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FOCUS TOPICS WOMEN’S HEALTH

SERVING A 24 COUNTY AREA, INCLUDING BIRMINGHAM, HUNTSVILLE, MONTGOMERY & TUSCALOOSA ON ROUNDS PHYSICIAN SPOTLIGHT

What You Don’t Know About Edward Logue, MD

MAY 2021 / $5

EAMC Opens New $33.7 Million Facility at Auburn

The new EAMC facility sits in the well-lit Auburn Research Park. Addie C. Photography.

Ed Logue, MD is a familiar name to most Alabama healthcare professionals. Logue, who at age 86 still goes into the office every day, has been practicing psychiatry in Birmingham for 50 years. ... 3

By Steve Spencer

The Auburn Research Park covers more than 170 acres of lakes, meadows, forested areas and a wetland preserve adjacent to the Auburn University campus. The Park, described as an entrepreneurial ecosystem, hosts both research institutes and businesses to develop partnerships and new ventures commercializing Auburn University’s intellectual property assets. Tenants range from businesses like Kassouf & Co and Northrop Grumman to researchers

Tackling T-Cell Lymphomas Cutaneous T-cell lymphoma (CTCL) is a rare idiopathic cancer that tends to occur later in life. ... 7

(CONTINUED ON PAGE 6)

Cullman Regional Opens Alabama’s First Health Park

The Hartselle Health Park under construction in February.

By JAne eHrHArDt

ACP Recommends Shorter Antibiotic Courses for Common Infections New guidelines, developed with the help of UAB physicians, that recommend shorter courses of antibiotics for four common infections are being welcomed by clinicians across Alabama and the U.S.... 8

The first phase of a new health park will open this month in Hartselle. An outreach of Cullman Regional Medical Center, the park will be the first of its kind in Alabama. “It’s a new concept of care in Alabama,” says Cullman Regional CEO James Clements. The new premise offers a large number of outpatient services in a single location without the complexities of negotiating a hospital. “A hospital can be a bit of a maze to walk through, just for a doctor’s appointment or test,” Clements says. “The health park, instead, offers several facilities that (CONTINUED ON PAGE 4)

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2 • MAY 2021

Birmingham Medical News


PHYSICIAN SPOTLIGHT

What You Don’t Know About Edward Logue, MD By Steve Spencer

Ed Logue, MD is a familiar name to most Alabama healthcare professionals. Logue, who at age 86 still goes into the office every day, has been practicing psychiatry in Birmingham for 50 years. In 1974, he established the psychiatric unit at Brookwood hospital, which grew to a 96-bed clinic. He has been named the Mental Health Professional of the Year; received the Exemplary Psychiatrist Award; named a Distinguished Life Fellow by the American Psychiatric Association and been on the Best Doctors list for the past decade. This is the Ed Logue, MD that many of us know. What we don’t know is the story of how unlikely it is that Logue ever became a doctor in the first place. In fact, it’s a miracle that he survived infancy. Harry Edward Logue was born in a two-room sharecropper’s house in rural Georgia. The nearest town had barely 2,000 people. It was 1934, in the depths As seen on FOX6

of the depression. This was a difficult time to provide for a child, but he was a healthy baby until age two when he contracted colitis. “I went down to skin and bones,” Logue said. “One night when my condition got really bad, the doctor came to our house. He examined me and before he left, he told my parents to prepare themselves, that this would be my last night. My parents sat with me, doing everything they could to keep me alive. They talked to me. They rubbed me and they prayed. But I just kept getting worse. They held on, continuing to pray, and finally in the darkest part of the night, they offered my life to God in his service. From that point, I began to recover.” Logue paused for a moment and cleared his throat. “Now a chill just shot through my body, remembering that.” When Logue was growing up, education was a scarce commodity. His father had finished the third grade and his mother, the fifth. When he decided to try to go to college, everyone except his parents told him he was over-reaching. Not only was this like going to the moon for most people in town, it was also nearly impossible to pay for. But one small incident, something completely meaningless at the time, changed the whole equation. “The year before I made the decision, I had a summer job working on highway resurfacing,” Logue said. “The job was close to home so it was easy

to get there. A flatbed truck picked us up. But halfway through the summer, the camp for the surfacing road moved further away. There were several of us working there and none of us had a car. I was 17 years old. So I went to the bank and talked to Charlie smith, the banker. I told him that if I had a car, I could charge the other guys a dollar a day to ride. He gave me the loan and I bought it 1940 Ford, as a poor kid in high school. I was able to sell the car to get enough money for my first semester of college. If the camp hadn’t moved further away, I would have never asked for the car loan and I couldn’t have made money, charging the guys.” His father, wanting a better life for him, helped stimulate his desire for education. “My dad did something that no dad would do,” Logue said. “In my senior year, 1953, he bought a $400 set of encyclopedias for me, something he certainly could not afford. With that, I read about things that I never dreamed of before. It pushed me towards science. That’s where I developed an interest in medical school.” There was a downside, though, to this career choice. “When I told my dad I had decided to go to medical school, he was disappointed because we were breaking the promise to God that I would be a missionary. I said I didn’t want to be a missionary and that I could serve God as a doctor,” Logue said. “He

Ed Logue, MD

didn’t feel that was enough to honor our vow so, with a third-grade education, he began driving to Macon, 60 miles away, two nights a week to take seminary courses and he became a preacher. I got to hear some of his sermons. “God has blessed me in so many ways. As I’ve aged, the things I’ve learned about spirituality have given me great comfort. Once when I was meditating, I asked God to show me as much as he would allow. From that experience, I’ve come to see that our mind, as distinct from our brain, is extracorporeal. It is not flesh and blood. It is dark matter and it is indestructible. It records everything about us so when the flesh is gone, it is still there for God’s spiritual world. It’s a fascinating undertaking to be able to see and understand all that’s been given to me.”

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Cullman Regional Opens Alabama’s First Health Park, continued from page 1 allow patients to reach specialseparate imaging center. Openists, therapists, and diagnostic ing in October, the center will tests without the long walks and perform MRIs, CT scans, ulconfusion. It’s easier to access. trasounds and x-rays. Set about You get to drive up, walk in, a block from the specialty clinic, and get it done.” the testing site allows patients to Hartselle Health Park, get diagnostic tests without havabout 20 miles from Cullman, ing to drive the much longer James Clements, CEO of CRMC will contain two buildings. distance to a larger urban area Phase I features a specialty or hospital. physician clinic with offices that cover a The other part of Phase 2 houses an broad range of fields, including general urgent care center with six exam rooms, surgery, mental health, orthopedics, pulincluding a procedure room, and a lab. monology, spine, urology, and cardiology. The center will improve after-hours acCullman Regional managers decided cess to medical care for Hartselle and its on the specialties based on the needs of outlying regions. that area. “We’ve been in the Hartselle Hartselle is a community of 14,400 market for five to six years, just talking residents that lies about 30 minutes with local providers, businesses and local north of Cullman. “In our market area, leaders, asking what services they needed, Hartselle is the next largest city, allowing what specialists,” Clements says. “We’ve us to reach the most people,” Clements also watched referral patterns at our hossays. The population is only slightly less pital to help pinpoint what has been most than Cullman’s 15,400 residents, but had requested from that area.” no specialists in residence. “This park not The specialists will come from a only brings access to specialty physicians pool of independent physicians and and services to Hartselle, but also to the those already employed by Cullman rural areas that surround the town.” Regional. “We will be recruiting new For Clements, health parks are a step physicians as well,” Clements says. The toward integrated care. “Our definition various providers will commit to a half of integrated care is fairly broad,” he day a week in the clinic, offering a rotasays. “We think it means collaboration tion of medical care that can extend to between healthcare providers to coordicover areas such as pain management, nate treatment and improve the patient’s wound care, and ortho pediatrics. overall wellbeing. And, of course, payPhase 2 of the health park includes a ors are trending toward systems that de-

4 • MAY 2021

Birmingham Medical News

Rendering of the Hartselle Health Park Urgent Care Center.

mand more collaborative care because it is a more efficient, higher-quality model since you are coordinating and communicating between what can be a complex issue that has many different inputs. “The umbrella of a larger healthcare system creates that efficiency and quality. Communication between providers of the same patient flows more easily and accurately with physicians, diagnostics and treatment input under one records system. The medical personnel and protocols are also vetted by and are accountable to the hospital.” Health parks also add a versatile way to evolve and adapt to the area around it. “The real benefit is that health parks can be tailored to accommodate the health care needs of each community,” Clements says. Having worked in healthcare in Atlanta for 25 years, Clements has had exposure to the

usefulness of health parks where Wellstar Health System has built five since 2012. Cullman staff also researched successful parks in Orlando and Tampa. Demand for outpatient services has increased with the rise in high-deductible health plans prompting patients to be more cost-conscious about their medical choices. An American Hospital Association report found that in 2016 hospitals’ net outpatient revenue ($472 billion) nearly matched inpatient revenue ($498 billion) for the first time. And hospital revenue from outpatient services has grown from 30 percent in 1995 to 47 percent in 2016. “Health parks only makes sense,” Clements. “They offer convenience and collaboration and closer access to a higher level of care. There will be as many services here in Hartselle as a small hospital offers.”


