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Doctors MetroDoctors THE JOURNAL OF THE HENNEPIN AND RAMSEY MEDICAL SOCIETIES

Physician Co-editor Y. Ralph Chu, M.D. Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Charles G. Terzian, M.D. Managing Editor Nancy K. Bauer Assistant Editor Doreen M. Hines HMS CEO Jack G. Davis RMS CEO Roger K. Johnson Production Manager Sheila A. Hatcher Advertising Representative Betsy Pierre Cover Design by Outside Line Studio MetroDoctors (ISSN 1526-4262) is published bimonthly by the Hennepin and Ramsey Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodical postage paid at Minneapolis, Minnesota. Postmaster: Send address changes to MetroDoctors, Hennepin and Ramsey Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. To promote their objectives and services, the Hennepin and Ramsey Medical Societies print information in MetroDoctors regarding activities and interests of the societies. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily reflect the official position of HMS or RMS. Send letters and other materials for consideration to MetroDoctors, Hennepin and Ramsey Medical Societies, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: bauerfamily@earthlink.net. For advertising rates and space reservations, contact: Erica Nelson 2318 Eastwood Circle Monticello, MN 55362 phone: (952) 903-0505, ext. 3 fax: (763) 497-8810 e-mail: erica@pierreproductions.com. MetroDoctors reserves the right to reject any article or advertising copy not in accordance with editorial policy. Non-members may subscribe to MetroDoctors at a cost of $15 per year or $3 per issue, if extra copies are available. For subscription information, contact Doreen Hines at (612) 362-3705.

CONTENTS VOLUME 8, NO. 5

2

SEPTEMBER/OCTOBER 2006

FEATURE

Medicare 646: Quality Demonstration in the Upper Midwest

7 10

Why Should Health Care Organizations Apply Lean Thinking Principles? COLLEAGUE INTERVIEW

Nick Meyer, M.D.

13

Courage Center: A Leader in Rehabilitation, Policy and Reform

14

Classified Ad/Volunteer Opportunity

16

Ten Days in Haiti

20

Minnesota Immunization Information Connection

21

HMS and RMS Resolutions Being Submitted to MMA House of Delegates

24

Members in the News Index to Advertisers RAMSEY MEDICAL SOCIETY

25 26

President’s Message

27

RCMS, Inc. Becomes Minnesota Physician Services, Inc./ RMS Staff to Expand/New Board Member/Second Hand Smoke Speakers

28

In Memoriam/New Members/Senior Physicians

Introducing New Employees for Dakota County Smoke Free Partnership/ Doreen Hines Recognized for 25 Years of Service

HENNEPIN MEDICAL SOCIETY

29 30 31 32

Chair’s Report HMS In Action/Sue Schettle Departs HMS New Members/In Memoriam/Senior Physicians Association HMS Alliance On the cover: Haiti is rich in history, culture and opportunities to volunteer. Article begins on page 16. Photo by James A. Rhode, M.D.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

September/October 2006

1


FEATURE STORY

Quality Demonstration

Medicare 646 In the Upper Midwest

This demonstration proposal will...showcase exciting quality improvement, care coordination, and data exchange initiatives that are underway across the region.

T

THE MEDICARE MODERNIZATION ACT (MMA) of 2003 promised major health care changes through highly visible programs such as prescription drug coverage and Health Savings Accounts. However, the most dramatic changes may come from the MMA’s Health Care Quality Demonstration Program (The Section 646 Demonstration). Unlike CMS’s traditional approach to demonstration RFPs that dictate desired form and function, this demonstration will allow for creative, innovative models that fundamentally change the way providers are rewarded for doing the right thing for Medicare beneficiaries. A coalition of providers in seven Upper Midwest states is working to develop a unique response to this demonstration. It is well known that the states in the MMA Region 25 (Medicare Advantage) and Region 19 (PDP), plus Wisconsin, produce the highest quality, lowest cost care in the nation. This demonstration proposal will be designed to leverage that record and showcase exciting quality improvement, care coordination, and data exchange initiatives that are underway across the region. “This is regionalization at its best,” says Dave Durenberger, former U.S. Senator from Minnesota and chair of the National Institute of Health Policy, “…and a model that holds promise for the modernization of Medicare.” At a March working group meeting of the Coalition, members received affirmation from CMS leaders and national experts encouraging the Coalition to submit a one-of-a-kind proposal and offering to help us along the way. Barry Straub, Chief Medical Officer for CMS had this to say:

