__MAIN_TEXT__
feature-image

Page 1

MMS Fall 2019 covers_Layout 1 10/9/2019 2:26 PM Page 1

Volume 23, Number 3

Fall 2019

Catherine Womack, M.D. Leading the next generation


MMS Fall 2019 covers_Layout 1 10/9/2019 2:26 PM Page 2

Internal Mediciine and Multispecialty Clinic • Cardiology • Endocrinology • Infectious Disease

• Internal Medicine • Neurology • Nephrology

EASTT CAMPUS S

• Pain Medicine • Rhheumatology • Wound o Care

Gynecology and Menopause Care Physical Therapy and Rehabilitation Fertility and IVFF Urology and Urrogynecology On-site Pharmacy and Imaging Cennter Online schedulling and same-day apppointments

REGIOONAL ONE HEALLTTH EAST CAM MPUS

Schedule online at

RegionalOneHealth.org//East Or call 901.515.EASTT

Regional One Health East Cam mpus 6555 Quince Road | Memphis, TN T 38119

Located at the Kirby Exitt of 385


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 1

SEEING A ALL THE DET TAIL A S doesn’t always require a microscope

As a mutual malpr m actice insurance compaany, SVMIC has developed a fast and easy alternative foor accessing policy informa o tion online. This new web-based tool was designed to match the resp s onsive service that our poliicyholders already experience w with us over the phone.

See our new policy management plaatform o

at svmic.com /vanttage


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 2

Editorial Thomas C. Gettelfinger, M.D. Managing Editor Allison Cook 2019 Board of Directors President Jimmie Mancell, M.D.

Inside This Issue Volume 23, Number 3

Fall 2019

President-Elect Danielle Hinton Hassel, M.D. Vice President Justin Monroe, M.D. Secretary Christopher M. Pokabla, M.D. Treasurer David L. Cannon, M.D. Immediate Past President Autry J. Parker, M.D. Board Members W. Clay Jackson, M.D., DipTh Walter Rayford, PhD, M.D., MBA Paul Tackett, M.D. Lisa S. Usdan, M.D. Lindi Vanderwalde, M.D. Raymond R. Walker, M.D. Andrew Watson, M.D. Catherine Womack, M.D. JoAnn Phillips Wood, M.D. Ex-Officio Board Members LaTonya Washington, M.D., President of Bluff City Medical Society

3 5 8 9 10 14 16 18 21 22 25 26 27 28

Editorial President’s Letter Benefits Membership Hospital Updates Spotlight: Catherine Womack, M.D. Feature: World’s First Voice Box Reconstruction Legislation Finance Community Research Practice In Training Bulletin

Karen Adams, President of MidSouth MGMA

Cover:

2

The Memphis Medical Society Quarterly


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 3

Q

Editorial

My Summer Vacation On the road, it comes with you You remember going back to school, grade school more than likely, after the summer, your teacher says ‘write me a story, write about your summer vacation’. I won’t pretend that you have any interest in mine, but I’ll tell you a few things about it anyway. While in practice, few of us, unless in academic medicine and privileged with sabbatical time, have the luxury of months, even a year to take off, try something different, recharge, refresh. Retirement, which descended upon me in May, is an entirely different thing. You’re supposed to have a plan, long thought out, and I certainly recommend such, but that has never been my strong suit. I determined on a road trip, several in fact, so the first months in retirement were just that, half of those months, driving,…6,000 miles behind the wheel. It was away from medicine, from practice, time to process, traveling alone. On the east swing I stayed with old friends, some medical school classmates, one who now lived on Chesapeake Bay, in the former home of the Admiral of the Fleet; another who had retired twenty years ago to lead bicycle tours in New England and Scotland, imagine a cardiologist doing that; another who had built a home in rural New Hampshire, an oncologist up a two mile gravel road clearing winter snow with his tractor; a practice colleague living on a crest overlooking the Blue Ridge Mountains; a resident friend cruising the Chesapeake on his motor yacht.

The west trip took me to a conclave in the Nevada Desert, Burning Man, and a controversy, for who knew there were companies contracted for medical care at big festivals and if they’re unfamiliar with the territory, they stock too few suture kits, not enough supplies to treat dehydration; a stay in the Columbia River Gorge with a niece and nephew, Emergency Room Physicians living in a glorious place; a stay with a retinal surgeon friend in Seattle who reminded me we don’t need to follow Marie Kondo’s Tidying Up creed, she keeps her stuff, overflowing, ‘let my heirs deal with it’; a reunion with the Residency Department Chair where I had trained and with one of my junior residents who had become president of our American Academy of Ophthalmology. So, away from practice, my summer vacation with no end in sight, on the road, medicine was there. Though you may retire, medicine comes with you. And with it the reminder that the pursuit of medicine is as good a way to spend a lifetime as any.

Thomas C. Gettelfinger, M.D.

Fall 2019

3


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 4

Tee up to a pain-free lifestyle with the top experts in spine care. Our doctors are always on par with the latest treatments and technologies to get you back on the green.

 

 


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 5

Q

President’s Letter

Dear colleagues, It is my hope you have had a joyous summer, one which allowed for personal time with family, friends or comrades. For some of us, school is back in session which brings excitement and enthusiasm. I would like to thank those members of the Memphis Medical Society and the Bluff City Medical Society who were able to attend the M1 welcoming reception at the Dixon Gallery and Gardens. Despite the heat and humidity, attendance was phenomenal. Students were very engaging and inquisitive, desiring to becoming involved with our organization, a testament to the early introduction of organized medicine to them. As the summer recess concludes for members of Congress, organized medicine’s efforts will become extremely important and our involvement imperative at the state and federal levels. The three biggest healthcare priorities on their agenda are: tackling “surprise” medical bills, curving increases in prescription drug prices, and funding the federal government including Health and Human Services and other healthcare programs. By all indications healthcare will be one of the leading topics in elections at both the state and national forums. At multiple levels, from individual conversations to representation from our associations, we must have an organized consistent message to protect our patients and healthcare in our country. To put it more eloquently, “ if you are not at the table, you are usually on the menu!”