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MAY 2021 • 5


EAMC Opens New $33.7 Million Facility at Auburn, continued from page 1

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in disciplines such as biological sciences and biosystems engineering. And in a few weeks, the Park gets a new Tenant when East Alabama Medical Center (EAMC) opens its 84,000-square-foot healthcare facility. The genesis for the new $34 million facility grew out of an expanding population and a busy emergency department. “The ED on our main campus was built to service 36,000 patients a year, and we are now averaging 50,000 patients. That ED is sort of landlocked in a tight space, making it impossible to expand. So in an effort to keep up with the growth of our community, we were looking at locations for a new emergency department. Likewise, we wanted to base it in an area where the community was growing. The Auburn Research Park turned out to be the perfect spot,” said Laura Grill, President and CEO of EAMC. The new freestanding emergency department anchors the 37,500 squarefoot first floor in the three-story building. It is only the fifth freestanding ED in Alabama and will be serviced by the same pool of physicians and nurses that staff the ED on the main EAMC campus. The project executives designed the FED to move patients through quickly and efficiently. Along with 12 exam rooms, the first floor will contain all the necessary services, including an inhouse pharmacy to provide medicine for patients while in the FED; a retail pharmacy, which is EAMC’s third retail pharmacy location, for patients who need to fill a prescription before leaving for home; along with laboratory services and outpatient diagnostic imaging services. There is an ambulance station two miles away that will handle transporting patients who need to be moved from the FED to the main hospital and a helipad is located adjacent to the FED. At the same time that EAMC executives were looking for a place to locate the FED, they were in conversations

with some of their affiliated surgeons about building an ambulatory surgery center. The group soon realized that it made sense to put both in the same building. Now the ambulatory surgery center, a joint venture between EAMC and a group of physicians, is on the second floor. This floor is 24,000 square feet and contains four operating rooms and four endoscopy suites. “The surgery center gives us extra operating room capacity which we needed for a growing community,” Grill said. “They will serve multiple surgical specialties, including orthopedics, ENT, ophthalmology, general surgery, gastroenterology, and plastic surgery, to name a few.” The third floor houses a dedicated breast imaging facility, which occupies 5,800 of the 24,000 square feet, with the remaining space left open for future growth. “The breast imaging facility is designed to be isolated from the main floor imaging center,” Grill said. “It's a one-stop shop for all breast imaging needs, including ultrasound, MRI, biopsy, all the things patients would need for mammography care. We have dedicated physicians who serve that space.” The Auburn Research Park location will benefit both Auburn University and EAMC, as nursing and pharmacy students will have access to rotate through, providing the students with training while they help assist EAMC staff. “Auburn is a strategic partner of ours for training and developing people in their health sciences program, which makes this a good fit,” Grill said. “We are planning to move in and start seeing patients for the first floor FED and imaging around the end of May. The surgery center will probably begin operations around the end of July and the breast imaging should be available around the end of August or the first of September.”

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Birmingham Medical News

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Tackling T-Cell Lymphomas By Ann B. DeBellis

Cutaneous T-cell lymphoma (CTCL) is a rare idiopathic cancer that tends to occur later in life. It originates in the white blood cell subset of T-lymphocytes that normally help the immune system fight infections. Mutations in the T-cells’ DNA cause the cells to develop abnormalities that push them to attack the skin. “In CTCL, the atypical T-cells have homing devices or markers that cause them to gather in the skin,” says Lauren Hughey, MD, a dermatologist at Renew Dermatology in Birmingham. Hughey, who has been treating cutaneous lymphoma patients for 15 years, explained that by virtue of their training, dermatologists’ skin examinations can sometimes give them a window into what’s going on inside the body. “I have devoted my career to learning about and treating these cutaneous lymphomas,” she says. There are several subtypes of T-cell lymphomas, each of which can present differently in the skin. Some may have round, itchy, scaly, red patches or areas of skin that appear either lighter or darker in color than the surrounding skin. Others may present as deep, firm plaques

under the skin in the fat, or even skin tumors. “Mycosis fungoides (MF), the most common subtype of CTCL, presents with eczematous patches on the skin. Sezary syndrome, an even more rare blood form of CTCL, causes erythroderma which is skin redness over the entire body,” Hughey says. One of the challenges with cutaneous lymphomas is that it is hard to distinguish from ordinary rashes. “CTCL often appears like eczema or psoriasis, but recognizing the classic distribution of the rash in what we call the sunprotected areas or bathing trunk distribution (hips, buttocks, underarms and breasts) is one of the keys to diagnosing this entity. But even then, it can sometimes take years to get a correct diagnosis,” Hughey says. “Once, I had to biopsy a patient 11 times. I knew in my heart that it was CTCL, but I couldn’t prove it on biopsy. We kept at it until it finally revealed itself.” Mycosis fungoides typically has

Hughey (right) discusses T-cell lymphoma with a patient.

a more indolent course, whereas the Sezary syndrome subtype in the blood is much more aggressive. Most stage 1 mycosis fungoides patients, despite its life-long course, will die of something else. “However, a percent of MF patients may progress to have cancer cells in their lymph nodes and in their blood stream,” Hughey says. “I always palpate lymph nodes in each patient, and we also do blood work periodically to make sure there are no cancer cells in the bloodstream. A stage 3 or stage 4 patient will need radiation or systemic

medications that can include chemotherapies, new targeted drugs or immunotherapies. “Unfortunately, there is no way to prevent CTCL. We don’t know why it occurs, but it can be treated and controlled with therapy. Control is a word that I use a lot with my patients. Unlike other cancers that can be cured with treatment, CTCL is a life-long cancer. I don’t like to use words like ‘remission’ or ‘clearance.’ Instead, I say ‘control.’ Our goal is to find a treatment regimen that keeps patients under control and stable with a good quality of life.” Hughey generally sees lower-stage patients in her private practice office, but when a patient’s disease becomes more severe, she sees him in a multidisciplinary clinic at UAB that is led by Hughey and oncologist Amit Mehta, MD. “We see patients in the clinic sideby-side, and it has been extraordinary and a great experience for the patients,” Hughey says. “It is like one-stop shopping – patients come for one appointment, and they get both of us in the same room to discuss their case. We each use (CONTINUED ON PAGE 14)

Birmingham Medical News

MAY 2021 • 7


ACP Recommends Shorter Antibiotic Courses for Common Infections By lAUrA FreemAn

New guidelines, developed with the help of UAB physicians, that recommend shorter courses of antibiotics for four common infections are being welcomed by clinicians across Alabama and the U.S. “This gives us clear, concise bestpractice advice we can use in treating conditions that require antibiotics, namely COPD exacerbations with bronchitis, community acquired pneumonia, urinary tract infections and cellulitis,” Lauren Pacheco, MD, internal medicine specialist and faculty member at Princeton Baptist Medical Center, said. “When I was in training, and more recently in talking with the physicians I’m helping to train, there has been a lot of discussion about shorter duration antibiotic treatment. We want to be good stewards of antibiotics to avoid resistance, as well as to minimize the effects on the patient’s microbiome. The new guidelines will help us achieve those goals.” UAB infectious disease specialist Rachel Lee, MD, is first author on the guidelines. “I was working on cases

Rachel Lee, MD

Lauren Pacheco, MD talks with a patient.

with the paper’s senior author, Robert Centor, MD, who is professor emeritus in the UAB Department of Medicine,” Lee said. “We were discussing the effectiveness of shorter duration antibiotic treatment and the need for updating guidelines so physicians would have the information to confidently make decisions about when to prescribe a shorter course. “Dr. Centor is a member of the

American College of Physician’s Scientific Medical Policy Committee. He brought up the issue before the committee while I started gathering data. It took just over a year of compiling data, writing, reviews in the committee’s quarterly meetings and peer review.” The recently released guidelines recommend starting with a five-day course for acute bronchitis with COPD, and community acquired pneumonia.

