a significant difference for patients, both in terms of satisfaction and overall health.

“It doesn’t matter if it’s imaging or a primary care physician appointment or physical therapy. The harder it is to access it, the harder it is for people to be compliant with their follow-up care,” Molsberger said. “When we have high quality and accessible healthcare in our community, it just keeps everyone healthier, and this is what the mission of Orlando Health is – “to improve the health and quality of life of the individuals and communities we serve.” 

ORLANDO HEALTH LAKE MARY HOSPITAL SERVICES • Six state-of-the-art operating rooms • Three catheterization labs with a dedicated interventional radiology and vascular lab • Comprehensive cardiovascular care • 16 ICU beds • Observation unit • Imaging • Lab

“I used to do procedures downtown and a lot of patients would come and see me and once I mention ‘downtown’ they wish they could have an option closer to home in Seminole County,” Dr. Elshazly said. “But now, when I’m offering to do it here, all of them are super pleased and happy.”

For some patients, this easy access is more than a convenience.

Many older patients can’t drive and don’t have easy access to transportation, making trips to other parts of Central Florida challenging.

The new Lake Mary hospital helps ensure patients can receive the same caliber of care they would at our downtown campus— care that is competitive with some of the top healthcare options in the nation—without having to travel long distances.

This elevated care is only going to increase over time. The hospital, for example, is working to add its own neonatal intensive care unit in the coming years, significantly expanding its labor and delivery services. The hospital is currently working through the approval process and hopes to have 10 to 12 beds.

380 RINEHART ROAD LAKE MARY, FL • 32746 407-767-1200 WWW.ORLANDOHEALTH.COM/FACILITIES/ LAKE-MARY-HOSPITAL

FLORIDA MD - JULY/AUGUST 2025

7

DERMATOLOGY

Melanoma Makes Me a Real Doctor

By John “Lucky” Meisenheimer, MD and John Meisenheimer, VII, MD

Melanomas come in all different shapes and sizes. They are rarely the archetypal jet black, nodular mole-like growth, in which even a first-year medical student could make the diagnosis.

Melanomas may appear elevated, they can be flat, they can be multicolored, and they do not have to have pigment. Some melanomas can persist for very long periods before being discovered, such as lentigo maligna melanoma. Others can grow rapidly and deadly in a few weeks. Melanomas can develop beneath the nails, and even in non-skin areas such as the eye, oral cavity, nasal sinuses, even rectally.

The best guidance for identifying melanomas for non-dermatologists is using the mnemonic ABCDEs of melanoma evaluation, Asymmetry of the lesion, Border irregularity, Color variation, Diameter greater than 6mm and Evolution. However, dermatologists rarely use the ABCDE guide, as most of us know by looking because of intuitive expertise. When a dermatologist observes a suspicious lesion, in our mind, it pops up, “that looks suspicious.” Intuitive expertise is ubiquitous throughout all specialties and comes with experience. The ER doc that walks into a patient room and immediately diagnoses congestive heart failure with only a glance is demonstrating intuitive expertise. Intuitive expertise can be confounding to medical students who need to look up everything online. Still, it is this intuitive expertise we all gain through training and experience that makes us “real” doctors.

Lucky Meisenheimer, M.D. is a board-certified dermatologist specializing in Mohs Surgery. He is the director of the Meisenheimer Clinic – Dermatology and Mohs Surgery.

John Meisenheimer, VII is an MD practicing in Orlando.  8 FLORIDA MD - JULY/AUGUST 2025

PHOTO: JOHN MEISENHEIMER, VII, MD

Lentigo maligna melanoma.

PHOTO: JOHN MEISENHEIMER, VII, MD

As a Mohs surgeon, I rarely “pop” pimples anymore, not that there is anything disgraceful about helping a patient with a disfiguring skin disease that can leave them permanently scarred.

As the Seinfield episode would suggest, laypeople might seem to think unless you are saving lives, you are not a “real” doctor. So, I guess in a sense, melanomas make dermatologists “real” doctors (and let’s not forget squamous cell carcinomas and basal cell carcinomas can also kill you).

I know in my practice over the last 30 years, I have found hundreds of melanomas. Even to this day, when I see a melanoma, I quietly give myself a high five. When you catch melanoma in time, you have changed a person’s life for the better, even if they may not realize it. At the same time, I am also grateful that I did not miss that melanoma. There is always a degree of stress when doing a “routine skin exam” there is nothing routine about melanoma or the potential for missing a melanoma.

A superficial spreading melanoma.

Nodular melanoma.

PHOTO: JOHN MEISENHEIMER, VII, MD

Jerry was having dinner at a restaurant with his dermatologist girlfriend.

Seinfield - “How’s the life-saving business?

Dermatologist girlfriend - “It’s fine.”

Seinfield - “It must take a really, really big zit to kill a man.”

Dermatologist girlfriend - “What is with you?”

Seinfield - “You called yourself lifesaver. I call you pimple popper M.D.” A restaurant patron walks up to their table and says, “Dr. Sitarides?”

Dermatologist girlfriend - “Mr. Perry, how are you?”

Mr. Perry - “I just want to thank you again for saving my life.”

Seinfield - “She saved your life?” Jerry has a shocked look on his face.

Mr. Perry - “I had skin cancer.”

Seinfield - “Skin cancer, damn.” Jerry’s face twists in the agony of defeat.

PHOTO: JOHN MEISENHEIMER, VII, MD

When I was in medical school and revealed to my classmates that I wanted to be a dermatologist, they usually gave me a flabbergasted look and said, “You want to pop zits for a living?” Immediately followed by, “You don’t want to be a real doctor?” I wish the Seinfeld episode, when Jerry was dating a dermatologist, had been released so that I could refer them to it. The Seinfeld episode went something like this:

Pathology of a melanoma.

