FOCUS TOPICS ONCOLOGY • BEHAVIORAL HEALTH • CYBERSECUIRTY • RURAL HEALTHCARE
March 2019 >> $5 ON ROUNDS New Center Director Aiming at Something Rather ‘Remarkable’ A summer job at a camp for kids with cancer changed the life of David Schwartz, a radiation oncologist who is director of the Center for Health Equity and has his sights set high.
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NRHA Fighting For Healthcare In Small Towns Rural health has taken a number of hits during the last decade, but now the NRHA is fighting to ensure small towns across America keep access to care.
Despite Improved Technology, Healthcare Cyber Attacks Rise Reducing Employee Negligence a Critical Goal By JAMES DOWD
In the two years since this publication featured a story about cybersecurity, hackers have launched even greater cyber assaults on unsuspecting and unprotected healthcare systems. The 2018 Cyber Claims Study compiled by NetDiligence found that from 2013-2017, healthcare system breaches accounted for 17 percent of all claims and 15 percent of total breach cost. In addition, the HIPAA Journal reported that since 2015 – a year in which more than 113 million healthcare records were breached and exceeding the combined number of breaches from 2009-2014 – cyberattacks have skyrocketed. Furthermore, the HIPAA Journal’s 2019 January Healthcare Data Breach Report revealed 33 healthcare data breaches were reported during the first month of 2019, with nearly a half-million records “exposed, stolen or impermissibly disclosed.” (CONTINUED ON PAGE 4)
Article on page 8.
Unity’s Lynn Doyle Gains Wisdom from Her Seniors
End of Partnership Opens Brand New Path for Methodist With one road closing after seven years, another one has quickly come open for Methodist Le Bonheur Healthcare.
By JUDY OTTO
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“Old age ain’t no place for sissies.” Bette Davis is credited with saying it first. But few people understand the deeper darknesses that face aging seniors — and how to help navigate them — better than Lynn Doyle, who joined Unity Psychiatric Care-Specialty Hospitals for Seniors in January, bringing 40-plus years of experience in the behavioral health field to her new role as administrator. Perhaps best known for her 30 years at Delta Medical, where she recently served as Executive Director of Business Development and Marketing, she credits Delta for the rich experience she
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Radiation Oncologist Targets Cancer Inequities Dr. David Schwartz Attempting ‘Something Remarkable’ in Memphis By LAWRENCE BUSER
When David Schwartz, MD, was finishing college at Stanford, he wasn’t sure what was next. There was possibly law school, a career in literature or a few other options, but medical school didn’t top the list. “I had worked as a camp counselor every summer, and then I got an opportunity to be a counselor at Camp Ronald McDonald in Los Angeles, one of the first camps in the U.S. specifically created for kids with cancer,” Dr. Schwartz recalled. “It was a life-changing experience. It was so formative, so emotionally resonant that it placed me on a new path. I wanted to be a cancer doctor.” After medical school at UCLA, Dr. Schwartz trained and worked at some of the leading cancer research centers in the country, including Fred Hutchinson Cancer Center in Seattle, MD Anderson Cancer Center in Houston, and UT Southwestern in Dallas. In 2016, with a curriculum vitae the size of a phone book, Dr. Schwartz was recruited to Memphis as Vice-Chair in the Department of Radiation Oncology at the University of Tennessee Health Science Center-West Cancer Center. He currently serves as interim chair of the Department of Radiation Oncology at the UTHSC College of Medicine and is also Professor in the Department of Preventive Medicine. As founder and director of the Center for Health Equity, which is part of the Center for Innovation in Health Equity Research at UTHSC, Dr. Schwartz has found Memphis to be a perfect fit. “Coming to Memphis gave me the opportunity to do something remarkable, to a cancer disparities program in direct partnership with its home community,” he said. “I came with the purposeful intent to create a health disparities and outcomes research center in radiation oncology. It’s the first of its kind in the United States.” Dr. Schwartz is now helping to lead the creation of a new academic cancer center spearheaded by Methodist Le Bonheur Healthcare and UTHSC. “We are building a 21st century cancer center from the ground up. My partners are the best of the best; they’re national experts from big-time places. We’ve faced up to the fact that Memphis has never had a nationally recognized academic referral center for adult cancer like St. Jude Children’s Research Hospital, and, simply put, it deserves one. “But this center has to fit Memphis, not the other way around. We are framing the center as being not just a partner with the community, but as a true part of the community. We are picking what is the best of Memphis – the authenticity, the soul, the culture – and mixing it with memphismedicalnews
what’s best from outside Memphis. We will bring the best technology and talent from across the country and place it into the hands of our neighbors and our clinical colleagues practicing in the region.” There may not be a better place or greater need for such an ambitious project than Memphis, with its large medically underserved populations and high poverty levels. Rates of cervical cancer, head & neck cancer, breast cancer and lung cancer are among the highest in the nation. Much of that, he said, is preventable.