In cellulitis, five to six days of treatment against streptococci are suggested. Recommendations for urinary tract infections vary based on the specific medication prescribed. Treatment can range from a single dose to three to five days, or as much as 14 days for particular medications and circumstances. Specific guidelines are posted on the American College of Physicians website under best practices advice. (CONTINUED ON PAGE 14)

Medical West is an acute care community hospital offering a wide range of diagnostic, surgical, medical, and emergency services. Primary care physicians, specialists, and sub-specialists have offices located on Medical West’s main campus in Bessemer as well as 17 satellite health centers and a Freestanding Emergency Department in the West Jefferson County area. For more information about Medical West and our services, visit us online at www.medicalwesthospital.org.

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MAY 2021 • 9


WOMEN’S HEALTH

New InterStim Micro Helps Battle Incontinence By Ann Debellis

More than 37 million American adults suffer from overactive bladder and nearly 18 million have bowel incontinence. About 45 percent of these people will not seek treatment and many stop using medicines because of side effects or unsatisfactory results. Many of these sufferers may be unaware that there has been an effective treatment used by physicians since 1997. The Medtronic Interstim system, now on version InterStim II, delivers sacral neuromodulation therapy to treat overactive bladder, fecal incontinence, unobstructive urinary retention, and urinary urge incontinence. This past August, the FDA approved a new version of the system, the InterStim Micro neurostimulator, which is 80 percent smaller than the InterStim II. And, whereas the InterStim II has a battery that lasts about five to seven years, at which time it must be replaced, the InterStim Micro has a rechargeable battery. This system features

a small wireless charger that patients use for once a week to recharge the system. The battery should last 15 years. “The InterStim Micro can correct a communication problem between the brain and bladder or bowel that may cause symptoms that are embarrassing and can compromise a person’s lifestyle,” says Glori Short, MD, an Obstetrics & Gynecology physician practicing at Henderson & Walton Women’s Center. “Because many people don’t know about the InterStim Micro, they are not able to take advantage of its benefits. We want to tell patients and physicians about this treatment and how it can change people’s lives.” The InterStim therapy sends mild electrical pulses to the sacral nerves, which are located near the tailbone. The sacral nerves control the muscles related to urinary function. If the brain and sacral nerves don’t communicate correctly, the nerves can’t tell the bladder to function properly. That can lead to symptoms of overactive bladder. Short has treated incontinent men

and women with the InterStim since 2009. “I look at a patient’s symptoms and how they have been addressed, such as lifestyle changes and first-line therapy that might control their symptoms,” she says. “I also do an exam to help evaluate the cause of the problem. When a woman says she is leaking urine, there are a lot of different types of leaking – urgency or activity-induced or both. Glori Short, MD discusses Medtronic’s InterStim Micro neuroThere is no medicine or one pro- stimulator with a patient. cedure that can meet both needs.” meets the patient’s needs,” Short says. Short has done hundreds of these “In that regard, I always tell patients procedures which require an implant that they don’t have anything to lose under the skin. She says she usually because in the worst-case scenario, they sees at least 75 percent improvement will be same as before.’” in those patients. Test simulation of the Many physicians have learned to InterStim therapy allows the patient to implant the device, but the therapy has temporarily see if it helps symptoms not been widely advertised to the pubbefore getting the implant. Patients lic or to physicians. “As a result, many generally know within five to seven patients haven’t had the opportunity days if the device works for them. “As to take advantage of a treatment that a surgeon, I don’t know of any other could change their lives,” says Short, procedure where you get a trial run be(CONTINUED ON PAGE 12) fore you do the surgery to make sure it

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TFA Affords Women Another Option to Treat Symptomatic Fibroids By cinDy SAnDerS

Although symptomatic fibroids are usually benign, most women would be quick to say it doesn’t mean these tumors aren’t troublesome. In the United States, symptomatic uterine fibroids are the most common reason for hysterectomy, which remains the only definitive cure for the myomas. Since prevalence of problematic uterine fibroids (UFs) are most common during reproductive years, the cure presents an unacceptable trade-off for women who hope to bear a child in the future. As a result, many women live with painful symptoms for years. While not a cure, there are an increasing array of alternatives to manage fibroids for those trying to preserve fertility. Medication management, myomectomy, radiofrequency ablation, uterine artery embolization and MRI-guided focused ultrasound have all been shown to offer some relief with varying degrees of invasiveness, efficacy, longevity and

mectomy is a major surgical propatient satisfaction. cedure that typically takes four One of the newest opto six weeks for full recovery. tions for women is the Sonata® Minimally invasive laparoscopic System from Gynesonics®, a myomectomy requires a much women’s health company fosmaller incision but is still percused on minimally-invasive formed under general anesthesolutions for treating symptomatic uterine fibroids. Gyneson- David Toub, MD sia, could include an overnight hospital stay and typically takes ics® first received Food & Drug two to four weeks for full recovery. Administration 510(k) approval to mar“According to the literature, women ket the Sonata System for Transcervical typically wait, on average, 3.6 years and Fibroid Ablation (TFA) in August 2018 a good percentage wait five years to seek and received clearance for their next treatment to relieve symptomatic figeneration system last year. The system broids,” Toub said. “The reason is they can be used to treat most fibroid types don’t want that disruption to their life. including submucous, intramural, trans“In contrast, Transcervical fibroid mural and subserous. ablation heats the fibroid by going in “Women deserve choices when it through the cervix, so there are no incicomes to the management of fibroids,” sions, and it conserves the uterus. The said David Toub, MD, MBA, FACOG, Sonata System combines intrauterine medical director of Gynesonics. “There ultrasound guidance for advanced visuused to be only two options – hysterecalization with targeted radiofrequency tomy, which was curative but precludes ablation to treat the fibroids. Because it’s fertility, and myomectomy, which reinside the uterus, it’s very high resolution. moves fibroids but preserves the uterus.” We can see details that we don’t always However, open abdominal myo-

WOMEN’S HEALTH

see on transvaginal ultrasound or MRI.” It is performed as an outpatient procedure so women don’t have to undergo general anesthesia, and about half the cases in a large study used sedation. “The average length of stay in our study was about two-and-a-half hours and that includes the procedure,” Toub said. “The majority of women returned to normal activity within 2.2 days on average, with many able to do so within one day.” Although a few other radiofrequency ablation systems exist, they have typically required adaptive devices. “Because the ultrasound is part of the device itself, you don’t have to manipulate multiple tools. There is just one device and one screen,” Toub said. “It also doesn’t require advanced ultrasound skills. In fact, most physicians who are using the system are not highly specialized in ultrasound technologies. Yet, it’s proven to be very effective and safe in their hands.” (CONTINUED ON PAGE 12)

Medical Group Greg Thompson, MD, is a board-eligible and robotically-trained General Surgeon. He received his medical degree from the University of South Alabama College of Medicine and completed his general surgery residency at Brookwood Baptist Health where he was the resident ambassador to the American College of Surgeons. He was also awarded the Hugh Linder Award which recognizes the top surgical resident in the program. Dr. Thompson specializes in a variety of common surgical procedures including: • • • • • • •

da Vinci Robotic Surgery Gallbladder Removal Appendectomy Bariatric Surgery Breast Biopsy Breast Lesion Surgery Endoscopy (Colonoscopy/EGD)