MARKETING YOUR PRACTICE

Is Your Online Reputation Costing You Patients?

By Sonda Eunus, MHA, CMPE What does your online reputation say about your practice? If you have a negative online reputation, you are missing out on new patients every day. Most medical practices now get the majority of their new patients through Google and other search engine queries, such as “Pediatrician in Orlando”. If your practice appears in these searches, the most common next step for a potential new patient would be to check out your reviews – what are other patients saying about your practice? It has been reported that 90% of consumers read online reviews before visiting a business and that online reviews influence 67% of purchasing decisions (Bright Local). For this reason, it is incredibly important to pay attention to the rating and reviews that your practice has on search engines, social media platforms, and local online business directories.

However, despite the importance of cultivating a positive online reputation, only 33% of businesses report actively collecting and asking for reviews (1). One great process to set in place at your practice is asking for patient reviews after each patient visit. It can be as simple as training your front office staff to ask each patient how their visit went while checking them out, and if they receive favorable feedback then they can ask the patient to please leave a review on Google or Facebook about their experience. If they receive negative feedback, this feedback should be taken very seriously, and management should be notified as soon as possible so that the issue can be mitigated before the patient decides to post a negative review.

Setting up an automated text or email campaign that asks each patient for their feedback after their appointment is also a great way to improve your online reputation as well as to correct any issues that may be occurring at your practice.

When you receive feedback from patients, you are then able to prompt them to leave a public review on Facebook, Google, Yelp, Healthgrades, or other applicable review platforms. However, you must be aware that legally, you are not allowed to only direct people with favorable feedback to leave reviews, which is known as review-gating – so if you are implementing an automated system like this, just make sure that you are aware of this limitation. There are online reputation management platforms which allow you to customize the messages that people see when they leave negative feedback as opposed to positive feedback, but both of those messages must still offer the option to leave a public review. However, if you create your message in such a way as to communicate to the patient who may leave negative feedback that you are working hard on resolving the issue and that someone will be in touch shortly, that may prevent them from leaving a public negative review.

When you receive a public review on Google, Facebook, or other review sites, make sure that you respond to it – either by thanking them for a good review or by asking them to contact you to discuss how you can improve their experience. Do not argue or try to defend yourself online – try to speak about it with them privately, fix the issue, and ask them to remove the review if possible.

When you receive great reviews, make sure to cross-share them on your various social media platforms. You should also create a “Reviews” page on your website and add all great reviews to this page. This instantly adds credibility to your website.

Finally, make sure that when you look over the feedback and reviews that you receive, you are paying attention to what the negative reviews are saying – this is a great opportunity to identify current process challenges and improve your patients’ experience at your practice. Need help managing your practice’s online reputation? Visit www.lms-plus.com to see how Leading Marketing Solutions can help.

Sonda Eunus is the CEO of Leading Marketing Solutions, a Marketing Agency working with Medical Practices and other Businesses to help them identify the best marketing strategies for their business, create a strong online presence, and automate their marketing processes for a better return on their Marketing budget. Learn more about Leading Marketing Solutions at www.lms-plus.com.

FLORIDA MD - JULY/AUGUST 2025



9

PULMONARY AND SLEEP DISORDERS

Shift Work Sleep Disorder

By Daniel T. Layish, MD, FACP, FCCP, FAASM

Optimal sleep and wakefulness requires proper alignment between an individual’s intrinsic circadian rhythm and their desired sleep wake schedule. The word circadian comes from the Latin “circa” meaning “about” and “dian” meaning “day”. Our intrinsic circadian rhythm is controlled by an internal clock in the hypothalamus (suprachiasmatic nucleus). The hypothalamus receives signals from the retina that entrain the circadian rhythm to the light dark cycle. The circadian rhythm affects the timing of sleep.

There is also a homeostatic sleep drive, which controls sleep intensity, and it is determined by how long an individual has been awake.

Shift work sleep disorder is a recurrent or persistent mismatch between a person’s habitual sleep wake schedule and their endogenous circadian rhythm. Shift work sleep disorder can be associated with insomnia or excessive sleepiness (or both). The conventional time cues (zeitgeber = “time giver” in German) of sunlight and social activities are frequently out of phase with the altered sleep schedule in an individual with shift work sleep disorder. Many shift workers revert back to their traditional daytime schedule during non-work days. By definition, the course of shift work sleep disorder parallels the period of the shift work and remits with termination of shift work. An individual SLEEP FACTORS with shift work sleep disorder may use a large portion of their free time for recovery of sleep, which may have negative social consequences such as marital discord and impaired social relationships. Shift work sleep disorder tends to be more common after age 50. Between 5 and 8% of the population is exposed to night work on a regular or periodic basis.

Shift work sleep disorder is usually a clinical diagnosis. A formal sleep study (polysomnogram) may be helpful to exclude other etiologies of a patient’s symptoms. The sleep study should ideally be performed during the regular hours of sleep of the individual having the study. To diagnose shift work sleep disorder one must exclude any other medical or psychiatric conditions which could account for the symptoms. In addition, the symptoms should not meet criteria for any other sleep disorder which can produce insomnia or excessive daytime sleepiness (such as Jet-lag syndrome). Women appear to be slightly more prone to developing shift work sleep disorder. Interestingly, women tend to quit their shift work less often than men. The occurrence of shift work sleep disorder may vary depending upon the speed and direction 10 FLORIDA MD - JULY/AUGUST 2025

of shift rotation. It may also vary depending upon a patient’s diurnal preference. It appears to be less common in individuals who identify themselves as “night owls”. Individuals with shift work sleep disorder have been found to have higher rates of peptic ulcer disease as well as more sleepiness related motor vehicle accidents. Other consequences of this disorder include absenteeism from work, higher rates of depression and missed family and social activities as well as chronic fatigue and poor work performance. There have also been studies which link shift work sleep disorder to glucose intolerance as well as higher risk for alcohol and substance use. Sleep CIRCADIAN FACTORS

SHIFT WORK COPING ABILITY

ENVIRONMENTAL FACTORS

diaries can be helpful in assessing patients with shift work sleep disorder. Actigraphy can be useful as an adjunct to history, physical exam and sleep diary. Actigraphy recording should consist of at least three consecutive 24-hour periods. Circadian rhythm markers (such as core body temperature monitoring or timing of melatonin secretion) are more difficult and typically are not used in routine clinical settings.