With best personal regards, I remain,

Jimmie Mancell, MD President, MMS

As the summer fades (and thankfully the heat), the nights become cooler and Fall festivities begin, if I, our Board members, or associates of the Memphis Medical Society can be of any assistance, or you have any ideas on how the Society can better serve it’s members, please do not hesitate to contact us.

Fall 2019

5


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 6

The Memphis Fire e Department is enhancing itts Emergency Medical Services (EMS) to ensure you receive the RIGH HT RESPONSE for your emergency. Our goal g is to help connect you w with consistent health care support for increased health and vitality.. Depending upon your emergency, EMS will give you the RIGHT RESPONSE, whether it’s an ambulance, an immediate or upcoming doctor visit or a ch hance to speak directly with a healthcare provider.

WHEN Y YO OU H HA AV VE AN EM MERGENCY Y‌ ‌ You will speak to professionals trained to recognize which medical          

MEDICAL CONSULTA LT TA AT TION

Our dispatchers will connect you with the appropriate health care professional by phone to determine further medical needs and/or follow-up.

ONSITE CARE

Some situations can be resolved by a visit with a healthcare provider, rathe er e than a routine visit to the emergency room.

AMBUL LANCE

If you require e immediate medical asssistance, an ambulancce will be dispatched to address your n needs.

For more information, visit memphistn..gov/healthcare-naviga ator.


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 7

l r h

T g r.

Fall 2019

7


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 8

Q

Membership

Membership News Welcome our newest members Abdul-Rahman Riyad AbdelKarim, MD Cardiology, Interventional Sutherland Cardiology Clinic 7460 Wolf River Blvd Germantown, TN 38138-1760 Karen Elizabeth Andrews, MD Internal Medicine Methodist Germantown Hospitalist Group 7691 Poplar Ave Ste 350 Germantown, TN 38138-3904 Arvind Reddy Ankireddypalli, MD Family Medicine Peabody Family Care 1325 Eastmoreland Ave Ste 150 Memphis, TN 38104-3555 Bonnie L. Barnes, MD Family Medidcine Methodist Medical Group 8721 Winchester Rd Ste 2000 Memphis, TN 38125-3962 Aaron E. Bond, MD Neurological Surgery Semmes-Murphey Clinic 6325 Humphreys Blvd Memphis, TN 38120-2300

Charnell Cain, DO Family Medicine Peabody Family Care 1325 Eastmoreland Ave Ste 150 Memphis, TN 38104-3555

John Lynn Jefferies, Jr. MD Cardiovascular Disease Sutherland Cardiology Clinic 7460 Wolf River Blvd Germantown, TN 38138-1760

Fatima Sufiyan Chaudhry, MD Internal Medicine Methodist University Hospitalists Group 1265 Union Ave Memphis, TN 38104-3415

Fnu Kaweeta, MD Internal Medicine UT Methodist Physicians 1265 Union Ave Ste 184 Memphis, TN 38104-3415

Gunjan Dokania, MD Pediatrics Pediatric Consultants PC 6215 Humphreys Blvd Ste 200 Memphis, TN 38120-2382 John Francis Eick, MD Internal Medicine Methodist University Hospitalists Group 1265 Union Ave Memphis, TN 38104-3415 Elizabeth Hinds Gilless, MD Internal Medicine Methodist Germantown Hospitalist Group 7691 Poplar Ave Ste 350 Germantown, TN 38138-3904

Debaroti Mullick Borschel, MD Internal Medicine Methodist University Hospitalists Group 1265 Union Ave Memphis, TN 38104-3415

Amber L. Graham, MD Physical Medicine and Rehabilitation Semmes-Murphey Clinic 6325 Humphreys Blvd Memphis, TN 38120-2300

Charles E. Brown, MD Internal Medicine Methodist Medical Group South 1264 Wesley Ste 606 Memphis, TN 38116-6426

Poonam Lata Gutt, MD Internal Medicine UT Methodist Physicians 1265 Union Ave Ste 184 Memphis, TN 38104-3415

8

Samira Mujtaba Khan, MD Internal Medicine UT Methodist Physicians 1265 Union Ave Ste 184 Memphis, TN 38104-3415 Scott Wood Kirsch, MD Family Medicine Methodist Olive Branch Hospitalists 4250 Bethel Rd Olive Branch, MS 38654-8737 Michael David Koplon, MD Internal Medicine Methodist University Hospitalists Group 1265 Union Ave Memphis, TN 38104-3415 Aneel Kumar, MD Internal Medicine UT Methodist Physicians 1265 Union Ave Ste 184 Memphis, TN 38104-3415 Joe Thomas Lequerica, MD Internal Medicine Methodist South Hospitalists 1300 Wesley Dr Memphis, TN 38116-6426

The Memphis Medical Society Quarterly


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 9

Q Imran Mirzaa, MD Internal Mediccine Memphis Medical Specialty 6555 Quince R Memphis, TN 38119

Latonya B. Washington, MD Internal Medicine UT Methodist Physicians 1265 Union Ave Ste 184 Memphis, TN 38104-3415

Vamsee Krishna Mupparaju, MD Internal Medicine Methodist South Hospitalists 1300 Wesley Dr Memphis, TN 38116-6426

Amna Ahmad Zaidi, MD Internal Medicine Methodist South Hospitalists 1300 Wesley Dr Memphis, TN 38116-6426

Egunmwendia Iguodala Ogbeide, MD Internal Medicine Methodist South Hospitalists 1300 Wesley Dr Memphis, TN 38116-6426 Joel E. Perchik, Jr, MD Interventional Radiology and Diagnostic Radology Mid-South Imaging and Therapeutics 7600 Wolf River Blvd Ste 200 Germantown, TN 38138-1788 Yasmina Pokharel, MD Internal Medicine Methodist South Hospitalists 1300 Wesley Dr Memphis, TN 38116-6426 Tina Puthalon Kunnath, MD Rheumatology Methodist Medical Group Rheumatology 1211 Union Ste 200 Memphis, TN 38104-3415 Salman Saeed, MD Neurology West Tennessee Neurology, PC 6570 Stage Rd Ste 202 Bartlett, TN 38134-2840 104-3415 Ellis Tavin, MD Plastic Surgery Plastic Surgery Group of Memphis PC 1500 W Poplar Ave Ste 304 Collierville, TN 38017-0601