“If you look at the instances and risks for hypertension, diabetes, obesity, chronic renal failure, stroke or heart attack, it walks hand in hand with cancer risk,” Dr. Schwartz said. “I really harp on my patients to get primary care and focus on their overall health, for themselves and their families, because cancer is the stalking horse for just about every chronic illness you can think of.” He envisions a more proactive approach to healthcare that not only helps current patients, but also reaches out to their families and neighbors to prevent cancer through healthy living. “What we as Americans think of as healthcare focuses mostly on restoring health after it has been lost, which is the wrong time to jump into the fight,” Dr. Schwartz continued. “We need sustainable, affordable, authentic ways to nurture health, to keep it intact in the first place. How can we engage with our neighbors to ensure we can all flourish in a more healthful city without expensive medications or procedures? We are focusing many of our current research projects on this question. “Nobody knows what one individual’s cancer comes from, but we all know instinctively that the way you live your life, the things you’re exposed to, your family background, and maybe even your emotional and psychological state – all of
these things weave together into a tapestry that determines whether you thrive or don’t.” Dr. Schwartz says he, wife Katherine and their two daughters, ages 10 and 12, have been taken by the friendliness and soulful charm of Memphis, but he also sees “an underdog mentality” about the city that is unwarranted, given the medical resources and level of expertise that is here. “We need to raise our expectations of what we have to offer to the city and what we can help our city attain on a more global level,” he said. “Here in Memphis there’s a lot of cancer, and we have to be realistic about the profound social realities and disparities impacting our city. But I believe it’s ironic and happily fixable, that the most under-utilized communitybased cancer fighting resource is our own medical community here in Memphis. We purposefully will never create a specialty center ‘black hole’ for doctors to refer patients to, never to hear from again. We’re partners. “We plan to work with our colleagues entrusting us with their patients. We will study and establish holistic healthcare pathways which provide not only durable cures but also durable health, for everyone. This is my personal mission at the medical school. It is also shared as a mission, I (CONTINUED ON PAGE 4)
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Despite Improved Technology, Healthcare Cyber Attacks Rise, continued from age 1 But despite the growing numbers of security.” cyberattacks across the industry, finding In the 2017 article about cybersecurity, the Memphis Medical the funds to implement News interviewed “Jack,” and maintain robust an expert hacker who protection plans remains works for a company a challenge for many that investigates and healthcare systems. And tests the security sysaside from budgetary ... fortunately tems of healthcare facililimitations, some facilities for the systems ties. Then as now, Jack find it difficult to devote that hire me, requested that this publiadequate time to training staff on how to reduce cation not identify either I’m one of the risk. him or his company in good guys. “It’s all about manorder to maintain anoaging risk and prioritiznymity when he conducts — “Jack” ing expenses,” said Dave his assessments, Lewis, chief information “I wish I could say security officer for Duo that a lot has changed for Security, which is not the better, but although part of Cisco and has there are definitely some more than 800 healthhealthcare systems getcare clients across the country, includting on board, not enough of them are ing several in Memphis. “Many medical and not fast enough,” said Jack, who infiltrates medical systems across the U.S. “I facilities already have these structures in still manage to get into restricted areas place, but some need help performing an without official credentials. I still manasset inventory of their systems and conducting due diligence to improve data age to gain access to patient records. I still
manage to find things that bad guys would have a field day with, but fortunately for the systems that hire me, I’m one of the good guys. I’m here to help.” And while allowing hackers to penetrate a healthcare system’s database may seem counterintuitive to strengthening its operations, Jack emphasized that authorized breaches by “white hats” (ethical hackers) can offer solutions that will help prevent criminal attacks by “black hats” (criminal hackers) from stealing information. To help mitigate increasingly aggressive ransomware attacks that result in an organization’s information being stolen and its access denied to operating systems unless ransom is paid, Duo emphasizes the necessity of employee training. Making it harder for hackers, not employees, to access a system is key. “The focus has to be on balancing security with usability. Medical personnel should be able to do what they do best, which is taking care of patients, without spending precious time worrying about systems access,” said Amanda Roger-
Radiation Oncologist Targets Cancer Inequities, continued from page 3 believe, by everybody I’m blessed to work with.” Since Dr. Schwartz is seeking to bring cancer care directly into the worlds of patients to make them active partners in the quest for good health, why not start early? The radiation oncologist’s work recently got the attention of TEDx Memphis, local independent producers of videos featuring expert speakers on science, business, technology and other disciplines. The project that got their attention was a National Institutes of Health grant submission that he helps to lead that would allow 6th and 9th graders to apply for cancer research grants in their communities. He is partnering with Michelle Martin,
PhD, at UTHSC College of Medicine, and Idia Thurston, PhD, University of Memphis, on the project. Martin is head of the UTHSC Center for Innovation in Health Equity Research. Thurston is an assistant professor in the Department of Psychology and is an adjunct assistant professor in the Department of Pediatrics, UTHSC/Le Bonheur Pediatric Obesity Program. The young students would take a fundamentals of science research course and then, working with their teachers, scientists and doctors, formulate their own research questions and research plans to answer those questions. “We envision the projects being focused on real world issues that the kids see as directly relevant to their own
neighborhoods and their own lives,” Dr. Schwartz explained. “This could be something as straightforward as hypertension control and its relationship to cancer risk, or as profound as trust and trauma issues impacting their neighbors’ relationships with cancer providers. “They will apply for grants, get resources, literally own their projects, and then present their results in a local scientific forum to their community. They may even get the chance to present at real medical meetings and publish in real medical journals. We want to train the new energetic experts who will replace us, and who will excite younger students to follow them. There’s never been a program like this in the country. I think it’s pretty cool.”
son, product marketing manager at Duo. “There are programs that provide multifactor authentication and reduce the risk of cyberattack, but also make it easier for doctors and nurses and other medical workers to access patient records.” In addition, healthcare systems must analyze operating systems to get an accurate picture of network usage. “We conducted a survey for one healthcare organization and discovered that there were more than 300,000 devices connected to the system than were accounted for,” Rogerson said. “You have to know your system and who’s authorized to access it in order to protect it.” Reducing employee negligence is another key component, Rogerson said. Keeping up with technology is vital, but the human component must never be overlooked. Jack agreed. “Robust security systems lose effectiveness if employees don’t take them seriously or if they become lax in monitoring who’s coming in and out of their area,” Jack said. “You can have the most technologically advanced system in the world, but if your frontline employees don’t scrutinize my credentials when I show up pretending to be an IT guy checking their computers, well your system is pretty much worthless. And if it turns out to be a bad guy instead of me accessing your information, it’s game over.”