Treatment for shift work sleep disorder can include exposure to bright light in the work place as well as administration of wake promoting agents during evening work hours. Other treatments include scheduled napping as well as hypnotic agents to improve daytime sleep. Maintaining a regular sleep wake schedule during both work and non-work days is also recommended (as well as minimizing light or noise in the bedroom and allowing sufficient time in bed for sleep during the daytime). Other recommendations include limiting light exposure by using dark sunglasses during the morning trip home from work. The timing of

PULMONARY AND SLEEP DISORDERS

FLORIDA MD - JULY/AUGUST 2025 11

PULMONARY AND SLEEP DISORDERS light therapy is critical. The American Academy of Sleep Medicine recommends light exposure before the core temperature is reached in an individual with a morning/evening/night schedule (versus administrating light therapy after core temperature in an individual with a night/evening/morning schedule). Studies have utilized various light intensities from 2350 to 12,000 lux. Some but not all studies of bright light therapy have also restricted daytime light exposure. Different schedules of light exposure have also been used. Melatonin has both sleep promoting (hypnotic) and phase shifting properties. Melatonin (when given to night workers before their daytime sleep) may enhance daytime sleep and appears to have no effect on subsequent nighttime alertness.

In a study published by Czeisler in The New England Journal of Medicine in 2005, modafinil resulted in decreased accidents/ near accidents during the commute home (versus placebo). Treatments for shift work sleep disorder can include modafinil (Provigil) as well as armodafinil (Nuvigil). These medications are nonamphetamine stimulants believed to act on the hypothalamus, although their exact mechanism of action is unknown.

Shifts can be permanent, fixed or rotating. Shift can rotate forward (clockwise) (from morning to evening to nighttime) or backward (from night to afternoon to early morning shift). Rotating shifts seem to cause more sleep difficulties than permanent shifts and counter clockwise rotation affects sleep wake activities more than clockwise rotation. The speed of rotation and the length of the shift may also impact an individual’s symptoms.

It appears that workers on permanent night shifts sleep one to four hours less than day workers and individuals on rotating shifts sleep about two hours less than day workers. There are several factors involved in this. Shift workers must try to sleep at a time when their circadian/wakefulness drive is exerting pressure on them to remain awake. The desire to spend time with family or take care of household or social obligations is also a factor. Environmental factors such as noise and light may also be obstacles to sleep quality for shift workers.

TABLE 1: FACTORS INFLUENCING THE EFFECT OF SHIFT WORK ON SLEEP AND WAKEFULNESS • Type of shifts (permanent, rotating).

• Duration of shifts.

• Speed of rotation (slow or fast).

• Direction of rotation (clockwise or counter clockwise).

• Social and family disruption.

• Exposure to natural or artificial light.

• Existing health problems.

• Age (over 50 is more adversely affected than younger individuals) • Gender (female shift workers seem to have more difficulty coping with shift work than men).

In general, the circadian clock adjusts better to clockwise rotation because it is naturally easier to delay sleep to a later hour.

Typically, longer shifts (such as 10-12 hours) cause more sleepiness than eight hour shifts. Women doing shift work tend to 12 FLORIDA MD - JULY/AUGUST 2025

get less sleep than men when they are not working because of their persistent family and social obligations. Overall, night and rotating shift workers comprise approximately 6% of all workers. About 1% of the working population in the United States is believed to suffer from shift work disorder. Increased awareness of this disorder should allow more individuals to receive proper diagnosis and therapy.

Daniel Layish, MD, graduated magna cum laude from Boston University Medical School in 1990. He then completed an Internal Medicine Residency at Barnes Hospital (Washington University) in St.Louis, Missouri and a Pulmonary/Critical Care/Sleep Medicine Fellowship at Duke University in Durham, North Carolina. Since 1997, he has been a member of the Central Florida Pulmonary Group in Orlando. He serves as Co-director of the Adult Cystic Fibrosis Program in Orlando. He may be contacted at 407841-1100 or by visiting www.cfpulmonary.com. 

HEALTHCARE LAW

Understanding Exculpatory Clauses

By Julie A. Tyk, JD. An exculpatory clause purports to deny an injured party the right to recover damages from a person negligently causing his injury. Cain v. Banka, 932 So. 2d 575 (Fla. 5th DCA 2006).

They are disfavored in the law because they relieve one party of the obligation to use due care and shift the risk of injury to the party who is probably least equipped to take the necessary precautions to avoid injury and bear the risk of loss. Applegate v.

Cable Water Ski, L.C., 974 So. 2d 1112, 1114 (Fla. 5th DCA 2008). Such clauses are strictly construed against the party seeking to be relieved of liability. Sunny Isles Marina, Inc. v. Adulami, 706 So. 2d 920 (Fla. 3d DCA 1998). Thus, exculpatory clauses are enforceable, only where, and to the extent, that the intention to be relieved from liability is made clear and unequivocal. Tatman v. Space Coast Kennel Club, Inc., 27 So. 3d 108, 110 (Fla. 5th DCA 2009). The wording must be so clear and understandable that “an ordinary and knowledgeable person will know what he is contracting away.” Id. (quoting Gayon v. Bally’s Total Fitness Corp., 802 So. 2d 420 (Fla. 3d DCA 2001)).