Fall 2019

New Interns/Residents/Fellows: Yousef Khaled Abdel-Aziz, MD Ahmed Salama Ahmed Abdelmeguid, MD Faisal M. Abdulameer, MD Zachary Richard Abramson, MD Nisreen Awni Daoud Abu Al Hommos, MD Hanna Y. Akalu, MD John MIlton Alexander, DO Emad Mohd Ahmed Alghazo, MD Lamia Aljundi, MD Jennifer Marie Allison, MD Pedro Salvador Argoti Torres, MD Anas N. Asad Andrew Stephen Astin, DO Ambreen Azhar, MD Ali Azim, MD Anshika Chopla Bakshi, MD Maha Bano, MD Kelsey Ray Bastian, MD Courtney A. Bayruns, MD Mary Elizabeth Belles, MD Cheri Denise Benner, DO Jacob Anthony Bezold, MD Yashubhrika Bharani, MD Corinne Nicole Blackburn, MD Aaron Solomon Bloch, MD Deke Blum, MD Jordan Michael Bond, MD Cory Bosworth, MD Courtney Racquel Brooks, DO James Benjamin Burke, MD Jonathan Taylor Butts, MD Mary Elizabeth Butts, MD Cihangir Buyukgoz, MD

Membership

Tyler Edwin Calkins, MD Ethelin Camille Cammock, MD Kathleen Ticu Linh Cao, MD Xochitl America Castillo, MD Abhishek Ac Chakraborty, MD Ankita Chauhan, MD Viswanatha Reddy Chinta, MD Lyle William Christiansen, MD Nicholas Christopher Clemm, MD Benjamin Steven Clifford, MD Matthew Michael Cook, MD Lauren Christine Correa, MD Lucille Janine Cox, MD Joseph Powell Creel, MD Andrea Joan Cuviello, MD Yoseph A. Dalia, MD Cassandra Lowana Devol, MD Rahil Praful Dharia, DO Nicholas Alexander Diloreto, MD Zachary Robert Diltz, MD Anita Eapen, MD Ibrahim El Masri, MD Makkalon Em, MD Morgan Ashleigh Enty, MD Mohammad Ali Esmadi, MD Juilia Elizabeth Esswein, MD William Ian Evans, MD Christina M. Fahey, MD Allison Katherine Falcon, MD Mina S. Fanous, MD Taiane Ferrari, MD James Ashton Fisher, MD Miranda So Floen, MD Joshua Davis Fowler, MD William Charles Gambla, MD Kavitha Ganesan, MD Sarah Ganji, MD Krishna Ksahyap Gannamraj, DO Connor Wayne Gatewood, MD Rebecca C. Gerrity, MD Jazmin Graff, MD Alexa Nicole Gusmeroti, MD Ilya Mikhailovich Gutman, MD Jessica Ashley Gutman, MD Shane Michael Hagen, MD Sarah Elizabeth Hammond, MD Danielle K. Harrell, DO Claire Elizabeth Hays, MD Collin David Henry, MD Devin Nicole Hicks, MD Continued on page 12 9


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 10

Q

Hospital Updates

UT Methodist Physician Treats Vocal Fold Lesions with Advanced In-Office Laser Procedure Otolaryngologist Sandra Stinnett, MD, with UT Methodist Physicians, and assistant professor and director, division of Laryngology at the University of Tennessee Health Science Center, performs in office laser of the vocal folds, a relatively new treatment.

Traditionally, laser treatment of the vocal folds was performed under general anesthesia in the operating room.With the technological development of superior vocal fold imaging using flexible laryngoscopy, distal chip scopes along with advances in laser fiber technology, in office lasers have become an option to reduce patient downtime. This procedure is used to treat a variety of vocal fold issues including recurrent respiratory papillomatosis (RRP), Reinke's edema and certain polyps. It can also be used to treat premalignant lesions such as leukoplakia or erythroplakia.

In many cases lesions such as RRP as well as leukoplakia recur, and therefore require repeated laser treatments. In office laser is much more convenient during these circumstances since it does not require general anesthesia. The laser treatment is performed by anesthetizing the vocal folds by either aerosolized or topical liquid anesthesia. The laser fiber is passed through the flexible laryngoscope and the lesions are removed using the heat of the scope, while preserving the normal anatomy of the vocal folds. Patients may feel some mild heat and pressure. The procedure takes about 30 minutes.

The Center of Excellence directs Baptist patients with SUD and AUD to IAC Associates for evaluation and treatment. The IAC Associates team is led by the Mid-South’s only fellowship-trained, board-certified addiction medicine physicians and includes a therapist and a social worker.

Baptist Memorial Health Care, Integrated Addiction Care Associates increase access to addiction care Baptist Memorial Health Care and Integrated Addiction Care Associates, a medical practice that treats patients with substance use disorder (SUD) and alcohol use disorder (AUD), have formed a Center of Excellence in Addiction Medicine to provide patient care, clinical research and physician education in addiction medicine. 10

Baptist is implementing this program in its hospitals and Baptist Medical Group physician offices. If clinicians believe a patient may be suffering from SUD and/or AUD, they can arrange for an addiction medicine physician to consult with the patient promptly, if the patient consents. The Center of Excellence also includes the only fellowship program of its kind in the region, which will educate future addiction medicine physicians. Staff will also study best practices for addiction treatment and offer physician education seminars to help all doctors identify patients who may have SUD or AUD. The Memphis Medical Society Quarterly


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 11

Q Regional One Health Receives America’s Essential Hospitals Honor America’s Essential Hospitals awarded Regional One Health a 2019 Gage Award honorable mention for population health for its ONE Health initiative. “When faced with some of the nation’s most pressing health care challenges, essential hospitals step up,” said America’s Essential Hospitals President and CEO Bruce Siegel, MD, MPH. The ONE Health team focuses on treating the needs of the person first and improving access to appropriate care.