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Unity’s Lynn Doyle Gains Wisdom from Her Seniors, continued from page 1 acquired while holding multiple positions that allowed her to explore new areas and hone emerging skills. After opening and helping to manage Delta’s mental health unit, she discovered a special affinity for working with seniors. “Despite the fact that the seniors that I worked with had psychiatric issues,” Doyle said, “their wisdom was so sage, and I learned so much from them, that I think my love for senior adults started at that point.” It’s one reason she joined Unity’s team, with its senior psychiatric focus. But her concern for seniors and the issues they face doesn’t stop at her office door. She serves as chairman of the board for Alzheimer’s & Dementia Services of Memphis, past president and board member of Creative Aging, and past president and board member for the Professional Network on Aging. She also hosts a talk show on WYPL and contributes her experience to WKNO’s “Best Times” series. Her dedication, in fact, is responsible for one of her proudest accomplishments: earning the 2018 Senior Advocacy Award from the Professional Network on Aging. “To get that award from my peers was probably one of the biggest happenings in my life,” she said. Doyle points to unnerving statistics comparing death rates from heart disease to deaths from Alzheimer’s. Between 2000 and 2015, heart disease deaths decreased 11 percent while Alzheimer’s deaths increased 123 percent, with 1 in 3 seniors dying from Alzheimer’s or other dementia. “It is definitely on the increase, partly because we have better reporting than we used to, but also because we’re living longer,” she said. “Had they lived longer than their 60s, probably more people in the past would have had dementia.” Unity’s focus on senior mental health reflects a trend we can expect to continue, she predicts, as the adult population grows older and larger. Previously accustomed to a 120-bed psychiatric unit, she appreciates the more intimate feel of Unity’s 16-bed Memphis facility, which enables its “really good team of energized and engaged employees to interact with patients all day long, and have some very personal time with them. Our primary goal is giving patients the very best care, and getting them back to where they need to be.” People need to feel a sense of warmth, comfort and safety when they go into a facility, she added. “We continue to elevate that profile.” All behavioral health facilities “are looking deep into the face of senior care,” she said. “The senior years are not as golden as we’ve been led to believe. We may be living longer, but we’re not necessarily living well.” As people age, they lose more loved ones, peers and friends — increasing the pain of loss. Because aging seniors deal 6
with increasing health issues and often increased financial stresses, some dread becoming a burden to their families. Feeling betrayed by their own bodies, sometimes reduced to living from check to check, they contribute to a rising rate of senior suicides that is larger than most people realize, Doyle reports. She worries that many families are largely unprepared to deal with the needs of aging, and the situation is rapidly becoming critical. “We are an as-needed society,” she said. “We only look at things as we need them.” She points to Seniorcare.com statistics that claim only a third of Americans think they will need long-term care, while two-thirds actually will. “I think in the future you’re going to see a waiting list at every place that treats behavioral health,” she said. “I just hope we’ll have enough beds in this city to be able to treat everybody and treat well. “For seniors (and families) it’s just imperative that we get them the resources that they need — and that they begin to make decisions regarding long-term care. Because most of us just don’t look at that until we have to. And we are so emotionally distraught at that point that it’s hard to make a decision.” The good news? Seniors are better equipped than ever to understand and utilize technology to research health issues and symptoms — through Facebook, WebMD, etc. — and identify health indicators to their doctors. FaceTime, Skype and other services enable better connections to distant family members, friends and peers. “Most people agree that peer support is important for all of us. We need to be with people our own age,” she said. “It helps people live longer, more productive lives if they can be connected with family and friends.” A wife, mother, sister, aunt, friend, new grandmother and new administrator, Doyle is committed to her personal goal: “to make all those roles fit together so that I’m giving each one of them the right amount of time and energy and love.” In her leisure time, she enjoys reading escapist fiction and pursuing the volunteerism that she finds so energizing. “I love what I’m doing; I want to continue to be a force in every opportunity in the senior community — to love them and to lift them up.” She and her husband, John Doyle, Executive Director of the Memphis Rock n Soul Museum, are also experienced global travelers who have enjoyed visits to many European countries. “Meet as many people in this field as you can,” she advises. “Take advantage of every bit of their wisdom and vision to create your own path. If you’re going to treat seniors, learn as much as you can from them. Ask questions, discover the greatest times in their lives; they can still teach you so much!” memphismedicalnews
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Small Towns, Big Fight for Continued Access to Communities’ Healthcare Rural Hospitals Face Death by a Thousand Cuts By CINDY SANDERS
More than 60 million Americans – nearly one in five residents – live in rural communities. While these small towns and wide swaths of farmland are an integral part of the American fabric, the nation has seen the rural population drop from 54.4 percent in 1910 to 19.3 percent a century later, according to the U.S. Census Bureau. As Americans have migrated to urban areas and urban clusters, it has become increasingly difficult to sustain services, particularly access to healthcare, in many of these rural communities. Although a little more than 80 percent of the country lives in urban areas and the clusters surrounding them, the actual land urbanites use is only 3 percent of the country’s total. The remaining 19.3 percent of the population is spread across 97 percent of the nation’s landscape. In a service industry where ‘minutes matter,’ closure of a rural hospital facility likely means adding significant time to get to the next closest medical facility. By the beginning of this year, the