The seminal Florida case on exculpatory clauses is the Florida Supreme Court case of Sanislo v. Give Kids The World, Inc., 157 So. 3d 256 (Fla. 2015). Give Kids the World, Inc. (“GKTW”) provided free vacations to seriously ill children and their families.

When applying for the vacation, the Sanislos executed a “wish request” form that contained a waiver of liability, also known as an exculpatory clause. When the parents arrived at the resort village they again signed a liability release form, also an exculpatory clause. The language of the exculpatory clause is reprinted below for reference: I/we hereby release Give Kids the World, Inc. and all of its agents, officers, directors, servants, and employees from any liability whatsoever in connection with the preparation, execution, and fulfillment of said wish, on behalf of ourselves, the above named wish child and all other participants.

The scope of this release shall include, but not be limited to, damages or losses or injuries encountered in connection with transportation, food, lodging, medical concerns (physical and emotional), entertainment, photographs and physical injury of any kind....

I/we further agree to hold harmless and to release Give Kids the World, Inc. from and against any and all claims and causes of action of every kind arising from any and all physical or emotional injuries and/or damages which may happen to me/us....

Sanislo at 258-259.

While participating in a horse-drawn wagon ride, a rear pneumatic lift designed to allow those in wheelchairs to participate failed, and Ms. Sanislo was injured. The Sanislos brought suit and GKTW filed a motion for summary judgment arguing that the signed releases precluded an action for negligence. The Sanislos filed a motion for partial summary judgment against GKTW’s affirmative defense of release. The trial court granted the Sanislo’s

motion and denied GKTW’s motion.

The jury found for the Sanislos and GKTW appealed. Id. The Fifth District reversed, finding the lower court erred in denying GKTW’s motion for summary judgment because the release signed by the Sanislos was unambiguous and did not contravene public policy. It ruled the exculpatory clause barred the negligence action despite the lack of a specific reference to “negligence” or “negligent acts” in the exculpatory clause.

The Fifth District reasoned that exculpatory clauses are effective if the wording of the exculpatory clause is clear and understandable so that an ordinary and knowledgeable person would know what he or she is contracting away, and that the court had previously rejected “‘the need for express language referring to release of the defendant for “negligence” or “negligent acts” in order to render a release effective to bar a negligence action.’ ” On the public policy argument, the Court said the relative bargaining power of the parties should not be considered because it was outside of the public utility or public function context and the Sanislos were not required to request a vacation with GKTW or go on the vacation. Id. In affirming the Fifth District’s decision, the Supreme Court wrote that the conflict for the Court’s resolution was “whether an exculpatory clause is ambiguous and thus ineffective to bar a negligence action due to the absence of express language releasing a party from its own negligence or negligent acts.” Id. at 260.

The Florida Supreme Court wrote: .... we are reluctant to hold that all exculpatory clauses that are devoid of the terms “negligence” or “negligent acts” are ineffective to bar a negligence action despite otherwise clear and unambiguous language indicating an intent to be relieved from liability in such circumstances. Application of such a bright-line and rigid rule would tend to not effectuate the intent of the parties and render such contracts otherwise meaningless.

Id. at 270.

The Court found that the GKTW liability release form released GKTW and all of its agents, officers, directors, servants and employees from “any liability whatsoever in connection with the preparation, execution and fulfillment of said wish…” The release then provided that the scope of the agreement included “damages or losses or injuries encountered in connection with transportation, food, lodging, medical concerns (physical and emotional), entertainment, photographs and physical injury of any kind . . . .” The Court found that the release clearly conveyed that GKTW would be released from any liability, including negligence, for damages, losses, or injuries due to transportation, food, lodging, entertainment and photographs. Id. The determination of whether an exculpatory clause is en Continued on page 20 FLORIDA MD - JULY/AUGUST 2025 13

ORTHOPEDICS

A New Way to Avoid Surgical Pain Without Drugs

By Firas Abdul, MD Ask any patient and they can tell you that regardless of the benefits they expect to receive from a planned surgical procedure, they are dreading post-operative pain during their recovery. They may accept this as an inevitable part of their treatment, but that doesn’t lessen their stress and anxiety.

The potential habit-forming aspects of some opiates are a big concern. So, the development of a new procedure to block pain receptors with minimal medication is a major step forward. This approach can lead to less stress and anxiety before surgery and faster recoveries afterwards.

Cryoneurolysis is the technical term for the process. The word is a mouthful for a fairly straightforward procedure.

Before getting too deep into the procedure, let’s first think about how your central nervous system works. At the risk of oversimplifying an extremely complex system, you have nerves that control muscles and nerves that transmit sensations to the brain. The network of nerves that transmit sensations to the brain are composed of the individual nerve endings or receptors and the system of fibers that connect those nerves to the brain. These fibers act as a sort of network of pipes carrying information from the receptors.

What we do in cryoneurolysis is to freeze specific nerves without affecting that system of pipes. This technique allows us to, in effect, switch off those nerves. The nerves stop sending signals to the brain, and the patient stops feeling pain from those specific nerves.

In practice, it works like this. Let’s suppose a patient has a severely arthritic knee, and joint replacement surgery is scheduled.