ONE Health was able to make great strides in improving health while also avoiding health care costs. Within its first 11 months, the program enrolled 127 patients a Reduced emergency visits by 61 percent Reduced inpatient admissions by 71 percent Dropped inpatient hospital days by 80 percent Reduced hemoglobin A1C levels in 66 percent of enrollees with a diabetes diagnosis Achieved successive blood pressure readings lower than 140/90 among enrollees with hypertension

hope and healing to some of our community’s most vulnerable residents,” said Reginald Coopwood, MD, president and CEO of Regional One Health. “The economic impact for our system is valuable, but that is not why we do this work. The stories of lives changed that have come out of this work is immeasurable.”

“Regional One Health’s ONE Health initiative has made remarkable strides in providing

U.S. News & World Report Names Saint Francis Hospital-Memphis a High Performing Hospital for Chronic Obstructive Pulmonary Disease and Heart Failure The annual Procedures & Conditions ratings, now in their 5th year, are designed to assist patients and their doctors in making informed decisions about where to receive care for common conditions and elective procedures. These ratings extend the U.S. News mission of providing consumers with patient decision support beyond the Best Hospitals rankings, which are geared toward complex specialty care.

Fall 2019

Hospital Updates

Saint Francis Hospital-Memphis earned a “High Performing” rating for chronic obstructive pulmonary disease and heart failure, in recognition of care that was significantly better than the national average, as measured by factors such as patient outcomes. “High Performing” is the highest rating U.S. News awards for the care of chronic obstructive pulmonary disease and heart failure. “We are so thrilled and humbled by this prestigious distinction,” said Dr. Audrey Gregory, Market CEO of Saint Francis Healthcare. “Our staff and providers work hard each day to exceed expectations and provide an exceptional level of care to the communities we serve.”

11


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 12

continued from page 9 Dih-Dih Huang, MD Gina Hurng, DO Karrar Husain, MD Divya L. Indrakanti, MD Eva Jaymes Ingram, MD Deeyam Adel Itayem, MD Amit Jethanandani, MD Yuli Jiang, MD Sherin M. John, MD Dawit Kamil Jowhar, MD Emma Marks Kelly, MD Kianoush Khalili, MD Sania Hanif Khan, MD Jason Dongjin Kim, MD Willis T. Ko, MD Kyle R. Kreitman, DO Pooja Kumari, MD Fouad Kutuby, MD Puneet Gurmukh Lakhmani, MD Lauren Ashley Lange, MD Anne Murray Laverty, MD Benjamin Harris Lehrman, MD Ruth Arielle Lewit, MD, MPH Joan Chern-Hui Lien, MD Lauren Angela Linker, MD Daniel Lee Lodwick, MD Matthew Stephen Lyons, MD Victoria Sheree Lyons, MD Karim Mahmoud, MD Ammar Obaid Mahmood, MD Karim Mahmoud, MD Jessica Rae Matthews, MD Jessica Ashlee McCall, DO Kelly Neal Mcintyre, MD Michael J. McNeil, MD Benjamin Randal Meis, DO Ian Wetzel Michalak, MD Ashley Nicole Miller, MD Andrew Christopher Mire, MD Hunter Leigh Mitchell, MD Ethan Daniel Monhollon, MD Lamar Houston Moree, MD Mustafa Motiwala, MD Christopher Nance, DO Phuoc Thien Nguyen, MD Chiamaka Chisom Ngwudike, MD Dieudonne Simplice Nonga Makon, MD Nariman Noorbakhsh Sabet, MD Yoshitsugu Obi, MD Janie Christine Ogle, DO Oluchukwu Evaristus Oluoha, MD Vanessa Ortiz-Hernandez, MD 12

Nisha Pande, MD Thomas Andrew Parker, DO Samantha Michelle Parkhurst, MD Bindusri Paruchuri Stephanie Arana Patrick, DO Katie Sue Payne, MD Ellen Marie Petryna, MD Drew Daniel Porter, MD Amelia Kate Ramsey, MD Subash Regmi, MD Joshua Timothy Rogers, MD Maxwell O. Rollins, MD Mark Walker Rushing, MD Rishika Prakash Sakaria, MD Barrett Ethan Schwartz, MD Hilal Sekizkardes, MD Danielle Marie Severns, MD William Colby Skinner, MD Carson James Smith, MD Bradley Patrick St. John, MD Kenan Tawaklna, MD Sara B. Taylor, MD Brittain Elizabeth Thompson, MD Ginger Marie Thompson, MD Katarzyna Trebska-McGowan, MD Robert Julian Vandewalle, MD Kaushik Varadarajan, MD Julia Maria Voelkl, MD Gina Fleming Walton, MD Stephen Franklin White, Jr., MD David K. Wilbanks, MD Taqwela Marie Williams, MD Benjamin Ross Wilson, MD Clayton William Wing, MD Caroline Lacy Young, MD Jamie Lynn Zeal, MD

The Memphis Medical Society Quarterly


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 13

We know w you’ve got a choice of healthcare providers to refer your patients.. That’s why we work so hard to make the patient experience with us as ple easing as possible. We listen carefully y. We answer questions. And we simp i lify the whole process, from getting a an appointment to following up after the patient is home. We strive to do more than keep patients well, but keep patients happy, too. So let us help you keep p patients healthy.

V isi t s f m p.c om to le arn mor e or r e f er a pa tien t to day.

Fall 2019

13


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 14

Q

Spotlight

Member Spotlight MMS Board member named Associate Dean of Studen Affairs and Admissions for UTHSC As associate dean, Dr. Womack will lead the Office of Student Affairs and oversee the Office of Medical Student Admissions for the College of Medicine. She will lead the student advisory system, the academic, career, mental health referral, and personal and professional conduct of the college’s more than 680 medical students. She will also provide guidance in the student preparatory process for residency match, oversee the medical student performance evaluation for every senior student, and help ensure all students obtain a medical residency position.

UTHSC College of Medicine Executive Dean Scott Strome, MD, has named Catherine Womack, MD, associate dean of Student Affairs and Admissions for the College of Medicine. “The college is fortunate to have someone like Dr. Womack serve as associate dean of Student Affairs and Admissions,” Dr. Strome said. “Dr. Womack is truly dedicated to helping students in their career choice from the day of their first admission committee interview to Match Day. Her energy, empathy, and strategies for improvement will be of considerable benefit to our students and these future physicians. I have no doubt Dr. Womack will help our students be happier, healthier, and more successful in medical school.”