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National Rural Health Association (NRHA) counted 95 rural hospital closures since 2010 and identified nearly 700 other facilities as being vulnerable for closing. “Everything that NHRA works on can be boiled down to one thing … and that’s access,” stated Diane R. Calmus, regulatory counsel for the NRHA. The reasons for the closures Diane R. Calmus are multifactorial. “It would be really easy if there was a silver bullet to solve the issues, but this has been the result of a whole lot of small cuts,” said Calmus. “A lot of cuts that have happened in D.C. have impacted rural hospitals in a way that haven’t impacted urban counterparts with a different payer mix,” she continued. In its #SaveRuralHospitals action center, the NRHA noted, “The rate of closure has steadily increased since
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sequestration began and bad debt cuts began to hit rural hospitals, resulting in a rate six times higher in 2015 compared to 2010.” Rural hospitals often lack the specialty services that bring in higher reimbursement to offset losses on general inpatient care and surgeries. Add to that, Calmus continued, “Rural Americans tend to be older, sicker, poorer than their urban counterparts.” She continued, “We know from MedPAC that at least since 2016, Medicare margins have been, on average, negative. By definition, rural hospitals are providing that frontline care, and that’s where negative margins are even worse.” Calmus said the bad debt cuts have been particularly hard for rural hospitals for a couple of key reasons. Prior to the Affordable Care Act, hospitals could write off a significant portion of their bad debt. However, since ACA was supposed to expand health insurance to everyone, the theory was bad debt would drop dramatically. Therefore, a bad debt cut was put in place. When Medicaid expansion was overruled by the Supreme Court, it left a coverage gap for a lot of Americans, which has been disproportionately felt by rural hospitals with a smaller patient census to offset uninsured care. Even when serving patients with insurance, rural hospitals often have been left with bad debt since paying a $5,000 deductible is nearly impossible for many people. The very nature of frontline care means that rural hospitals often stabilize a patient before sending that individual to an urban counterpart for more specialized treatment. Rural hospitals have found their services fall into the ‘deductible’ part of patient care, whereas insurance has kicked in by the time the patient is transferred to the larger urban center for continued services. “We’ve seen a 50 percent increase in bad debt at rural hospitals that we haven’t seen at urban hospitals,” noted Calmus. Sequestration is another area where federal cuts have made it increasingly difficult for some rural hospitals to keep their doors open. “Critical Access Hospitals were paid 101 percent the cost of providing care. That was cut by 2 percent by the sequester. If you do the not-so-difficult math, they are not being paid the cost of care,” Calmus said of the cost deficit faced by CAH-designated facilities. The ‘death by a thousand cuts’ reality has taken a steep toll on rural hospitals across the country. “From 2018, 46 percent of rural hospitals were operating at a loss. That’s up from 44 percent in 2017 and 40 percent the year before that,” outlined Calmus. Yet another threat to access is a lack of providers. “Recruitment and reten-
tion of physicians is always an issue for rural hospitals,” said Calmus. This is particularly true for a number of specialties. “Between 2004 and 2014, we’ve seen more than 200 rural communities lose their hospital-based obstetrics. Now, the majority of rural counties don’t actually have a place to deliver a baby,” she continued. Coinciding with the decrease in obstetric services has been an increase in precipitous deliveries with more rural babies delivered at home, in ERs, or in the back of an ambulance or in a car en route to a larger facility. On a more positive note, Calmus said, “340B is one of the bright spots in rural healthcare.” In addition to keeping the doors open, she said a number of hospitals are using the 340B money in innovative ways to improve care delivery … and, she stressed, the 340B money isn’t paid for by taxpayers. “The threats to 340B are frequent. We ‘re working constantly to educate legislators and the administration on how well hospitals are using this money,” she admitted. Happily, there are plenty of success stories to share. “Rural hospitals are uniquely positioned to know their patients in a way doctors in urban communities can’t,” she pointed out. Calmus noted one hospital in Kansas kept seeing a family in the emergency room because they had an infestation of bed bugs. Using just a few 340B dollars took care of the problem at a fraction of the cost of an ER visit. Similarly, another patient was having a hard time controlling his diabetes. Tapping into resources to pay his electric bill meant his insulin could be properly refrigerated and therefore more effective. Calmus said rural hospitals have become incubators for innovative practice. “In so many ways, it’s the rural hospitals who are figuring out how to do more with less,” she pointed out, adding that work mirrors the national call to deliver high-value care in the most costeffective manner possible. Despite the many ongoing threats to the nation’s rural healthcare facilities, Calmus said there is much to be excited about, as well. “Rural America is a great place to practice medicine in the cradleto-grave model so many providers say they want to practice.”
Mark Your Calendars The 42nd Annual Rural Health Conference is slated for May 7-10 in nearby Atlanta. For details on registration, housing and the 2019 agenda, go online to ruralhealthweb. org/events.