The patient can go to the anesthesiologist several weeks before the surgery for pre-operative cryoneurolysis treatment. There, the doctor uses an ultrasound device to view and identify the specific nerves that are involved. Then, after administering a local anesthesia, the doctor uses a thin probe – basically a needle with a sealed tip – into which a pulse of nitrous oxide creates a tiny iceball at the tip of the probe. Using the ultrasound device, we can see the nerves and precisely guide the probe so this tiny ice-ball forms around each specific nerve, freezing it without damaging the surrounding tissue or the network of nerve pipes. Without the nerve receptors sending sensations to the brain, the patient immediately stops feeling pain from those nerves. This decreases the patient’s pre-operative and post-operative discomfort, reducing the burden of medication. Typically, the nerve receptors regenerate within several months, and by that time the patient will have healed from the surgery.

they are able to be more mobile following surgery. Using this technique, we’re able to add another tool to help patients after a total knee replacement surgery. Many of our patients, already scheduled for an outpatient procedure in which they can go home on the same day as the surgery, now have an option that will further reduce their pain. It’s a game-changer.

We have even had patients for whom cryoneurolysis has been the treatment, not just a component of the treatment. We recently treated an 80-year-old patient who was mentally sharp, but in our judgement was too frail to undergo surgery. However, the pain she was experiencing due to arthritis had severely limited her quality of life. She was unable to walk unassisted, and every step was painful.

After cryoneurolysis treatment, her pain was substantially relieved, and her mobility was restored. In fact, she is even able to now walk without her walker.

It’s important to note that cryoneurolysis only addresses the patient’s pain and not the underlying problems caused by the arthritis. But since surgery was not an option, the elimination of the patient’s pain, and doing it without any of the side effects that might come with other pain treatments, was a terrific outcome.

I had first learned about this technique a couple of years ago, but it wasn’t until we established our new practice within Orlando Health Jewett Orthopedic Institute that we have been able to focus on this. It’s one of the advantages of being in a practice with a singular focus. Everyone who works in the Institute is working one-hundred-percent on our coordinated approach to patient health, patient experience and patient outcomes. It’s a very exciting and rewarding time to not only be practicing anesthesiology, but to be helping patients receive the most up to date care in Central Florida.

Dr. Abdul is the Director of Anesthesiology for the Orlando Health Jewett Orthopedic Institute. 

At Orlando Health Jewett Orthopedic Institute, we have already begun using this technique on some knee-replacement patients, and the results have been very reassuring. Patients have less pain going into surgery and their recovery times are faster because 14 FLORIDA MD - JULY/AUGUST 2025

FloridaMDMagazine.com Your Medical Business Resource

More Than Experienced GI Care We’re the oldest and most complete pediatric

GI surgery program in Central Florida.

Nemours Children’s is home to: •

Nationally recognized pediatric GI surgeons

•

A fellowship-trained, board-certified motility specialist

•

A fellowship-trained pediatric colorectal surgeon

•

Advanced procedures like intestinal ultrasounds and unsedated TNE

•

Specialized clinics for motility, IBD, short bowel, and feeding therapy

© 2025. The Nemours Foundation. Nemours Children’s Health® is a registered trademark of The Nemours Foundation. All rights reserved. MC14999 (04/25)

At Nemours Children’s, our colorectal surgeons, gastroenterologists, urologists, dieticians, and feeding therapists all work together, providing all the care that kids with GI disorders need, all in one place.

This unique, multidisciplinary approach, combined with our state-of-the-art robotic procedures and minimally invasive techniques, help kids heal faster and achieve the best possible outcomes.

To learn more or schedule an appointment, visit

Well Beyond Medicine

Nemours.org/gastrosurgerycenter or call 407.650.7715.

FLORIDA MD - JULY/AUGUST 2025 15

PEDIATRICS

Regaining Independence: How Advanced Colorectal Care Changed One Patient’s Life

By Robert Michael Dorman, MD Colorectal conditions like chronic functional constipation can significantly affect a child’s quality of life, limiting their ability to participate in activities and social interactions. At Nemours Children’s, we utilize advanced treatments to help pediatric patients overcome these challenges and live fuller, more independent lives.

Sarah struggled with severe functional constipation for years, leaving her dependent on regular enemas. Exhaustive attempts with traditional bowel management had only delivered limited improvement. As an active 11-year-old, it was becoming a burden on her daily life and independence, and her family began to seek more advanced solutions.

tions independently and confidently helps kids get back to being kids, enjoying the things they previously felt were out of reach.

At Nemours Children’s, we offer a comprehensive, multidisciplinary approach to pediatric colorectal conditions. Our expert team of surgeons, gastroenterologists, advanced practice providers, therapists and nurses collaborate on individualized care plans, working with patients from initial assessment through long-term management and transition to adult care.

To refer a patient or to learn more about our advanced pediatric colorectal care visit Nemours.org/gastrosurgerycenter or call 407.650.7715.

R. Michael Dorman, MD is a board-certified pediatric surgeon at Nemours Children’s Hospital, Florida in Orlando. He provides specialized colorectal surgical services as a member of the coordinated GI surgery center team. Dr.

(Illustration of MACE. Source: Wikipedia)

After thorough multidisciplinary assessments, our pediatric colorectal team recommended a-Malone antegrade continence enema (MACE) procedure for Sarah. This surgical procedure creates a small stoma in the abdomen, which enables an enema to be administered directly into the bowel through the appendix (as opposed to a rectal enema). This means Sarah would easily be able to administer enemas on her own.

The surgery was successful and improved Sarah’s condition dramatically. She quickly adapted to her new routine, regaining control over her bowel management. “She doesn’t even let us in the bathroom with her anymore,” her mother tells us, smiling. With her newfound independence, Sarah’s happiness is palpable. She’s now able to participate fully in school, social, and family activities without worry or embarrassment.