14

Dr. Womack will oversee the professional and scholarship committees, as well as student events including the Second Look Weekend, the White Coat Ceremony, the Student Clinician Ceremony, and commencement. In addition, she will direct the UTHSC MPOWER House mentoring system, which Susan Brewer, MD, helped to establish prior to her recent retirement.

The Memphis Medical Society Quarterly


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 15

Q

Spotlight

A graduate of the UTHSC College of Medicine, Dr. Womack earned her MD degree in 1995. She completed an internship and residency in Internal Medicine from the college. She is board certified by the American Board of Internal Medicine. Dr. Womack is the recipient of many honors and awards including the American College of Physicians Laureate Award, the Castle Connolly Exceptional Women in Medicine Award, and the Top Twenty Internal Medicine Teachers Award from UTHSC for multiple years.

“Dr. Susan Brewer has been my mentor, and I hope to further implement her mentorship plan for our medical students,” Dr. Womack said. “Each entering MPOWER cohort belongs to a community that will follow them from orientation to graduation, fostering academic excellence by exploring six dimensions of wellness — occupational, physical, social, intellectual, spiritual, and emotional. I enjoy serving as an MPOWER mentor, and I will be the Diggs House Leader for the coming year. We have many new faculty members, who have volunteered to be part of our MPOWER House system, and I am very excited to work with them to help the medical students as they matriculate to UTHSC and then on to residency.”

She joined UTHSC in 1998 and previously served as assistant dean of Student Affairs, interim chair of the Department of Preventive Medicine, and co-chief of the Division of Internal Medicine. “I love working with the medical students and helping them to be successful in the same way that my predecessors at UTHSC helped me,” Dr. Womack said. “I will continue to counsel them on everything from mentors for their summer research project to letters for their residency application. The medical students are dedicated and excited about becoming doctors, and I enjoy helping them choose the specialty that fits them best.” Adapted from release by Jackie Denton | July 12, 2019

Fall 2019

15


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 16

Q

Feature

Thompson voice box Le Bonheur team achieves voice box reconstruction, believed to be world’s first successful durgery of its kind Le Bonheur Children’s Hospital reports that Cooper Kilburn, a 2-year-old from Adamsville, Tennessee, is making an excellent recovery after doctor’s there successfully completed the reconstruction of an airway and voice box last month. It is believed to be the world’s first successful surgery of its kind. A team of pediatric experts, led by Le Bonheur and University of Tennessee Health Science Center otolaryngologist Jerome Thompson, MD, used a rib graft to create a voice box and establish a viable airway for Cooper. When his mother was 16 weeks pregnant with Cooper, she was in a car wreck that prompted her to visit the obstetrician for an ultrasound to check on her baby. The ultrasound revealed fluid was building in Cooper’s chest because of a rare condition – total laryngeal agenesis due to congenital high airway obstruction syndrome (CHAOS). Cooper had no airway, no larynx and therefore no voice or way to breathe outside the womb. Laryngeal agenesis occurs when larynx development is halted during pregnancy. The reasons for this condition are unknown. Larynx development begins in the fourth week of fetal growth. The windpipe starts as a solid tube and hollows out from the top and bottom to create an airway. About 50 documented cases of total laryngeal agenesis exist throughout history.

16

Most babies do not survive to term due to lack of diagnosis. Diagnosis depends on the discovery of indirect problems – like Cooper’s fluid-filled lungs. A lack of airway is rarely identified in fetal screenings. Survival depends on immediate diagnosis in utero and a rapidtracheostomy at birth to provide an airway. Le Bonheur Children’s Fetal Center, along with Dr. Thompson and his team, put together a plan for Cooper to survive the difficult delivery. As planned, Cooper was delivered next door to Le Bonheur at Regional One Health. During delivery, Dr. Thompson performed an ex utero intrapartum treatment (EXIT) procedure, a partial caesarean section that allowed Cooper to continue to receive oxygen via his mother’s placenta. While Brooke was recovering, he was transported to Le Bonheur’s Neonatal Intensive Care Unit (NICU) so he could continue treatment. Cooper stayed in Le Bonheur’s NICU for 324 days and had beaten the odds for survival. Once home, he still depended on help to breathe 24 hours a day. Any health issue would threaten his life. Two years and eight surgeries later, the Kilburn family was back at Le Bonheur. Cooper had developed well and continued to follow developmental milestones, despite never being able to make a sound. According to Dr. Thompson, “our goal was to create an anatomical airway, get him off the trach and, possibly, give him a voice.” There have been only a handful of attempts to create an anatomical airway from scratch and all have been unsuccessful. The Memphis Medical Society Quarterly


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 17

Q

Spotlight

The team at Le Bonheur included pediatric experts from ENT, neonatology, pulmonology, pediatric surgery and critical care. “We planned for this surgery from day one of Cooper’s life,” said Thompson. “Everyone from the nurses to surgery technicians to the neonatal team rose to the challenge and worked together for this surgery to be a success.” The four-hour surgery was conducted in tandem with pediatric surgeon Ying Weatherall, MD, and Dr. Thompson. Dr. Weatherall removed two of Cooper’s ribs to use to construct his new voice box. After navigating through complicated throat anatomy, Dr. Thompson and fellow otolaryngologist Jennifer McLevy, MD, began to create the new voice box. Dr. Thompson used the ribs to create the walls of a voice box. To learn more about Cooper’s journey, visit www.lebonheur.org/promise.