Methodist Le Bonheur Moving Quickly Following the End of Partnership Since its partnership with West Cancer Center officially ended last month, Methodist Le Bonheur Healthcare (MLH) has wasted little time in starting to build its own cancer treatment organization. With little fanfare – not even a news conference – MLH already has launched the Methodist Cancer Institute, a comprehensive cancer center in partnership with the University of Tennessee Health Science Center (UTHSC). In addition, MLH this month won approval to bring precision MRI-guided radiation therapy treatment to Methodist Le Bonheur Germantown Hospital. And while no announcement has yet been made, one might well expect a portion of the newly dedicated 450,000-square-foot Shorb Tower to be devoted to MLH’s newly formed Cancer Institute. The nine-story tower, named for its longtime CEO Gary Shorb, was part of MLH’s $275-million modernization plan in 2016. Before the dissolution of the partnership, the top four floors of the tower at Bellevue and Eastmoreland were designated for West’s cancer endeavors. Understandably, there is speculation on what now will be done with those four floors that still are not finished out, but there is no word from Methodist Le Bonheur president and CEO Michael Ugwueke. However he did address the Methodist Cancer Institute in a recent news release. “As MLH pursues its vision of building a National Cancer organization-designated Comprehensive Cancer Center – one of only 49 in the country – it will be built on a strong foundation to elevate education, research and clinical services in partnership with UTHSC,” Ugwueke was quoted in the release. “I am excited about the direction we are headed as we continue our work to bring world-class academic physicians and community physicians together to serve our entire community.” MLH, a 100 year old institution that provided care through nearly 2.2 million patient encounters last year, already has been able to regain some of the funds it most likely lost when the partnership dissolved. On February 22, shortly after the sevenyear partnership officially ended, MLH sold its 198,000-square-foot medical facility at 7945 Wolf River Blvd. to West Cancer Center for $51 million. Seven years earlier, in 2013, MLH purchased the building from the UT Medical Group for $22.5 million. This month, MLH ‘s approval to bring precision MRI-guided radiation therapy treatment to Methodist Le Bonheur Germantown Hospital will allow it to initiate the addition of an MRI/RT Linear Accelerator to be added to the hospital’s megavoltage radiation therapy services. “We’re incredibly excited to receive this approval as we continue our work to create a comprehensive cancer program focused on providing expert cancer care across all of the communities we serve,” said Ugwueke said. “Adding a linear accelerator to our Germantown Hospital will enable memphismedicalnews
Le Bonheur Selects Michael Wiggins President Le Bonheur Children’s Hospital has selected Michael Wiggins, MBA, FACHE, as its next president. He will begin his tenure April 8, 2019. Wiggins comes to Le Bonheur from Children’s Health in Dallas, Texas, where he served as senior vice president of Clinical Operations and the Northern Market and administrator of the Children’s Medical Center Plano. Wiggins was selected through a national search process that included candidates from throughout the country. The search committee was composed of members from the community, including St. Jude Children’s Research Hospital, the University of Tennessee Health Science Center, donors and physicians. He succeeds Meri Armour, who is retiring after 12 years at Le Bonheur. Under her tenure, Le Bonheur was consistently named one of the country’s ‘Best Children’s Hospitals’ by U.S. News & World Report and was awarded Magnet status by the American Nurses’ Credentialing Center. The hospital was also verified by the American College of Surgeons as a Level 1 Trauma Center, awarded a three-star rating for Le Bonheur’s Heart Institute by the Society of Thoracic Surgeons (STS) and received designation for FedEx Neuroscience Institute as a Level IV Center by The National Association of Epilepsy Centers. Under her guidance, Le Bonheur was also named a Top Children’s Hospital Michael Wiggins in 2017 by the Leapfrog Group, an independent hospital watchdog organization. Armour also opened a $340 million state-of-the art hospital addition, led a $100 million capital campaign and established a $100 million hospital endowment. “The search committee was impressed with Michael’s experience and commitment to safety and quality for children’s health,” said Michael Ugwueke, president and CEO of Methodist Le Bonheur Healthcare. “He has great passion for caring for children in their communities and I believe he will continue Le Bonheur’s trajectory as a top-tier children’s hospital. I am confident that he will build on the momentum that Meri Armour has begun.” Wiggins holds a master’s of business administration and a bachelor’s of science from the University of Alabama at Birmingham. He is a fellow of the American College of Healthcare Executives (FACHE). He and his wife, Robin, have three children.
us to bring advanced treatment options out East and continue to elevate care in Germantown and surrounding areas just as we have done for more than 20 years.” Hospital officials say with the addition of the MRI/RT Linear Accelerator, MHT MLH becomes the first to bring this innovative technology to Tennessee, Linear Accelerators are a type of external beam radiation therapy that delivers a beam of high energy x-rays directly to the location of a tumor or other tissue being irradiated. The technology images soft tissue, not just the bone and air that conventional technology captures to improve treatment accuracy and reduce the amount of radiation to which a patient is exposed. This approval marks an important milestone as MLH works to create the new Methodist Cancer Institute in partnership with The University of Tennessee Health Science Center (UTHSC). As, MLH is well positioned to elevate Education, Research and Clinical services and achieve its vision of building a National Cancer Institutedesignated Comprehensive Cancer Center – one of only 49 in the country. As for West, the hospital made its intentions clear last year. In September in announcing its termination of the partnership, West officials cited its “40-year legacy of innovation,” and said it will begin 2019 on a new course, with a new partner, OneOncology a Nashville-based cancer care startup. A West release stated it is “evolving into a new model – one, that will be a patient-centric, physician-driven and technology-powered center with a mission to improve the lives of those living with and beyond cancer.”