Sarah’s experience highlights the transformative impact of advanced colorectal procedures. The ability to manage condi16 FLORIDA MD - JULY/AUGUST 2025

Dorman earned his medical degree at the University of Arkansas, then completed his residency in general surgery at the University of Buffalo in New York. Dr. Dorman’s fellowship trainings include surgical critical care at Children’s Mercy Hospital, Kansas City; general pediatric surgery at the University of Mississippi; and pediatric colorectal surgery at Nationwide Children’s Hospital in Columbus, Ohio.

Dr. Dorman is board certified in general surgery, pediatric surgery, and surgical critical care. 

REFRESH - RENEW - REVITALIZE UPDATE YOUR MEDICAL OFFICE FOR 2025

ABOUT US

Healthcare Realty & Development Services LLC (HRDS) is pleased to offer this Winter special aimed to create healing environments for you, your staff and your patients.

As experts in Evidence Based Design, we proudly present these opportunities to improve your facility aesthetics and operational efficiency.

Call today for your free evaluation.

Refresh Package

Interior painting (walls, trim, and doors) Flooring replacement (carpet, vinyl, or tile) Wall repair and touch-ups (e.g., patching holes, smoothing surfaces) Minor lighting upgrades (e.g., replacing outdated fixtures)

Renewal Package (includes Refresh Package) Refresh Package plus: Exterior painting (walls, trim, doors) Pressure washing (sidewalks, parking lots, building exteriors) Landscaping refresh (mulching, pruning, new plantings) Signage Design and Installation (exterior branding, directional signs, or ADA-compliant wayfinding) Parking Lot Resurfacing and Maintenance (fixing potholes, sealing cracks, and restriping spaces) Renovation Package (includes Refresh & Renewal Packages) Refresh & Renewal Packages plus: Demolish interiors/exteriors as needed New walls, ceilings, insulation, electrical, plumbing, HVAC, building services Custom Millwork and Installation (reception desks, cabinetry, shelving) Door and Hardware Updates Window and Glass Upgrades (energy-efficient windows and glazing) Emergency Preparedness Updates (backup generators, evacuation plans, fire suppression, etc.)

Artwork and furnishings selection

Call Frank Ricci today for your free evaluation 407.947.5074

healthcarerealtyonline.com

Licensed Real Estate Broker BK 454428

FrankR@Healthcarerealtyonline.com

Licensed Building Contractor CBC 059244

FLORIDA MD - JULY/AUGUST 2025 17

Selecting a Real Estate Broker for Your Medical Practice

By Frank Ricci, Medical/Dental Real Estate Specialist, Licensed Broker & Building Contractor This is the fourth in a series on medical real estate, design and construction with “Selecting Medical Space” [here], Negotiating Medical Leases” [here] and “Central Florida Hotspots.”

There are many sectors in the real estate industry and each sector has its very own unique needs. Even though a real estate license allows a licensed professional to operate within all of these sectors, most professionals concentrate on one in order to become proficient in the unique characteristics of their chosen sector. Residential is vastly different than commercial, industrial vastly different than office and even within the office sector, medical office is very different than general office space. This article will guide you through the essential qualities you should look for when choosing a real estate broker to represent you, whether you are looking to acquire, lease, sell or manage medical property.

THE IMPORTANCE OF EXPERIENCE 1. Working with Medical Practitioners: A broker with extensive experience working with physicians understands the unique needs and challenges of medical professionals. This includes knowledge of the daily operations of a medical practice, patient flow, and the specific requirements for various medical specialties. An experienced broker can provide insights into the best locations, layouts, and features that enhance the efficiency and effectiveness of a medical practice.

2. Healthcare Design Principles: Understanding healthcare design principles, including Evidence-Based Design (EBD) and Therapeutic Environments, is essential. EBD involves using data and research to inform design decisions that improve patient outcomes and staff efficiency. Therapeutic environments focus on creating spaces that promote healing and well-being.

A broker knowledgeable in these principles can help physicians choose or design spaces that enhance patient care and satisfaction.

3. Navigating Complex Transactions: Medical real estate transactions can be complex, involving specific zoning laws, regulatory requirements, and specialized build-outs. An experienced broker has the expertise to navigate these complexities, ensuring compliance with all regulations and facilitating a smooth transaction process.

ADVANCED REAL ESTATE KNOWLEDGE 1. Due Diligence: Conducting thorough due diligence is a critical aspect of any real estate transaction. This involves researching and verifying all aspects of a property, including its legal status, physical condition, and compliance with zoning and environmental regulations. A diligent broker will conduct comprehensive due diligence to ensure that there are no hidden issues that could impact the property’s suitability or value.

18 FLORIDA MD - JULY/AUGUST 2025

2. Utilizing the Latest Tools: The use of advanced tools and technologies is essential in modern real estate practice. This includes geographic information systems (GIS), demographic analysis software, and property search platforms. A broker who leverages these tools can provide detailed insights into market conditions, demographic trends, and property availability, helping physicians make informed decisions.

3. Market Analysis and Demographics: Understanding the demographics of a location is crucial for selecting the right property for a medical practice. This involves analyzing population density, age distribution, income levels, and other relevant factors. A broker with expertise in demographic analysis can help physicians identify locations with the highest potential for patient growth and practice success.

4.`Competitor Analysis: When negotiating a lease or purchase, it is crucial to consider the presence of competitors in the same complex. A broker with a thorough understanding of the local medical market can provide valuable insights into the competitive landscape, helping physicians choose locations that maximize patient access and minimize competition.

5. Financial Analysis: A comprehensive financial analysis of potential properties is essential. This includes evaluating the total cost of ownership, potential return on investment, and the financial implications of different lease or purchase options. An experienced broker can provide detailed financial analyses to help physicians choose properties that align with their financial goals.