Cooper Kilburn

Reprinted with permission. Memphis Medical News, September 2019

Fall 2019

17


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 18

Q

Legislative

Legislative Update Court of appeal sides with TMA on unwritten rule issue

The Tennessee Court of Appeals recently sided unanimously with TMA in the matter of Norma J. Sparks, PA v. Tennessee Department of Health, Board of Medical Examiners Committee on Physician Assistants. TMA submitted an amicus curia brief in the case and the court issued its decision on Sept. 6. The case involved a licensed physician assistant who fell under fire with her licensing board, the Tennessee Committee on Physician Assistants, in February 2017. Sparks, who worked part time in a free clinic in Grundy County after retiring from an unblemished 40 years in practice, was disciplined for prescribing controlled drugs while being supervised by a physician with no DEA certificate. Sparks carried a valid DEA certificate and infrequently wrote controlled drug prescriptions at the clinic. There is no rule that a supervising physician have a DEA certificate. TMA’s concern was that a PA, physician, or any health licensee for that matter, could be disciplined by his/her licensing board based on unwritten or unclear grounds. TMA has long promoted physician-led, team-based healthcare delivery models as the safest and most effective care in Tennessee. The Sparks case has broad implications for doctors who collaborate with PAs and/or other midlevel providers. Physicians expect and deserve clear guidance in terms of prescribing and collaboration requirements, and relative liabilities, and should not be penalized for violating what TMA termed in its brief, the Court expressed in its opinion, “unwritten rules.” In its brief, TMA urged the Court to force health professional licensing boards to clearly provide notice of the standards of practice to their licensees before taking disciplinary action against them. The State has until early November to appeal. 18

MAKE A DIFFERENCE AT THE LOCAL AND STATE LEVEL This year has been a great one for MEMPAC, the Memphis Medical Society’s Political Action Committee. Through a generous corporate gift from Semmes-Murphey and contributions from individuals like you, we are able to give out more than $3,000 in contributions. Our primary expense in previous years has been paying for the annual Legislative Dinner that has almost dwindled our accounts down to zero. With our recent contributions and our decision to pay for the dinner through the Society’s operating budget, we now should have the ability to strengthen our ties to local officials and physicians running for municipal and state offices. Please make a suggested $200 contribution or more this year through the link below. Of course, any amount is greatly appreciated. Thank you for all of your support of all of the Society’s efforts, including this one. Visit http://bit.ly/2019MEMPAC to make a donation

Save the Date! Legislative Reception Buckley’s November 11 Invitation to follow

The Memphis Medical Society Quarterly


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 19

NEW!

401 (k)

Member Retirement Plan

BENEFITS Save on program fees with flat pricing and low institutional fund cost Reduce administrative burden by eliminating annual audit, shifting plan trustee duties, and having a dedicated 3(38) fiduciary Safe harbor provisions to maximize physician savings and streamline administration

Gain financial peace of mind for your future with the new TMA 401(k) plan, designed for member groups of any size.

How it Works The TMA Multiple Employer 401(k) does all the heavy

Complete flexibility in plan design and profit sharing

Opportunity to have financial planners advise on 401(k)

Contact

Kevin Rainwater

    

866.893.4103

      

krainwater@acgwealth.com

        we manage your retirement plan.

'&%$#"!"& &#&!#$#" "!&&#  '   " #'&# "%& &#&!#$&!% &!#" "! #" &!#&"!&!#$%&# "  &#!""" "$  %"!&"!#&&&! &#&" !&#&#&#& &!!" & #" "! 


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 20

give e back

& vvolunt l tteer a Church Health at H

Whe Whether th you volunte l teer once a week k or once a year, your time and tale ent matter. We need n primary and d specialty medical providerrs like you to care for th hose most in-need. V Vo oluntteer either Concourse in our Crosstown C      Co ontact Courtney Munson M to lea arn about opporttunities for al providers and practices. individua 901-70 01-2338 or mu unsonc@churchh health.org.

ChurchHealth.org/Volunteer


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 21

Q

Finance

Financial Q&A Protecting your investment portfolio

Q. My uncle recently passed away and named his only son and myself as equal beneficiaries of his traditional IRA account valued at $250,000. Can I transfer my share of the inheritance into an existing IRA or do I need to open an inherited IRA in my name? A. Only the spouse beneficiary has the option of transferring an inherited retirement account into an existing IRA. As a non-spouse beneficiary, you have several options available. The most common choice is to open an inherited IRA account in your name. The inherited IRA assets continue to grow tax deferred, but the IRS requires distributions from this account to start no later than the year after the year of death. Assuming your uncle passed away in 2019, the deadline to start distributions would be the end of 2020. You can elect to withdraw a portion of the account balance each year or a lump sum distribution. Early withdrawal penalties do not apply, but you will pay income tax on all distributions. If you choose an annual amount, there is a minimum you must take every year. This required minimum distribution (RMD) allows you to stretch out payments over your life expectancy. This is a popular method to receive payments because you avoid a large tax bill and benefit from tax-deferred growth. When dealing with multiple beneficiaries from the original IRA account, pay attention to this important deadline. A separate inherited IRA account in your name must be established no later than December 31 of the following year after death.

Under this five-year rule, no amount is required to be distributed in any year, but by the end of the fifth year all assets must be distributed. This delay might provide some time for additional tax planning especially if you expect to be in a lower tax bracket during the five-year period. An alternative option is to disclaim your share of the IRA and pass that portion to the next entitled beneficiary. This election can be useful depending on your financial or tax situation but must be made within nine months of the original owner’s death. If you decide to disclaim, pay close attention to the language in the beneficiary form because disclaimed assets normally pass directly to the other primary beneficiaries without your input. If you want a contingent or alternate beneficiary to receive assets, all primary beneficiaries would have to disclaim their portion of the IRA. I would recommend that you consult with a qualified financial advisor before you take any action. They can explain all the options above in more detail and assist you in the correct RMD calculation. Missing an RMD or incorrectly calculating the amount to be distributed can be a costly mistake due to the 50% penalty tax.

Otherwise, distributions payable to you will be based on the life expectancy of the oldest beneficiary instead of your own. This can be a huge disadvantage if you are significantly younger than the other beneficiaries.

William B. Howard, Jr., ChFC, CFP

Another option to receive your inherited funds is based on the age of the original IRA owner at their death. If the IRA owner passes away before age 70.5, the beneficiary(s) can choose to let the assets stay in the original IRA account for up to five years after death.