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Violence Increasing in Nation’s ERs By CINDY SANDERS
By their very nature, emergency departments are high-stakes settings filled with vulnerable patients and frightened families. Increasingly, they are also highrisk settings for healthcare providers, staff and patients. Last fall, the American College of Emergency Physicians released data and insights into the rising violence in U.S. Emergency Departments. In a poll of more than 3,500 emergency physicians nationwide, nearly seven in 10 said ED violence is increasing, and nearly eight in 10 said the violence harms patient care. “More needs to be done,” said ACEP President Vidor Friedman, MD, FACEP, in presenting the survey results during the organization’s annual meeting. “Violence in emergency departments is not only affecting medical staff, it is affecting patients,” he continued. Findings from the poll, included: • 47 percent of emergency physicians reported having been physically assaulted at work, with 60 percent of those assaults occurring in the past year. • 71 percent personally witnessed others being assaulted during their shifts. • 77 percent said patient care was being affected with 51 percent of those saying that patients also have been physically harmed.
(L-R) Drs. Terry Kowalenko, Vidor Friedman and Leigh Vinocur present survey findings at an ACEP meeting.
• 50 percent believe the majority of attacks are from people seeking drugs or under the influence of drugs or alcohol. While 70 percent of those surveyed said hospital administration or hospital
security did respond to the incident, only 21 percent said hospital security arrested the assailant or enlisted law enforcement to do so; 6 percent said hospital administration advised them to press charges;
and 3 percent said hospital security pressed charges. The other 70 percent said response to the assault resulted in a behavioral flag being added to a patient’s (CONTINUED ON PAGE 11)
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Violence Increasing, continued from page 10 chart or ‘other’ measure. The vast majority of physicians said patients were responsible for the attack, but 28 percent reported being assaulted by a patient’s family member or friend (results totaled more than 100 percent because some respondents had been attacked more than once). 83 percent of emergency physician respondents said a patient has threatened to return to harm them or their emergency staff. The most common types of assault are being hit, slapped, spit upon, punched, kicked or scratched. In addition, to physical attacks, 80 percent of male and 96 percent of female emergency physicians report having a patient or visitor make inappropriate comments or unwanted advances. 34 percent believe a lack of punitive consequence is the biggest contributing factor to the issue, and another 32 percent said behavioral health patients are driving the increases in violence (and 41 percent think the majority of attacks are from psychiatric patients). “Just in hospitals and healthcare in general, people are at their most vulnerable, and family members are at their most worried. The ER is the worst-case scenario for most, so it is this extremely volatile experience,” said Leigh Vinocur, MD, FACEP, past chair of ACEP’s Emergency Department Violence Committee and a national spokesperson for Leigh Vinocur the organization. She added that when most people think about doctors and nurses being harmed or killed, they think of those practicing in war-torn counties. “Yet, here in the United States, it’s possible for your ER physician to become a victim of violence.” The reasons for increasing violence are multifactorial. “I always say the emergency department is a microcosm of society – gun violence, domestic violence, homelessness, psychiatric issues. As there is an increase in violence in society, it’s going to spill over into the emergency department,” noted Vinocur, a boardcertified emergency physician with more than 25 years of experience. Add overcrowding and boarding into the mix of heightened emotions, and Vinocur said it isn’t surprising to see tempers flare. While nearly half the physicians surveyed have been physically assaulted and more than 70 percent have witnessed someone else be assaulted, Vinocur said the numbers climb even higher when verbal abuse is added to equation. And while this poll was conducted among emergency physicians, she said nurses are often on the front lines of the potential danger. “The person who is more hands-on with the patient is susceptible to even more abuse,” she pointed out. “If you look at the Bureau of Labor Statistics, being a healthcare professional memphismedicalnews
is one of the most dangerous professions … and it’s very underreported,” Vinocur said, noting those in healthcare chose the profession to help people and often don’t report incidences because they recognize patients are under stress and don’t want to stigmatize them. Even while being mindful the situation might cause patients and family members to act in ways they normally wouldn’t, Vinocur said she believes hospitals are trying to get in front of bad behaviors that could quickly escalate. “Hospitals and health systems realize it’s the safety of their employees and also the safety of their patients,” she said. Of increasing concern, however, are freestanding EDs and urgent care centers. While most hospitals have guards, Vinocur pointed out, “In these ambulatory settings where you are siloed and there’s no security, you are even more vulnerable … and a lot of healthcare is moving to ambulatory settings.” To offset the disturbing trend in violence, Vinocur said there are a number of concrete steps facilities and health systems could take to improve safety. Additional security is one key step whether that is in the form of more guards or more cameras on site. When adding security cameras, it’s beneficial to have the devices visible so that individuals are aware their actions are being recorded. Improved visitor screening is another crucial step. In some areas, particularly large urban areas, metal detectors help screen for weapons. In addition, Vinocur said staff should be trained to ask patients if there is anyone who shouldn’t be allowed in to see them to help curb potential domestic violence interactions. “Training people to deescalate situations, too, is important … teaching hospital staff to recognize the signs of someone who is escalating as they are starting to get more and more agitated,” she said. Vinocur noted clinicians could also play a vital role in easing agitation through clear communication with patients and family members to keep them up to speed. While it’s easy for physicians to get distracted because they are so busy, she said it’s crucial to be aware of how stressful the situation is for patients and their families and why it’s so important to foster engagement. “Tensions run high,” Vinocur concluded. “Open communication can help allay fears and help mitigate out-of-control feelings. It can help ameliorate the very emotional experience of healthcare.” And a calmer emergency department is ultimately a safer one.