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MAY 2021 • 11


TFA Affords Women Another Option to Treat Symptomatic Fibroids continued from page 11 How Big a Problem Are Fibroids? Epidemiologists have found it tricky to nail down exact incidence and prevalence rates of uterine fibroids (UFs). Since many are small and/or asymptomatic, these muscular tumors in the wall of the womb often aren’t diagnosed or reported. However, from the studies that exist, general consensus puts incidence rates at upward of 70 percent for developing one or more fibroid tumors over a lifetime. The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) cites fibroids as “the most common non-cancerous tumors in women of childbearing age.” An estimated 25 percent of women of in this group have symptomatic tumors that moderately or greatly impact quality of life, and symptomatic fibroids are the most frequent reason for hysterectomy in the United States. Risk profiles also are not clearly understood, but age is a key factor with UFs becoming more common as a woman ages up through menopause, after which time tumors begin to shrink. Race also plays a major role with black women having a significantly higher risk of developing fibroids and of having symptoms. Family history, obesity and eating habits have also been linked to UFs. Women who consume a lot of green vegetables seem to be afforded some protection from developing fibroids, while eating a lot of red meat has been linked to a higher risk of tu-

mor development. Last year, researchers at Michigan State University College of Human Medicine, Van Andel Institute and Spectrum Health uncovered new information on genes associated with fibroid tumors. In releasing their research findings, the group stated one of the genes they discovered, HOXA13, which is associated with uterine fibroids, “appeared to correlate with a transformation of cells in the muscle of the uterus into cells more typically found in the cervix when activated — a process called ‘homeotic transformation.’” The study, funded by the National Institutes of Health and published in Cell Reports, could ultimately lead to new therapeutic targets. Although many women with UFs have no symptoms, those who do often find the symptoms take a toll on quality of life. The most common issues include heavy menstrual bleeding (sometimes to the point of anemia), menstrual periods a week or more in length, enlargement of the lower abdomen, frequent urination, pelvic pain or pressure, constipation, pain during sex, and pain in the legs or back. Depending on the size and positioning of the fibroid tumors, women might also have difficulty in achieving pregnancy. They also face increased potential for complications during pregnancy, as well as a higher risk for requiring a cesarean delivery.

Sonata includes the SMART Guide – Setting Margins of Ablation in Real Time. The Gynesonics literature explains this technology displays a real-time graphic overlay on the live ultrasound image to determine the size and location of the ablation zone, safety borders and duration of the radiofrequency energy delivered. In April, the company announced publication of a clinical study analysis assessing effectiveness of the system. The peer-reviewed article, Transcervical Fibroid Ablation with Sonata System for Treatment of Submucous and Large Uterine Fibroids, appeared in the International Journal of Gynecology and Obstetrics. The analysis focused on a subgroup of patients with those specific types of tumors who had been enrolled in two previously published multicenter clinical trials –FAST-EU, primarily in Europe, and SONATA, primarily in U.S.-based centers. Among 197 women who had been treated for 534 fibroids, 86 percent of patients with only submucous fibroids and 81 percent with large fibroids (>5 cm) had bleeding reduction at three months post-ablation with sustained improvements over 12 months. Fibroid mapping with MRI in the FAST-EU trial showed an average volume reduction of 68 percent. Toub noted the volume reduction compares favorably to other uterus-sparing technologies with embolization typically seeing reduction of 50 percent, pharmaceuticals achieving 40 to 50 percent reduction and fo-

cused ultrasound in the range of 15 to 30 percent reduction. Furthermore, the rate of surgical reintervention among the women with only submucous fibroids was 3.7 percent in FAST-EU and 0.7 percent in SONATA at the one-year mark. The reintervention rate on the SONATA trial at the two-year mark was five percent and at three years was 8.2 percent. “It showed great results through 36 months,” Toub said of the durability of the treatment protocol. It isn’t surprising to see the need for additional intervention in some candidates because women who have many fibroids at baseline have a proclivity to form more fibroids. The patient response to this treatment has been positive with 94 percent of patients reporting satisfaction after three years. With positive durability and safety outcomes, along with minimal procedure and recovery time, Toub said Gynesonics believes they are offering women and physicians a new option to deal with a condition that is too often minimized. For women who suffer through painful periods, miss work days and skip social activities, UFs are more than just a nuisance. “By treating the fibroids successfully, you can have such a positive impact in their life,” Toub said.

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who has performed hundreds of these procedures. “When I evaluate patients and they meet the qualifications, the conversion rate going from the testing phase and the implant phase is 99 percent. Once the device is implanted in the patient, we see about 85 percent improvement.” Patients are not required to be put to sleep during the implant procedure, and the test procedure can be performed in the doctor’s office or in an outpatient setting. If a patient no longer wants the device for some reason, the InterStim therapy can be removed. “Not too many things are truly permanent. In that case, there are other options for the patient that includes Botox or peripheral nerve stimulation to the ankle, both of which have their own risks, benefits and success rates,” Short says. Short’s goal for each of her patients is improved quality of life. “This procedure adds a wonderful opportunity for patients who meet the qualifications,” she says. “Incontinence is so emotionally, physically and financially draining on people. The InterStim Micro gives positive results, and it gives hope.”


Five Information Blocking Takeaways By Kelli Fleming

On April 5th, the final information blocking rules issued by the Office of National Coordinator (“ONC”) took effect, leaving providers with numerous questions regarding what information has to be released, to whom, and how quickly. The information blocking rules, enacted as part of the 21st Century Cures Act, prohibit a healthcare provider, among other “actors” as defined in the rules, from taking any action that is likely to interfere with the access, exchange, or use of electronic health information contained in a designated record set (“EHI”), unless the action is required by law or an applicable exception is met. An action is likely to interfere with the access, exchange, or use of EHI if there is a reasonably foreseeable risk that the action will interfere with the access, exchange, or use of EHI. What is reasonable depends on the facts and circumstances. While these rules are complicated and additional guidance is certainly necessary, below are my five takeaways with respect to the new information blocking rules. 1. The information blocking rules are not limited to patient access to EHI through a patient portal.

The information blocking rules apply to any request for EHI from any requestor, not just a request to access information from patients. For example, the rules can be triggered when responding to a request for information from another treating provider. 2. Compliance with HIPAA timeframes (or other state law timeframes) is not always sufficient.

HIPAA currently allows a healthcare provider thirty days to respond to a patient’s request for access, although the proposed changes to HIPAA, if implemented, would shorten that time period to fifteen days. ONC has stated that simply because a healthcare provider satisfies the HIPAA timeframes for access (i.e., 30 days), that does not necessarily prevent a violation of the information blocking rules. In other words, a provider can comply with HIPAA, yet still run afoul of information blocking requirements. Unfortunately, the information blocking rules do not set forth a specific timeframe that would be

compliant, deferring to a facts and circumstances analysis.

if the denial of access, exchange, or use is due to the infeasibility of the request (e.g., lacking the requisite technological capabilities), as long as certain conditions are met.