Telephone: (901) 761-5068 Facsimile: (901) 761-2217

Fall 2019

International Place II 6410 Poplar Ave., Suite 330 Memphis, TN 38119

E-mail:whoward@whcfa.com 21


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 22

Q

Community

Community Work

Local non-profit partners with healthcare and community leaders to close HPV Immunization Gap HPV Cancer Prevention Starts with You By Carol Minor, health systems manager American Cancer Society, Tennessee The HPV vaccine delivers on a dream many have held for decades: a cancer prevention vaccine. We can help prevent six types of cancer with the human papillomavirus (HPV) vaccine, an opportunity to put a stop to more than 31,000 new cases of cancer each year. It’s a call to action we can’t ignore. That’s why the American Cancer Society is working with healthcare providers, community leaders and volunteers across Tennessee to close the HPV immunization gap. An effective clinician recommendation – recommending the HPV vaccine in the same way and on the same day as other adolescent vaccines – is the number-one reason parents choose to vaccinate their children. Recent studies show a patient who receives a recommendation from a provider is four to five times more likely to receive the HPV vaccine. Studies have also shown that parents value the HPV vaccine equally with other adolescent vaccines.

As one of the most respected cancer organizations in the world, the American Cancer Society is uniquely positioned to lead the fight. Our national infrastructure and volunteer base will make HPV cancer prevention a priority for the nation. We are a trusted, sciencebased organization committed to reducing our country’s cancer incidence and mortality through partnerships. Our work will increase HPV vaccination rates for preteens to at least 80 percent by June 8, 2026, the 20year anniversary of the FDA’s approval of the first HPV vaccine. Now is the time for partners across Tennessee to join us in the fight. Together, we are stronger than cancer. And, if you are a provider in Tennessee who has a best practice for increasing vaccination rates, please contact me so I can help bring attention to your efforts. E-mail carol.minor@cancer.org.

The two-shot HPV vaccine series is best given to boys and girls at ages 11 or 12. HPV vaccination prevents an estimated 90 percent of HPV cancers when given at the recommended age, but cancer prevention decreases as age of vaccination increases. Proven safe and effective, the vaccine prevents infection with the most common types of HPV that can cause cervical, throat, vulvar, vaginal, penile and anal cancer Providers with questions about the vaccine or who need material to share with parents and guardians, can go to www.cancer.org/hpv.

22

The Memphis Medical Society Quarterly


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 23

LEAVE V YO OUR LEGACY CY. PRESERV VE THE LEVITT SHELL S FOR FUTURE GENERATIONS.

Become a Preservation Circle Member M today. From our dance floor bricks to Legacy e Giving, your generosity and vision w will sustain the Levitt Shell for generrations of music lovers. A financial commitm ment to the performing arts at the Levvitt Shell will help preserve one of the few bandshells left in the United Stattes. This gift supports a vibrant mission that brings thousands of Memphianss together every year.

Building community through free music and a education, finding common ground for a diverse audience.

LevittShell.org/PreservationCircle 72-2722 LauraBeth@LevittShell.org | 901-27


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 24

Hiring g in H lth Healthcare?

da Need Healthcaare Job?

We staff We offfer emp-to-hire, Director of Operations, CEO, Direct hire, Te ositions and Medical Coder, RN, CRNA Permanent po and many others Part timee jobs

Call Cailyn Lillard today! 761-0200 901-7 MedTem mps is accredited by Th he Joint Commission, and is a division of Th he Memphis Medical Society

Learn more at w www.mdmemph his.org 24

The Memphis Medical Society Quarterly


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 25

Q

Research

Current Research

UTHSC/Methodist study suggests transplantation of Hepatitis C-infected kidneys to uninfected recipients safe, should be standard of care Transplantation of kidneys from Hepatitis C-infected donors to uninfected recipients is safe and can be successfully implemented as a standard of care, according to an observational study by physicians at the University of Tennessee Health Science Center and the James D. Eason Transplant Institute at Methodist University Hospital. The practice, which has been tested in two smaller clinical trials, could expand the number of kidneys available for transplantation and reduce wait times for donors, said MMS member, Miklos Z. Molnar, MD, PhD, FEBTM, FERA, FASN, associate professor of Medicine at UTHSC, transplant nephrologist at the James D. Eason Transplant Institute, and director of the Transplant Nephrology Fellowship program at UTHSC. Dr. Molnar is the principal author of the study published by the American Journal of Transplantation. In current practice, Hepatitis C-infected kidneys are transplanted only to patients already infected with the disease, Dr. Molnar said. The number of these available kidneys greatly exceeds the population of infected recipients. As a result, up to 1,000 or more Hepatitis C-infected kidneys are discarded annually. “Our thought was using these kidneys, which are usually pretty good, other than the Hepatitis C,” he said. The Memphis team began its study in March 2018. To date, more than 80 uninfected recipients have received Hepatitis C-infected kidneys. The paper cites 53 patients, since the remainder are too soon after transplant to evaluate fully. All patients consented to the surgery, after being made aware that by receiving an infected kidney, they would be infected with Hepatitis C. All were successfully transplanted, and after receiving 12 weeks of antiviral therapy, show no signs of Hepatitis C and are considered cured. “We did not lose any patients, but there were some unexpected complications,” Dr. Molnar said. Fall 2019

High volume of BK virus, common after transplantation and generally treatable, was evidenced in a number of the recipients. While this factor will demand further research, Dr. Molnar said the study results are positive for patients in need of transplant. “These people would not get this offering (a transplant) without these kidneys,” he said. “If you’re willing to accept these kidneys, the waiting time can go down by two years.”The five-year survival rate on dialysis is 50 percent, Dr. Molnar said. “We are losing 10 percent of the patients every year on dialysis.” Dr. Molnar said the study indicates that transplantation of Hepatitis C-infected kidneys to Hepatitis Cnegative recipients has potential to become a standard of care in the United States. “Otherwise, the patients would be on dialysis and die,” he said. “These patients have good kidney graft function. The transplantation of Hep C-infected kidney to non-Hep C-infected recipients can be done and should be done.” Director of the Transplant Instituteand MMS member James Eason, MD, said, “This is a landmark paper outlining a novel approach to using kidneys, that would otherwise be discarded, to save more lives.