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GrandRounds Southern College of Optometry Receives Historic Gift An agreement between the Optometry Association of Louisiana (OAL) and Southern College of Optometry (SCO) last month has resulted in the transfer of a $1.5 million trust to SCO made possible by the estate of the late Dr. Mark W. Franks, a 1955 SCO graduate and longtime Louisiana optometrist. Following his death in 1989, Dr.
Franks and his wife, Mary, bequeathed approximately $500,000 to the OAL to establish a low interest loan trust for Louisiana optometry students who attended SCO. After several years of legal and financial transactions to establish the trust, it finally came to fruition in 2000, at which time the college agreed to help administer the loan program with oversight from the OAL. To expand upon the potential impact originally envisioned by Dr. Franks more than 30 years ago, an agreement was reached this year to donate the ex-
isting trust fund and its control to SCO to form the Mark W. Franks and Mary Franks Scholarship and Loan Fund. The fund’s total current value is approximately $1.5 million, making it the single largest bequeathment gift in the college’s 87-year history. Dr. Franks was born in 1922 in Owasso, Oklahoma. After working in construction, he served in World War II then pursued an engineering degree before switching to optometry. He worked his way through SCO by serving as a draftsman on a Memphis railroad yard.
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SCO was established in Memphis in 1932 and is the only accredited optometry college in Tennessee. One of only 23 optometry colleges in the nation, it has a student body of about 500.
BMHC, Christ Community Health Services Open Homeless Clinic Baptist Memorial Health Care (BMHC) and Christ Community Health Services (CCHS) have opened a clinic for the homeless that will complement already-existing mobile healthcare services offered through Baptist Operation Outreach. The new facility, located inside Catholic Charities of West Tennessee’s main building at 1325 Jefferson Ave., opened March 1. The facility, available to patients Tuesday, Wednesday and Thursday, includes two exam rooms, a lab, a waiting area and staff offices. Patients who receive care at the clinic will also have access to dental and vision services, as well as immediate access to support services through CCHS. The mobile clinic travels several days a week to locations that serve the homeless and offers free acute and primary care, disease management support, prevention services and medication. “We are proud to be the largest provider of healthcare for the homeless in Memphis through our partnership with Christ Community Health Services,” said Jason Little, president and CEO of BMHC. “It is an important part of our mission. . .” “Providing comprehensive health care and access to other vital needs, such as housing, food and clothing, in one location has been a part of our vision for Baptist Operation Outreach for many years,” said Shantelle Leatherwood, CEO of CCHS. “To see that vision realized along with the impact we’ve had on so many lives is beyond gratifying.” Since 2004, Baptist Operation Outreach has grown from a staff of four with less than 500 patient visits to a staff of 10 with more than 3,000 patient encounters in 2018. The staff now includes a physician, nurse practitioner, behavioral health provider and social worker.
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GrandRounds cer Charitable Fund, established by his family in order to pay tribute to a man who battled cancer with dignity and courage. The organization’s programs include a yearly symposium headlined by nationally recognized leaders in the field of pancreatic cancer, as well as fellowship training for future pancreatic cancer surgeons. It also hosts a monthly support group meeting, providing hope and help for patients and their families. Those wanting more information should visit www.kostenfoundation. com.
TMA to Hold “Doctors’ Day on the Hill” March 26 The Tennessee Medical Association expects at least 300 physicians from across the state to attend its annual Day on the Hill in Nashville on Tuesday, March 26. Physicians from all regions of Tennessee representing all medical specialties come to Nashville during each legislative session to meet with lawmakers, attend committee meetings and share their expertise on issues affecting healthcare in Tennessee.
TMA has an intentionally limited list of topics it is pushing this year in the newlook General Assembly, but is a visible and respected voice for any healthcare-related bills that affect doctors and patients. TMA reviewed all 1,684 bills filed in the 2019 session and is actively monitoring more than 300 bills affecting healthcare, including 114 caption bills, on a range of healthcare issues. To read more about TMA’s legislative priorities visit tnmed.org/legislative.
A patient at Baptist Children’s Hospital, wearing his new Starlight hospital gown, enjoys a treat during a “Day of Joy.”
“Day of Joy” Held for Patients at Baptist Children’s Hospital The Joy in Childhood Foundation, a charitable foundation powered by Dunkin’ and Baskin-Robbins, hosted a “Day of Joy” at the Spence and Becky Wilson Baptist Children’s Hospital. The event included delivery of Joy in Childhood Foundation custom Starlight hospital gowns for the young patients. The “Day of Joy” is a designated day when the Joy in Childhood Foundation offers its support to organizations that share its mission to provide the simple joys of childhood through special events and activities to kids battling hunger or illness. As part of last month’s event, patients at the hospital received a donation of Starlight Gowns to wear. Hospital staff and families also were served coffee and donuts donated on behalf of Dunkin’. The Starlight Gowns, designed by the Joy in Childhood Foundation, feature colorful depictions inspired by “the courage of pediatric patients.”
Audrey Gregory Included on Prestigious Healthcare List Becker’s Hospital Review has included Audrey Gregory, Saint Francis CEO, on its 2019 list of top the 68 African American Leaders in Healthcare. The list highlights African Americans who have taken on healthcare leadership roles across the country. These individuals influence how their organizations approach healthcare delivery, develop healthcare policy and advocate for the next generation of leaders.