6. Understands the Importance of Key Contract Terms: A thorough knowledge of important contract terms and strategies, such as Rights of First Refusal, is vital. These terms can provide significant advantages in securing and expanding practice locations. An experienced broker will know how to negotiate these critical terms effectively, ensuring that physicians have the flexibility to grow their practice as needed.

7. Unique Marketing Strategies: A proficient broker will employ unique marketing strategies to attract potential prospects. This includes utilizing digital marketing, networking within the medical community, and leveraging professional associations to reach the right audience. Innovative marketing ensures that available spaces are presented to the widest and most relevant audience possible.

Continued on page 20

It’s not about

counting the days.

It’s about making the days count.

Hospice • Palliative Care • Grief Support

Featuring specialized programs and services for children to seniors, and a proud Level 5 We Honor Veterans program provider. (866) 269-4240 I reflectionslsc.org FLORIDA MD - JULY/AUGUST 2025 21

EXPERTISE IN HEALTHCARE DESIGN AND CONSTRUCTION 1. Evidence-Based Design (EBD): EBD principles are crucial in creating spaces that improve patient outcomes and staff efficiency. A broker familiar with EBD can guide physicians in selecting properties that incorporate these principles, resulting in better-designed facilities that support high-quality care.

2. Therapeutic Environments: Creating a therapeutic environment involves designing spaces that promote healing and well-being. This includes considerations such as natural light, noise reduction, and comfortable waiting areas.

A knowledgeable broker can identify properties that offer these features or have the potential for such modifications.

3. Understanding the Construction Process: A thorough understanding of the construction process is essential for any broker working in the medical real estate sector. This includes knowledge of medical build-outs, compliance with healthcare regulations, and the ability to manage construction timelines effectively. An experienced broker can oversee the construction process, ensuring that the final space meets all requirements and is delivered on time.

4. Cost Segregation: Cost segregation is a valuable tax strategy that involves identifying and reclassifying personal property assets to shorten the depreciation time for taxation purposes. This can result in significant tax savings for medical practices. A broker who understands the value of cost segregation can provide invaluable advice during the property selection and purchase process.

SUPPORTING THE MEDICAL COMMUNITY A broker who is deeply embedded in the medical community not only understands the technical aspects of real estate but also the broader context in which medical professionals operate. Going beyond traditional brokerage services to actively support the medical community through various initiatives demonstrates a commitment to the field:

1. Technical Articles and Presentations: Contributing to the knowledge base of the medical real estate sector by writing technical articles and delivering presentations on relevant topics helps keep clients and the broader medical community informed about the latest trends, challenges, and opportunities in medical real estate.

2. Board Memberships: Involvement in local professional organizations that support the medical community ensures staying connected and contributing to the industry’s development. Serving on boards allows brokers to influence decisions that shape the future of medical real estate and advocate for the needs of medical professionals.

3. Community Engagement: Actively participating in community events and professional organizations not only strengthens networks but also reinforces commitment to the medical community. This engagement helps brokers better understand the unique challenges faced by healthcare providers and tailor their services to meet specific needs.

CONCLUSION In summary, selecting a broker with the right experience and expertise can provide you with a strategic advantage, helping you find the ideal space for your medical practice and ensuring a smooth and successful transaction. The right broker will not only secure the best property for your needs but also offer valuable insights and support throughout the process, contributing to the long-term success and growth of your medical practice.

Frank Ricci is president of Healthcare Realty & Development LLC and H R & D Construction Inc. and has over 30 years of medical real estate brokerage, construction and development experience. He can be reached at (407) 947-5074, or FrankR@HealthcareRealtyOnline. com. • https://www.healthcarerealtyonline.com/contact • www.linkedin.com/in/frank-ricci-b0832a9 • https:// www.facebook.com/HealthcareRealty/ .

HEALTHCARE LAW Continued from page 13 forceable will be determined by the Judge as the enforceability of a pre-injury release is a question of law. The enforceability therefore, will depend on the Judge assigned to the matter. Physicians should not assume that because a patient signed a liability release form the patient does not have a viable cause of action.

Physicians should consult with an experienced attorney who can examine the facts of the case and help you determine the best path forward. The Health Care Practice Group at Pearson Doyle Mohre and Pastis, LLP is committed to assisting Clients in navigating and defending medical malpractice claims. For more information and assistance, please contact David Doyle and Julie Tyk at Pearson Doyle Mohre & Pastis, LLP. 20 FLORIDA MD - JULY/AUGUST 2025

Julie A. Tyk, JD, is a Partner with Pearson Doyle Mohre & Pastis, LLP. Julie concentrates her practice in medical practice defense litigation, insurance defense litigation and health care law. She has represented physicians, hospitals, ambulatory surgical centers, nurses and other health care providers across the state of Florida. She may be contacted by calling (407) 951-8523; jtyk@pdmplaw.com.. 

Helping Veterans Treat Obstructive Sleep Apnea

By Tara M. Griffin, DMD, DBDSM, DASBA As we celebrate Independence Day, it is crucial to remember the brave men and women who have fought for our freedom.

Veterans have made countless sacrifices to protect our nation, and it is our duty to ensure they receive the care and support they deserve. One prevalent issue among veterans is obstructive sleep apnea (OSA), a condition that can have serious consequences if left untreated.

A 2019 report estimates that over 1.5 million veterans have been diagnosed with OSA and up to 80% of those diagnosed are not being successfully treated. Continuous Positive Airway Pressure (CPAP) has been the gold standard for treatment for the past 40 years, however, in 2020 after a world-wide recall of CPAP machines, more than 600,000 veterans have been affected and another 600,000 are not compliant with the machines they have been prescribed.