3. The exceptions are complex and contain several factors that must be met.

• Health IT Performance Exception:

There are eight exceptions to the information blocking rules. If an exception is satisfied, the action will not be considered to be information blocking. Each exception to the information blocking prohibition is complex and contains a number of factors that must be met in order to qualify for the exception, a discussion of which is beyond the scope of this article. Thus, if you are relying on an exception to prevent the access, exchange, or use of electronic health information, each exception must be carefully reviewed. Any provider utilizing an exception should document the use of the exception and how the exception was satisfied. The eight exceptions to the information blocking rules are as follows: • Preventing Harm Exception: It will not be considered information blocking to engage in practices that are reasonable and necessary

to prevent harm to a patient or another person, as long as certain conditions are met. • Privacy Exception: It will not be considered information blocking if the action is designed to protect an individual’s privacy (e.g., by complying with state or federal privacy laws), as long as certain conditions are met. • Security Exception: It will not be considered information blocking if the action is designed to protect the security of the EHI, as long as certain conditions are met. • Infeasibility Exception: It will not be considered information blocking

It will not be considered information blocking if you take reasonable and necessary measures to temporarily suspend access to information through health IT in order to benefit the overall performance of the heath IT, as long as certain conditions are met. • Licensing Exception: It will not be considered information blocking if you license interoperability elements for EHI to be accessed, exchanged, or used, as long as certain conditions are met. • Fees Exception: It will not be considered information blocking if you charge a reasonable fee for accessing, exchanging, or using EHI, as long as certain conditions are met. • Content and Manner Exception: It will not be considered information blocking to limit the content or manner of response for a request for access, exchange, or use, as long as certain conditions are met. (CONTINUED ON PAGE 14)

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Birmingham Medical News

MAY 2021 • 13


ACP Recommends Shorter Antibiotic Courses, continued from page 8 There are estimates that at least 30 percent of the antibiotics prescribed are unnecessary and often continued too long. “We see an average of 791 antibiotic prescriptions per 1,000 people annually in the US. In Alabama that number is 1,158 antibiotic prescriptions per 1,000 people,” Lee said. “We need to look at how we’re using antibiotics and make sure we’re prescribing the right antibiotic for the right infection and the right number of days. “In the past, there was a tendency to prescribe a longer course of antibiotics to be sure of eliminating any lingering bacteria that might become resistant. However, more recent studies suggest that longer duration can play a role in driving resistance. I also read a paper pointing out how having a sevenday week seems to influence the timing in many of our treatments. Instead of having the calendar govern how we prescribe, it makes more sense to base treatment on how the bacterium behaves and how our patient’s bodies respond.

“That requires follow-up. We need to instruct patients carefully on when they need to check back with us, and make it easy for them to contact us—or set up a system to check back with them to see how they are responding to the antibiotic. “If the infection isn’t resolving as expected, we need to look into why. Could there be an underlying fungal infection we need to treat so the antibiotic can be more effective against the cellulitis? Do we need to do more testing to verify that it is bacteria and we’ve identified the right kind and prescribed accordingly?” The CDC has identified antibiotic resistance as a serious threat to the health of the United States. “So far, we’ve been able to come up with alternatives and the good news is that there are more new antibiotics in the pipelines than there were a few years ago,” Pacheco said “However, when we run into resistance, we may have to bring out the big guns. That could mean in-patient IVs and possibly

a greater risk of side effects. “Every city has its own resistant bacteria profile, and so does every hospital. If you’re dealing with an infection that isn’t responding as it should, you might want to check it against the strains known to be in the area.” The best antibiotic is prevention. “We learned a lot about infection control during the pandemic and in dealing with MRSA,” Pacheco said. “When infections happen, especially when they happen repeatedly or in a care setting, we need to track down the source. We should also be mindful of how we might be able to reduce risk as a patient’s condition improves. Does the patient still need a catheter? Is it time to move from a central line to IV?” Guidelines for other conditions frequently requiring antibiotics are likely to be updated in the future. On the horizon, Dr. Lee is interested in working on a new project comparing the effectiveness of oral and injectable antibiotics against bacterial infections.

ease and why it happens. They are also finding out how to treat it,” she says. Hughey points out that science has evolved over the past 20 years, especially in the area of immunotherapies and targeted drugs. “In the past, we had chemotherapy that hit every replicating cell in the body. Now we have new targeted

continued from page 13

4. Routine delays on the delivery of information, including test results, would be considered information blocking.

Many providers have established policies and procedures that delay certain test results for a period of time before the results are released to the patient portal, allowing time for the physician to review the results and, if necessary, contact the patient directly. ONC has stated that a wide-sweeping practice of this nature would be in violation of the information blocking rules. In other words, unless an exception is satisfied, test results should be released to the portal immediately, without delay, which may mean that the results are seen by the patient before they are reviewed by the physician. 5. Information blocking rules can be violated even if there is no harm.

Tackling T-Cell Lymphomas, continued from page 7 our expertise from both the dermatology and oncology realms to develop a unique treatment plan for each patient that addresses both skin and systemic issues.” Hughey says there is ongoing research in their field. “Experts are not only studying cutaneous lymphomas to better decipher the pathophysiology of the dis-

Five Info Blocking Takeaways,

drugs that attach to particular markers to attack just the cancerous T-cells and leave other cells alone,” she says. “It is great to see these advancements and the clinical trials at UAB. I am certain that many CTCL patients will benefit in the future from these endeavors.”

HEALTH INFORMATION SPECIALISTS Remote or On-Site Release of Information Services Audit Support Services Patient Form Completion

Because the information blocking rules contain a “likely to interfere” standard, the rules can be violated without any corresponding harm if an action is “likely” to interfere with the access, use, or exchange of EHI. 6. The information blocking rules are enforced by the Health & Human Services Office of Inspector General.

Specific penalties against providers for violations of the information blocking rules are currently unknown, but are expected to be released in future rule-making. Nonetheless, providers should pay close attention to these new rules and the impact they may have on existing policies and procedures related to the release of EHI. Kelli C. Fleming is a partner with Burr & Forman LLP and practices exclusively in the firm’s healthcare industry group. She may be reached at 205-458-5429 or kfleming@burr.com.

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Birmingham Medical News

MAY 2021 • 15


Healthcare Enforcement Actions By Bill AtHAnAS

Healthcare enforcement actions take multiple forms. The most impactful are: 1) civil complaints under the False Claims Act; and 2) criminal indictments. The first can result in substantial damages and penalties, as well as the implementation of an onerous multi-year corporate integrity agreement. Defending an FCA complaint can be expensive and timeconsuming, draining resources from a provider’s normal operations. Yet, if a company has to pick one of these two outcomes, it is the preferred choice. But healthcare companies don’t get to pick their poison: the government does. And in deciding which of these avenues to pursue, federal prosecutors enjoy substantial discretion. There are plenty of egregious criminal cases - involving fake patients, appalling patient harm, or obviously fraudulent schemes - where both outcomes result. This article focuses on a far more common scenario where the conduct falls near the boundary, and the question of whether to pursue the case criminally turns on a matter of degree. To be sure, there are wild cards that can impact that assessment process. Availability of investigative and prosecutorial resources and

• •

• even the interests of a particular prosecutor can play an outsized role in determining the path an individual investigation takes. But for the most part, the framework applied to assess how the government proceeds is predictable and reliable. Understanding which factors get considered - and how they drive outcomes - can be invaluable in formulating a response.

Measuring the dimensions of the conduct The goal here is to determine how “big” a violation the company committed. The spectrum of measurement runs from isolated instances of violations to that which is effectively systemic in nature. Within this framework, several key factors help to determine the size of the violation: • Amount of financial harm - how much loss resulted to victims from

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the conduct (and how much gain did the company realize)? Number of violations - how frequently did this conduct occur? Nature of the violations - are these major activities requiring the involvement of multiple employees (particularly senior management) Geographic scope - if the company has multiple locations, are the violations isolated or has it metastasized to a larger number? Length of time - is the conduct limited to a brief period, or has it taken place over an extended period? Efforts to conceal - are those engaged in the conduct - particularly senior management - actively working to cover it up? Self-disclosure - did the company find this on its own, taking measures to rectify the harm and prevent recurrence?

Evaluating the company’s preventative measures In addition to knowing the size of the problem, the government must consider whether and to what extent the company tried to prevent it. To do that, the government looks to the compliance environment where the conduct occurred, overlaying the degree to which the company implemented a compliance program which tracked “The Seven Fundamental Elements of an Effective Compliance Program” as announced by the Department of Health and Human Services, Offices of Inspector General. While updated and tailored to various sectors over the past several decades, these elements have remained largely consistent. They include: • Designation of a compliance officer and compliance committee. • Development of compliance policies and procedures, including standards of conduct. • Developing open lines of

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Turning knowledge into action While some percentage of the company’s legal and compliance departments may have an intellectual curiosity about these issues, a far greater number should care because they recognize that “forewarned is forearmed.” A company’s prior knowledge of how it will be judged when problems arise furnishes a tactical advantage to avoid those problems altogether. At a minimum, understanding how those will be assessed, both qualitatively and quantitatively, provides a leg up on how to minimize the adverse consequences that may result. This occurs through a candid assessment of the company’s compliance structure. To determine whether the company has really done what can reasonably be expected, it should revisit (or, in some situations, undertake as an initial matter) its risk assessment. Investing time to determine the types of problems that can take root and spread - and understanding how that’s likely to happen - can pay huge dividends when the company finds itself in the crosshairs (and even if it never does). Bill Athanas practices at Waller where he represents companies and individuals in all facets of government investigations, including grand jury investigations and other government enforcement actions.