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GrandRounds Le Bonheur Children’s Hospital to expand Heart Institute Le Bonheur Children’s Hospital unveiled plans this month for a $37.6 million expansion of its Heart Institute that when completed will give it a dedicated 31-bed cardiovascular unit. The two-story expansion will attach 70,500-square-feet on the west side of its hospital at the corner of Poplar Avenue and Dunlap. There will be 10 additional beds in its Cardiovascular Intensive Care Unit for a total of 20 beds. The increased space also will create room for an 11bed step-down cardiac unit. A new MRI-guided hybrid catheterization lab also is being added, for a total of three. Construction is scheduled to begin this year. Since 2015 the Heart Institute has added 19 new cardiologists to handle patient growth. Last year it evaluated and treated 387 inpatients.
McDonald Murrmann Center to Hold Open House on April 9 The McDonald Murrmann Center for Wellness and Health 360º will have a grand opening of its newly redesigned clinic from 4 to 7 pm Tuesday, April 9 at 7205 Wolf River Boulevard, Suites 150155 for the medical community. The event will be an opportunity to meet its physicians Dr. Mary McDonald, Dr. Susan Murrmann, and Dr. Heather Donato as well as its new providers Meredith Ryan, PA and Natalie Narrow, NP, and to introduce their new in house services.
Lamar Alexander Honored with Service Award by AMA The American Medical Association (AMA) has presented U.S. Senator Lamar Alexander (R-Tenn.) with the Dr. Nathan Davis Award for Outstanding Government Service. A former governor, university president and U.S. Secretary of Education with a bipartisan approach to legislating, Alexander has spearheaded significant healthcare bills, including the “21st
Century Cures Act,” which included provisions to help get treatment and cures to patients faster and comprehensive mental health legislation, and the “SUPPORT for Patients and Communities Act” – a legislative package to address opioid use disorders. Since 2015, Sen. Alexander has served as the Chairman of the Senate Committee on Health, Education, Labor and Pensions (HELP) Committee. Formerly a member of the Senate Republican Leadership team, Sen. Alexander stepped down from that position to forge relationships, and build bipartisan consensus on important issues. Sen. Alexander, who was nominated by the Tennessee Medical Association, was one of eight honorees chosen this year to receive the award.
Saint Francis’ Carla Kirkland Receives Nurse Practitioner Award Carla Kirkland, a Nurse Practitioner at Saint Francis Memphis Emergency Department, has been named the 2019 American Association of Nurse Practitioners® Tennessee State Award for Nurse Practitioner Advocate Excellence. The award is given annu- Carla Kirkland ally to a dnurse practitioner (NP) and NP advocate in each state. Recipients will be honored at an awards ceremony and reception held during the AANP 2019 National Conference, June 18—23, in Indianapolis. The State Award for NP Excellence, founded in 1991, recognizes an NP in each state who demonstrates excellence in practice. Kirkland is president of Tennessee Nurses Association District 1 and president elect for Tennessee Nurses Association.
Great Place to Work Lists Methodist Le Bonheur Healthcare Methodist Le Bonheur Healthcare (MLH) has been named one of the
G. Coble Caperton Licensed Tennessee Attorney
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Practicing in the following areas: • • • •
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RemediChain Launches National Chemotherapy Reclamation Program RemediChain announced it has begun accepting individual donations of oral chemotherapy prescriptions, the first step in the Memphis-based company’s use of blockchain technology to address the financial and environmental problems of medication waste. To facilitate the donation process, RemediChain will partner with three Memphis organizations to take in medications – Baptist Cancer Center, West Cancer Center and Church Health. “Nationwide, more than $100 billion worth of medication is destroyed each year, while 32 million Americans report that they can’t afford their medication,” said Jide Anyigbo, pharmacist and co-founder of RemediChain. “This is an especially prominent problem for cancer patients, as oral chemotherapy drugs can cost up to $45,000 for a 30day supply. By using blockchain technology, we can connect individual donors with unused medications to some of those patients most in need right here in Memphis. It’s literally life-saving.” RemediChain, a sister company for Good Shepherd Pharmacy, can accept and redistribute unopened oral chemotherapy tablets and capsules in their original packaging. Those medications can be donated by any patient or cancer clinic in the United States and will be distributed to vulnerable patients who would not otherwise be able to afford their life-saving medicine.
UTHSC’s Makowski Authors Paper on Sugar, Heart Disease A paper by Liza Makowski, PhD, professor of Medicine in the Division of Hematology and Oncology in the College of Medicine at the University of Tennessee Health Science Center (UTHSC), has been published In the Journal of Immunology that provides novel insights into the biochemistry of Liza Makowski the sugar glucose in immune cells critical to obesity and heart disease. Glucose metabolism in white blood cells, or macrophages, has been thought to play an important role in the best way to fight infection or “turn on defense” in response to chronic stressors like high sugar or cholesterol in dia-
betes or heart disease. “We wanted to test just how important glucose was in fighting disease,” Makowski said. Researchers found that when they inhibited glucose transporter 1 (GLUT1), the most important sugar transporter in cells, the macrophages adapted to use other biochemical substrates or biochemicals as fuels. This metabolic adaptation, however, was not sufficient enough for the macrophages to behave normally. Makowski advises that these findings are significant because they show that glucose transportation is key for certain cellular functions and white blood cell stability.
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