25


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 26

Q

Practice

Your Network Might Be Getting Narrower A new way of thinking about in-network We all know the term “narrow network”, don’t we? It’s a commonly used term describing an insurance company’s attempt to lower cost by offering a small percentage (as low as 10% in some cases, according to Consumer Reports) of providers in a given community to participants in the plan. Now, employers are upping the ante further by encouraging employees to see certain “quality” providers, who use data provided by (guess who?) the payers. According to Walmart’s corporate site and several other sites such as healthcaredive.com, Walmart will now offer a program connects employees with high-quality local doctors across a range of specialties, the company said. Patients will have to pay more if they choose to see a provider not on the recommended list. They’re using data from a company (directed by a doctor and ex-Walmart employee) that mines data provided by a subsidiary of BlueCross BlueShield. I see a silver lining, though. The article points out that Walmart wants to connect its employees to “local” doctors. If doctors can get ahead of employers paying other companies to tell them who quality providers are, we could direct them to great “local” doctors, right? We have to start working more directly with employers. Onsite clinics, preferred providers, narrow networks, the list goes on. Employers are motivated to lower their costs and provide value to their employees. We can sit back and let employers drive the conversation, or we can be there with them, and let them look their “local” and “quality” doctor in the eye and figure out ways to deliver better healthcare in our community. If you have ideas on how to address this challenge, email me at ccummins@mdmemphis.org.

Thank you for allowing me to represent you! Clint Cummins, CEO, Memphis Medical Society

26

The Memphis Medical Society Quarterly


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 27

Q

Training

In Training Members’ in training find time to get involved outside of a classroom and clinic Live music, food, a Memphis hot spot and networking came together when MMS hosted residents, students and active physicians at a private deck at Levitt Shell. Thanks to sponsor First Tennessee Medical Private Banking, the private deck and catered food provided full bellies and a confortable lookout for guests. Look for more upcoming networking events as MMS strives to create a strong and supportive membership.

TMA held an inaugural TMA Medical Student Leadership Summit in Nashville. Medical student leaders from all across the state met and discussed possible solutions to issues like medical student and physician burnout, e-cigarette use and substance abuse, and GME funding. Students getting involved in organized medicine is wonderful see, and we are especially proud of our MMS medical students pictured .

Fall 2019

27


MMS Fall 2019_Layout 1 10/9/2019 3:34 PM Page 28

Q The mission of the Memphis Medical Society is to unite the physicians of Memphis and Shelby County into an organization to promote the highest quality of medical practice and the health of our citizens.

The Memphis Medical Society 1067 Cresthaven Road Memphis, TN 38119 901-761-0200 Fax: 901-374-9574 CEO/Executive Vice President Clint Cummins Executive Assistant Janice Cooper

Bulletin

Society updates and events Fall Events November 5

Board Meeting

November 6

Money and Medicine Series: Estate Planning

November 11

Legislative Reception, Buckley’s

November 14

Women in Medicine: Old Dominick Distillery

November 28-29

MMS Office Closed

December 3

Board Meeting

December 23-January 1

MMS Office Closed

WE WANT TO HEAR FROM YOU! If you have ideas or suggestions for The Quarterly, please email info@mdmemphis.org. We are always looking for updates, achievements and stories of our members. Volume 22, Number 3

Fall 2018

Volume 21, Number 2

IN SERVICE TO OTHERS

Marion Boyd Gillespie, M.D., MSc, FACS

State Air Surgeon, Cassandra Howard, M.D.

Marketing and Membership Coordinator Cara Azhar Director, Healthcare Staffing Cailyn Bautista Lillard Finance Director Leah Lumm MedTemps Administrative Coordinator Katie Yaun

28

Summer 2018

Member Spotlight:

Members Serving Our Country Through Medicine

Director, Communications & Marketing Allison Cook

Bulletin

Feature: A House of Doctors

In Memoriam 2019 Emmitt S. Birdsong, Jr, M.D. — November 14, 1930- August 16 Fred T. Grogan, M.D. —March 2, 1930- June 13 David Meyer, M.D. —February 2, 1938- August 17 Harvey B. Niell, M.D.— August 25, 1943- June 19 James T. Robertson, M.D.—April 5, 1931- June 30 James Simmons, M.D. — November 17, 1926- September 7 O’Brian C. Smith, M.D.— October 11, 1952 - July 9 Herbert A. Taylor, III, M.D.— September 6, 1936- September 5 Joe L. Wilhite, M.D.— November 22, 1929- August 22 The Memphis Medical Society Quarterly


MMS Fall 2019 covers_Layout 1 10/9/2019 2:26 PM Page 3

GIVE YOUR FINANCES THE SAME CARE AS YOU DO YOUR PATIENTS.

In today’s uncertain markets, having a bank that tends to your financial health is vital. First Tennessee Medical Private Banking can help with today’s needs and tomorrow’s goals. Our Relationship Managers offer guidance and solutions tailored to medical professionals. So you can focus on your priority: your patients. To make an appointment with a Relationship Manager, please contact: Margaret Yancey Senior Vice President Medical Private Banking ph: 901-681-2526 email: myancey@ftb.com

Jeff McIlvain Vice President Medical Private Banking ph: 901-681-2555 email: jmcilvain@ftb.com

©2019 First Tennessee Bank National Association operating as First Tennessee Bank and Capital Bank. Member FDIC.


MMS Fall 2019 covers_Layout 1 10/9/2019 2:26 PM Page 4

1067 Cresthaven Road Memphis, TN 38119

K i d n ey Tr a n spl a n t Re c i p i e n t

K i d n ey Tr a n spl a n t Re c i p i e n t

Love s Tu to r i n g M a th

Love s T ime O u tdo or s R d es Ri B i c ycl e Fo r Fu n Fa a c to r s B i n om i a ls Fo r Fu n

What the ey have in com mmon is uncomm mon care. No matter who you y are, at Methodist Le Bo onheur Healthcare, we’ll mee et your unique health needs with expert care for your one-of-a-kind life.. Come experience healthca are that’s tailored to you. See our differenc ce, visit methodisthealth.org g/uncommon

Profile for mdmemphis

MMS Fall Quarterly Magazine  

MMS Fall Quarterly Magazine  

Profile for mdmemphis
Advertisement

Recommendations could not be loaded

Recommendations could not be loaded

Recommendations could not be loaded

Recommendations could not be loaded