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communication. • Appropriate training and teaching. • Internal monitoring and auditing. • Response to detected deficiencies. • Enforcement of disciplinary standards. The government’s goal at this stage is to measure the authenticity of the company’s preventative measures and responses to identified violations: did the company do what could reasonably be expected given the risks it faced or did just turn a blind eye to the risk of violations in an effort to maximize profitability?

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NCI Director Updates Cancer Progress By Cindy Sanders

In April, National Cancer Institute Director Norman E. “Ned” Sharpless, MD, FAACR, addressed the virtual attendees of the American Association for Cancer Research Annual Meeting to provide an update on where we stand in the ongoing fight against cancer. “We’re living in dizzying and challenging times, but we’re still making remarkable progress in cancer research,” Sharpless said. “We will look back at this era as the golden age of cancer research.” There have been more than 240 drugs, biologics and devices approved by the Food & Drug Administration for cancer indications since 2017. Sharpless said that this remarkable productivity is a testament to the work of basic and translational researchers in academic, government and private industry. He touted the Human Papillomavirus (HPV) vaccine’s safety and efficacy as an example of success. A recent study of nearly 1.7 million women in Sweden found that girls vaccinated before age 17 had a nearly 90 percent reduction in cervical cancer incidence over an 11 year period (2006-17) compared to the incidence in women who had not been vaccinated. “The key to more of these success stories is to ensure stable funding for re-

search. Investigator-initiated science is how we make progress for our patients,” Sharpless said. He pointed to the Cancer Moonshot, which started in 2017, as an accelerant that has helped fuel recent discoveries and information-sharing. Authorized at $1.8 billion spread over seven years, the program lapses in 2023. Launched while he was vice president, the project is deeply personal to President Joe Biden and First Lady Jill Biden, who lost son Beau to cancer in 2015. Sharpless noted that Vice President Kamala Harris also has a personal connection as the daughter of a cancer researcher who died from the disease. Not surprisingly, President Biden’s proposed budget for FY 2022, which was released on April 9, includes significant funding increases to address cancer. The budget suggests a total increase of $9.3 billion in funding to the National Institutes of Health. Additionally, the proposed budget includes $6.5 billion in funding for ARPA-H. Modeled on the military’s Defense Advanced Research Projects Agency (DARPA), this new Advanced Research Projects Agency – Health would look to speed innovation by investing in new projects and would be housed within the NIH. “Congress controls the power of the purse, and the president’s budget is just

Ned Sharpless, MD speaks to the American Association for Cancer Research virtual meeting.

a suggestion,” Sharpless said. “But while funding remains unclear, there is strong bipartisan support for cancer research. Everyone wants this effort to succeed.” The president has stated his goal is to end cancer as we know it. “I don’t us expect to eradicate all cancer deaths,” Sharpless said. “However, I believe it’s possible to dramatically impact the tragedy of cancer by developing new treatments, finding cures for pediatric cancers and helping people live longer and more fully, even with a cancer diagnosis. “One key metric is to cut cancer mortality in half from its peak in the 1990s. In the early 1990s, cancer was responsible for 215 deaths per 100,000 population. Now, that’s down to 150 deaths per 100,000. However, a 30 percent decline in 30 years is way too slow.” To meet the goal of cutting mortal-

ity in half by 2026 would require about a four percent decrease per year going forward, which has never been achieved to date. However, Sharpless said after historically reducing mortality by about 1.55 percent per year, the two most recent years for which data is available were trending in the right direction. In 2017, the country saw a 2.2 percent decline in cancer mortality and a 2.4 percent decline in 2018. “I think we can get there by 2026,” he said. “However, to achieve that goal will require focused efforts including developing large national trials aimed at early detection of cancer in healthy adults through blood-based screening, allocating resources to clinical trials focused on underserved populations and communities, and an increased commitment to accelerating drug discovery using new platforms and machine learning.” While the development of the COVID-19 vaccine showcased the ability to rapidly create highly effective measures to combat disease by harnessing information and technology, Sharpless said the pandemic also sharply showcased glaring health inequities in our country. “Underlying all this work is a need for health equity,” he said. “We can’t leave huge portions of the population behind and expect to make meaningful progress.”

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GRAND ROUNDS

Asif Named Associate Dean Primary Care and Rural Health

the AMSSM Collaborative Research Network. He is an associate editor for the journals Sports Health and the British Journal of Sports Medicine. Asif will be replacing William Curry, MD, who will be retiring from the School of Medicine but will continue his role with the UAB Health System in population health. “It is an honor to be chosen,” Asif said. “I look forward to working with dean of the School of Medicine Dr. Vickers, our regional campuses, and other partners to improve the primary care pipeline and address disparities in health outcomes, particularly in rural communities, through novel health care strategies that are developed at UAB.”

Irfan Asif, MD has been named associate dean for Primary Care and Rural Health at the University of Alabama at Irfan Asif, MD Birmingham School of Medicine. Asif currently serves as chair of the UAB Department of Family and Community Medicine. Asif joined UAB in 2018 from the Greenville Health System and the University of South Carolina School of Medicine where he served as the vice chair of academics and research in the Department of Family Medicine and as the sports medicine fellowship director. He earned his medical degree in 2007 at the University of Cincinnati College of Medicine. He completed his family medicine residency at the University of Washington with a concentration in sports medicine. He has served in several academic leadership positions, including sports medicine fellowship director at the University of Tennessee, sports medicine fellowship director at USC School of Medicine Greenville, interim director of the family medicine residency program in Greenville, and also as the interim chair for the Department of Family Medicine in Greenville. He has served on the Board of Directors for the American Medical Society for Sports Medicine and is chair of

Cullman Regional Medical Group Welcomes Richard Gonzales, MD Family Physician Richard Gonzales, MD has joined the Cullman Regional Medical Group. He is a board-certified Family Richard Physician, and after comGonzales, MD pleting medical school in the Philippines, he finished his postdoctoral training in Family Medicine at St. Clare’s Hospital in Schenectady, New York. Most recently, he practiced with Sutter Healthcare in California. With more than 20 years of experience practicing as a family physician, Gonzales has served as an Honorary Chairman of President George Bush’s

Physicians Advisory Committee and as Medical Director on the Board at Mark Twain Medical Center with Dignity Healthcare in California. While in California, his office was voted by patients and the community as the “Best Family Practice” in Customer Service Awards. “I care about my patients like they are my family,” he said. “I’m passionate about providing the best healthcare for my patients with professionalism, compassion and consideration for others while focusing on the vital mission of improving healthcare in the community.” Gonzales is very eager to return with his family and eventually retire in the south where he practiced at his own clinic in Georgia before relocating to California. He is accepting new patients and can be reached at (256) 297-4362.

Tita Replaces Retiring Saag as Associate Dean for Global and Women’s Health Alan Tita, MD, PhD has been named associate dean for Global and Women’s Health at UAB. Tita received his Alan Tita, medical degree from MD, PhD the Faculty of Medicine and Biomedical Sciences in Cameroon, Master of Public Health in International Health from the University of Leeds, and his PhD from the University of Texas Health Science Center School. He completed his residency in obstetrics and

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gynecology at Baylor College of Medicine and his maternal-fetal medicine fellowship at UAB. Tita currently serves as the John C. Hauth, MD Endowed Professor of Obstetrics and Gynecology, senior vice-chair for Research and Innovation, director of the university-wide interdisciplinary Center for Women’s Reproductive Health, and principal investigator of the NICHD Maternal-Fetal Medicine Units (MFMU) Network Center. With a background emphasizing maternal-fetal medicine, global health and perinatal epidemiology, Tita has led the design and conduct of collaborative trials that influence practice and global policy. He also co-leads the Cameroon Health Initiative at UAB and serves on the Eunice Kennedy Shriver National Institute of Child Health and Human Development Council. Tita will be stepping in for Michael Saag, MD, who will retire from UAB on June 30. As the current associate dean for Global Health, director of the UAB Center for AIDS Research, the founding director of the UAB 1917 HIV Clinic, and a professor of Medicine in the Division of Infectious Diseases, Saag has left a lasting impact on our community, state and beyond.