Obstructive sleep apnea is a common sleep disorder characterized by pauses in breathing during sleep, often leading to fragmented sleep and low oxygen levels in the blood. This condition not only affects the quality of sleep but can also have detrimental effects on overall health and well-being. When you experience low oxygen levels in the blood on a regular basis, this creates inflammation in every organ system which leads to chronic debilitating health issues. For veterans, the impact of OSA can be particularly challenging, given the physical and mental toll of their service.

Fortunately, there are effective treatment options available for “managing” and now “resolving” obstructive sleep apnea. While CPAP therapy and surgery are commonly used, most veterans may find these options unavailable and potentially dangerous after recent recalls, uncomfortable and invasive. In such cases, alternative treatments like FDA-approved oral medical devices for sleep apnea can offer a more comfortable and convenient solution.

These custom oral devices are designed to help keep the airway open during sleep, reducing the risk of breathing pauses and improving overall sleep quality. By using these devices, our veterans are experiencing fewer awakenings during sleep, reduced daytime fatigue, improved cognitive function, better overall health and improved quality of life.

Compared to CPAP therapy, studies show that oral medical devices have a compliance rate of over 80% after 5 years of use which is much better than CPAP compliance and just as effective at lowering high blood pressure and reducing cardiovascular risks for patients. Based on recent FDA approved technology, up to 34% of patients may no longer need an oral medical device after 12 months of treatment.

One of the significant benefits of using oral medical devices for sleep apnea is their ability to address not only the physical symptoms and root causes of OSA but also the associated mental health challenges. Many veterans with OSA also suffer from

conditions like post-traumatic stress disorder (PTSD), which can be exacerbated by poor sleep quality and trauma experienced while serving.

Over 1.3 million veterans have been diagnosed with PTSD through service-connection with the VA. By improving sleep quality with custom oral medical devices and adjunctive therapies, most veterans we have treated, experience a reduction in PTSD symptoms, fewer headaches, and a decrease in night terrors! Better sleep can have a profound impact on mental health and overall well-being, allowing veterans to lead more fulfilling and productive lives.

For healthcare providers working with veterans, it is essential to consider alternative treatment options for sleep apnea. By offering veterans a comfortable and effective solution for managing or resolving OSA, healthcare providers can help improve the quality of life for those who have served our country.

At Sleep Solution Centers, we are a Community Care Provider for veterans and make it our priority to see our new patients within a week of receiving a referral from the VA. Our motto is, “Our freedom isn’t free but a good night’s sleep can be!”

As we honor our veterans this Independence Day, let us not forget the importance of supporting their health and well-being.

By raising awareness about alternative treatments for obstructive sleep apnea and advocating for the use of FDA-approved oral medical devices, we can make a meaningful difference in the lives of those who have sacrificed so much for our freedom. Let us stand together in providing the care and support our veterans deserve!

Tara M. Griffin, DMD, DBDSM, DASBA, graduated from Nova Southeastern University in 2006, with a doctorate in Dental Medicine. She became passionate about helping her patients breathe and sleep better and completed her Diplomate with the American Academy of Dental Sleep Medicine in 2011. In 2015, she completed her Diplomate with American Sleep and Breathing Academy. In 2016, she became a Clinical Advisor with Vivos Therapeutics to help educate and mentor doctors interested in the treatment of OSA with oral medical devices.

She owned a private practice focused on sleep, TMD and general dentistry in the panhandle of Florida for 17 years before becoming the co-founder of Sleep Solution Centers in Medical City, Orlando in 2024. She may be contacted at 407-502-0110 or by visiting www.sleepsolutioncenters.com 

FLORIDA MD - JULY/AUGUST 2025 21

22 FLORIDA MD - JULY/AUGUST 2025

2025

EDITORIAL CALENDAR

Florida MD is a monthly medical/business digital magazine for physicians..

Florida MD has been serving the medical community in Florida for twenty years and is currently available as a bimonthly digital edition emailed directly to healthcare providers in Central Florida (Orlando area), Tampa metro and Southeast Florida. Cover stories spotlight extraordinary physician practices, new hospital procedures or facilities, and other professional and healthcare related business topics. Local physician specialists and other professionals, affiliated with local businesses and organizations, write all other columns or articles about their respective specialty or profession. This local informative and interesting format is the main reason physicians take the time to read Florida MD.

It is hard to be aware of everything happening in the rapidly changing medical profession and doctors want to know more about new medical developments and technology, procedures, techniques, case studies, research, etc. in the different specialties. Especially when the information comes from a local physician specialist who they can call and discuss the column with or refer a patient. They also want to read about wealth management, financial issues, healthcare law, insurance issues and real estate opportunities. Again, they prefer it when that information comes from a local professional they can call and do business with. All advertisers have the opportunity to have a column or article related to their specialty or profession.

JANUARY –

Digestive Disorders Diabetes

FEBRUARY –

Cardiology Heart Disease & Stroke

MARCH –

Orthopaedics Men’s Health

APRIL –

Surgery Scoliosis

MAY –

Women’s Health Advances in Cosmetic Surgery

JUNE –

Allergies Pulmonary & Sleep Disorders

JULY –

Neurology / Neuroscience Advances in Rehabilitation

AUGUST –

Sports Medicine Robotic Surgery

SEPTEMBER – Pediatrics & Advances in NICUs Autism OCTOBER –

Cancer Dermatology

NOVEMBER – Urology Geriatric Medicine / Glaucoma DECEMBER – Pain Management Occupational Therapy

Please call 407.417.7400 for additional materials or information.

FLORIDA MD - JULY/AUGUST 2025 23

18