Breana Whitten, RN Receives DAISY Award The DAISY (Diseases Attacking the Immune System) Award for Extraordinary Nurses is given by the DAISY Foundation to nurses who are nominated Breana Whitten, RN by their hospital or by patients for outstanding patient care. Last month, Breana Whitten, RN, in CICU from Grandview received the award. Whitten was nominated by the wife of a former patient.

Children’s of Alabama President and CEO Mike Warren Announces Retirement Mike Warren, who has served as CEO of Children’s of Alabama since 2008, is retiring effective June 1 and will be Retiring CEO succeeded by COO Tom Mike Warren Shufflebarger. Warren previously served as chairman and CEO of Energen Corp. Before that, he practiced law with Bradley, Arant, Rose & White. He served 22 years on the Children’s of Alabama board of trustees before he was named the hospital’s CEO. Under Warren’s leadership, Children’s of Alabama has grown both in size and standing. In 2012, the new $400 million Benjamin Russell Hospital for Children


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Birmingham Medical News

MAY 2021 • 19


GRAND ROUNDS opened. The 12-story building was designed to accommodate projected growth in patient volume, anticipated medical technology needs and the planned consolidation of pediatric services, including cardiovascular surgery and comprehensive solid organ transplant care. In 2010, six of the hospital’s programs were ranked for the first time among the nation’s best children’s hospitals by U.S. News & World Report. The most recent ranking, released in June 2020, marked the 11th consecutive year that Children’s has been included. Warren has also served as chairman of the Business Council of Alabama, the United Way, Leadership Birmingham and Leadership Alabama as well as the Metropolitan Development Board and the area American Heart Associa-

tion. He has twice chaired the general campaign for the United Way and the United Negro College Fund. In 2004, Warren was inducted to the Alabama Academy of Honor. Tom Shufflebarger joined Children’s in 1992, having previously served as the budget director and director of physician recruitment and development for Brookwood Medical Center. He is an honors graduate of Duke University, where he earned both a Bachelor of Arts in economics and a Master of Business Administration. He is a Fellow of the American College of Healthcare Executives and has served as a trustee of the Alabama Chapter of the American Hospital Association. He is chairman of the Child Health Patient Safety Organization, an affiliate of the Children’s Hospital Association.

Children’s Honors Physician Board Members with Endowed Chairs Children’s of Alabama has honored four members of its Board of Trustees who each have over 20 years of service by establishing endowed chairs in their names: Jeffrey Blount, MD, is the first holder of the Raymond J. Harbert Endowed Chair in Pediatric Neurosurgery. He is the division director and chief of pediatric neurosurgery at Children’s. He is also the medical director of the Spina Bifida Clinic and surgical director of the Pediatric Surgery Epilepsy Program. Santiago Borasino, MD, MPH, is the first holder of the Donald M. James Endowed Chair in Pediatric Cardiac In-

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20 • MAY 2021

Birmingham Medical News

tensive Care. He serves as an attending physician in the Children’s Pediatric Intensive Care Unit, section head of the cardiac intensivists team and medical director and attending physician of the Cardiovascular Intensive Care Unit. David Askenazi, MD, MSPH, is the first holder of the W. Charles Mayer Endowed Chair in Pediatric Nephrology. He serves as the medical director of the Pediatric Home Hemodialysis Program, the Pediatric Acute Kidney Injury Survivor Clinic and the Pediatric and Infant Acute Nephrology program, a program he founded. Drew Davis, MD, is the first holder of the Temple W. Tutwiler, III Endowed Chair in Pediatric Rehabilitation Medicine. He is the medical director for the division of pediatric rehabilitation medicine as well as the Children’s of Alabama Early Intervention Program. He is a member of the hospital’s Comprehensive Spina Bifida Program and Muscular Dystrophy Care Center.

Selwyn Vickers, MD, FACS, dean of the UAB School of Medicine, has been named president of the American Surgical Association (ASA) for 2021. Founded in 1880, the Selwyn American Surgical AsVickers, MD sociation is the nation’s oldest and most prestigious surgical organization. Vickers is the third African American president in the association’s history, and the second surgeon from UAB to serve as president. Kirby Bland, MD, a past president of the ASA, said “this election represents the highest honor in the surgical profession of the United States.” A world-renowned surgeon, pancreatic cancer researcher and pioneer in health disparities research, Vickers is a member of the National Academy of Medicine and the Johns Hopkins Society of Scholars. He has served as president of the Society for Surgery of the Alimentary Tract and the Southern Surgical Association. Vickers earned baccalaureate and medical degrees from Johns Hopkins University and completed surgical training there, including a chief residency and surgical oncology fellowship. He completed two postgraduate research fellowships with the National Institutes of Health and training at John Radcliffe Hospital of Oxford University, England. Vickers joined UAB in 1994 as an assistant professor in the Department of Surgery. In 2006, he left to become the Chair of the Department of Surgery at the University of Minnesota Medical School. He returned to UAB in 2013 to serve as dean of the School of Medicine.


GRAND ROUNDS

Princeton Awarded a Top Leapfrog Hospital Safety Grade

DON’T MISS THE Birmingham Medical News BLOG BLOG SCHEDULE  MAY 11 Brent Parnell, MD with OB-GYN South Stress incontinence Treatment Options

Princeton Baptist Medical Center was awarded an ‘A’ in the fall 2020 Leapfrog Hospital Safety Grade, a national distinction recognizing Princeton’s achievements protecting patients from harm and providing safer health care. The Leapfrog Group is an independent national watchdog organization committed to health care quality and safety. The Safety Grade assigns an ‘A’, ‘B’, ‘C’, ‘D’ or ‘F’ grade to all general hospitals across the country and is updated every six months. It is based on a hospital’s performance in preventing medical errors, injuries, accidents, infections and other harms to patients in their care. “With our high standard of safety and commitment to quality care, we are proud to achieve this award for the

third consecutive time,” stated Princeton Baptist Medical Center CEO, Mike Neuendorf. “At a time when our health care systems are called upon to care for our communities at unprecedented levels, this designation is a testament to our dedicated, skilled staff and physicians who remain steadfast in providing our patients with the highest level of care.” Developed under the guidance of a national Expert Panel, the Leapfrog Hospital Safety Grade uses up to 27 measures of publicly available hospital safety data to assign grades to more than 2,600 U.S. acute-care hospitals twice per year. The Hospital Safety Grade’s methodology is peer-reviewed and fully transparent, and the results are free to the public.

“One aspect of my career that I value most is caring for patients,” he said. “This recognition symbolizes my commitment to excellent patient care. To be honored by my colleagues this way is as exciting as any accomplishment in my academic career to date.”

provides opportunities for groups such as academic institutions, health systems, physician networks and self-insured employers to access the genomics expertise at the HudsonAlpha Institute for Biotechnology in order to develop customized genomic health screening programs for their patients and employees. The HudsonAlpha Health Alliance will work with the Auburn Pharmaceutical Care Center to provide genetic testing to Auburn University employees enrolled in Auburn’s health insurance program who meet certain criteria. AUPCC pharmacists will collect saliva, which will be analyzed for genetic markers that provide information on how medications interact with the body. Health care professionals can use this data to select the best medication

HudsonAlpha Teams with Auburn for Genomic Health Program The HudsonAlpha Health Alliance and Auburn University have begun a new collaboration to provide genomic health screening to Auburn employees through the Auburn Pharmaceutical Care Center (AUPCC). The HudsonAlpha Health Alliance

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 MAY 18 Bertha Hidalgo, PhD with UAB School of Public Health COVID-19: Where do we go from here?  MAY 25 Richard Stroud, MBA with Whatley Health Services The Challenges of Practice Administration  JUNE 1 Heather Williams, CRNP with UCA Women’s Center Urinary Tract Infection That Comes After Sex  JUNE 8 Mike Wilkerson, MD with Bradford Health Addiction in Healthcare: Know the Signs & How to Get Help  JUNE 15 Rhys Harris, MD with Southeast Clinical Labs Screening Test for Early Detection of Multiple Myeloma TO VISIT OUR BLOG Go to www.birminghammedicalnews.com and click blog on the far right column or go directly to www.birminghammedicalnews.com/mod/blogpress/index.php While there, you are welcome to scroll down for past blog articles.

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Birmingham Medical News

MAY 2021 • 21


GRAND ROUNDS

EAMC Donates Land to Alabama Institute for Deaf and Blind

(l to r) Inspecting the land are from EAMC: Roben Casey, legal; Laura Grill, CEO; Sam Price, CFO; from AIDB: Allen Cope, Seddrick Hill, Dr. John Mascia, and Jessica Westbrook

East Alabama Medical Center (EAMC) has donated a parcel of land in Opelika to the Alabama Institute for Deaf and Blind (AIDB). AIDB held groundbreaking ceremony in mid-April. “We’re excited that the AIDB has chosen to build a regional facility here that will serve five counties in this area,” EAMC President and CEO Laura Grill said. “And we’re pleased to provide them the land for this facility that will make them a next-door neighbor to our Opelika campus.” “We sincerely appreciate the support of EAMC,” said John Mascia, Au.D., President of AIDB. “Strong community partnerships, like our relationship with EAMC, allow us to do great work with

the local deaf and blind community.” The AIDB Opelika Regional Center will provide services to individuals who are deaf, blind, deafblind and multi-disabled from infancy through adulthood. Early intervention will be available to eligible infants, children and families. A host of support services will be provided to children in the local school systems as well as adult services like case management, Braille and ASL training, job coaching, advocacy and transportation. Along with housing the regional center staff, the building will include space for use by the community for training, a computer lab and assistive technology.

and dosage, creating a personalized prescription for the individual. “We are excited to conduct this pilot project,” said Kimberly Braxton Lloyd, Pharm.D., Associate Dean of Clinical Affairs and Outreach with Harrison School of Pharmacy. “This service not only enhances the health care benefit for our employees, but also allows us to provide pharmacogenomics training for health care students.” “Genomics is the future of medicine,” said Devin Absher, PhD, Director of Genomic Health at HudsonAlpha. “By collaborating with groups and institutions like Auburn, we have the opportunity to help individuals learn valuable genomic information that will lead to more informed healthcare decisions.” Integrated healthcare solutions offered include patient engagement and genetic education, physician education, genetic testing results interpretation, access to a medical geneticist, genetic counselors and more.

UAB Tops $300 Million in NIH Research Funding Research funding to UAB from the National Institutes of Health exceeded $325 million in 2020. The university received $325,573,502, which placed UAB 27th in the list of universities receiving funding from the NIH. Among public universities, UAB ranked 12th. The largest amount of funding, $269,911,974, went to investigators in the School of Medicine. This was an increase of more than $13 million over

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22 • MAY 2021

Birmingham Medical News

2019, good for 24th overall among the nation’s medical school. The School of Optometry ranked third among optometry schools. The School of Health Professions ranked sixth among allied health schools, while the School of Dentistry ranked 10th, one place higher than 2019. The School of Nursing ranked 11th, up four spots from last year. The School of Public Health moved up four spots to 15th. “This is the second year in a row that UAB research funding from NIH has been over $300 million, reaffirming UAB’s place as a leading academic research institution,” said Chris Brown, PhD, vice president for Research at UAB. “In addition to serving as a major economic driver for Birmingham and Alabama, this funding leads to discoveries that are responsible for dramatic improvements in the health of citizens of Alabama, the United States and the world.” Within the School of Medicine, five departments were in the top 10 in research funding. The Department of Dermatology was second, with more than $8.2 million. Cell, Developmental and Integrative Biology was sixth, with nearly $17 million. Biomedical Engineering landed in seventh place, with $4.7 million, while Microbiology ranked eighth, with $21.3 million. Obstetrics and Gynecology ranked 10th, with $6.4 million. Another seven departments landed in the top 20 in the nation, including Ophthalmology and Visual Sciences, Pediatrics, Urology, Neurology, Anesthesiology, Neurosurgery, and Physical Medicine and Rehabilitation. Three departments finished at 21st in their respective fields: Internal Medicine, Genetics, and Pathology. The Departments of Neurobiology and Radiation Oncology finished in the top 30. The Departments of Psychiatry and Behavioral Neurobiology, Otolaryngology, and Biochemistry and Molecular Genetics all ranked within the top 50 in their fields.

Will Ferniany to Retire at End of 2021 After nearly 13 years as CEO the UAB Health System (UABHS) and serving the same role in the new UAB/Ascension St. Vincent’s Alliance, Will Will Ferniany, PhD Ferniany, PhD will retire at the end of 2021. Selwyn Vickers, MD, senior vice president and dean of the UAB School of Medicine, will succeed Ferniany as CEO of UABHS and the Alliance while continuing in his role of dean of the medical school. After graduating from the University of Alabama in 1973, Ferniany earned a master’s degree and a doctoral degree in health care administration before embarking on a long career in health care management, including


GRAND ROUNDS

EDITOR & PUBLISHER Steve Spencer VICE PRESiDENT OF OPERATIONS Jason Irvin CREATIVE DIRECTOR Katy Barrett-Alley CONTRIBUTING WRITERS Cara Clark, Ann DeBellis, Jane Ehrhardt, Laura Freeman, Cindy Sanders, Marty Slay Birmingham Medical News 270 Doug Baker Boulevard, Suite 700-400, 35242 205.215.7110 Ad Sales: Jason Irvin, 205.249.7244 All editorial submissions should be mailed to: Birmingham Medical News 270 Doug Baker Boulevard, Suite 700-400 Birmingham, AL 35242

serving as chief executive officer of the University of Mississippi Medical Center and vice president/chief administrative officer of the University of Pennsylvania Health System. During Ferniany’s tenure as CEO, the UABHS has grown from five hospitals to 11, with revenues expanding from $2.3 billion in 2008 to more than $5.8 billion today. Ferniany says among the most gratifying accomplishments of his time at UAB is the engagement by the Health System to improve health care for Alabamians. “To that end, UAB is actively engaged with the Alabama Hospital Association, along with many other affiliations with Alabama health care facilities, to expand Medicaid and improve Medicaid funding, develop an extensive telehealth system, and operate the new Alabama Rural Hospital

Resource Center,” he said. Cooperative agreements established with many of the leading health care facilities in the state, including Mobile Infirmary Health and Northeast Regional Medical Center in Anniston, along with the forming of the Alabama Health Alliance with Huntsville Hospital, have contributed to the improvement in health care in Alabama. UABHS now manages four rural hospitals in Camden, Demopolis, Greenville and Alexander City, providing cost-savings that help these facilities continue to offer medical care in their communities. UAB affiliate Medical West Hospital in Bessemer is preparing to start construction on a new facility that will improve health care for residents in the south and southwestern parts of Jefferson County. “Dr. Ferniany is to be credited for his unwavering support of the mission

of academic medicine,” Vickers said. “The Academic Enrichment Fund developed under his leadership aligned the Health System with the academic departments, enhancing the school’s ability to retain and recruit top physicians and scientists.” “Quality has always been a focal point for Dr. Ferniany,” Reid Jones, CEO of UAB Medicine, said. “He is tenacious about producing better outcomes. He cares about his employees, and he cares about the patients. “It has been my honor to serve UAB Health System’s patients, physicians and employees, and the people of Alabama,” Ferniany said. “While it is bittersweet to announce my retirement, I do so with pride in all we have accomplished together for those we serve and knowing the future of continued success is in good hands.”

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MAY 2021 • 23


24 • MAY 2021

Birmingham Medical News

Profile for Medical News

Birmingham Medical News May 2021  

EAMC Opens New $33.7 Million Facility at Auburn Cullman Regional Opens Alabama’s First Health Park

Birmingham Medical News May 2021  

EAMC Opens New $33.7 Million Facility at Auburn Cullman Regional Opens Alabama’s First Health Park

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