“You have the experience and intelligent people to pull this off. With that baseline — and your combination of integrated health systems, health plans, academic centers, medical groups and your demonstrated ability to collaborate — yours is a perfect testing ground. We want to be very, very encouraging to you to come with a completed application by the deadline…This is the most exciting concept I have seen in my years at CMS.” Framework for the Demonstration The Upper Midwest Demonstration Project: “Providing Health Care of Value in the Upper Midwest” will build on the concept of a “medical home” for Medicare patients and will validate the tools that providers and facilities along the entire continuum of care need to ensure that all beneficiaries are receiving the most effective, appropriate care available. Academic health centers, large integrated delivery systems, and both rural and urban small physician groups have agreed to join the effort and see huge benefits in sharing best practices and creating a region-wide vehicle for exchanging clinical information.

B Y J E A N N E R I P L E Y, M B A

2

September/October 2006

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Coalition members will use their collective influence to re-shape Medicare payment policies in a way that will reward them for delivering quality care and empower providers to take the time and effort to appropriately care for seniors. The Coalition does not intend to create new initiatives, but will disseminate current practices and will create a national showcase for existing quality improvement activities in the Upper Midwest. Through the power of collective advocacy, the group will advocate for Medicare payment policies and regulations that support Upper Midwest models of practice and quality improvement. The potential for significant health system redesign and Medicare policy change grows exponentially as the Coalition grows. The regional scope of this demo is its hallmark, taking advantage of the regional infrastructure created by the MMA 2003 legislation. “If you consider better health care for beneficiaries the Holy Grail, and the sustainability of the Trust Fund an imperative, you cannot ignore this coalition,” says Durenberger. “We want to go from good to great and the providers who have joined this effort know how to do it. All they need to succeed is permission from CMS to do it their way — a way that has already shown great results and provides value to beneficiaries and Medicare —and get rewarded for it.” Goals The goals of the Coalition’s proposal include: • More effective quality improvement efforts through widespread dissemination of tools and data, and more equitable Medicare payment for high quality efficient care throughout the Upper Midwest. • A national showcase for the “Best of the Upper Midwest.” Quality-based health care at the lowest cost to Medicare. Given this track record, the innovative methods and care delivery models that are the heart of our success should inform all discussions and decisions about the future Medicare program nationwide. • Influence Medicare policies by demonstrating to CMS how the Upper Midwest models for value-based health care can, and should, be replicated nationwide and become the foundation for future Medicare policies.

...this demonstration will allow for creative, innovative models that fundamentally change the way providers are rewarded for doing the right thing for Medicare beneficiaries.

Designing the Demonstration Proposal Coalition workgroups will focus on the following areas: 1. Clinical approaches to optimal care delivery and methods for significant provider engagement across the entire region.

(Continued on page 4)

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The Journal of the Hennepin and Ramsey Medical Societies

September/October 2006

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Medicare 646 (Continued from page 3)

2. Financial models that support and reward providers for their efforts toward the established clinical goals. This group is also tasked with developing a research design and comparison population. 3. Technology and information exchange systems that will support the demonstration and provide useful and appropriate real-time information to providers and beneficiaries. 4. Organizational structure and Governance for the Coalition that will be appropriately sized and staffed to support the work of the demonstration without being overly cumbersome or costly. Membership in the Coalition The Coalition currently includes the following members: • Allina Hospital & Clinics, Minneapolis, MN • Avera Health, Sioux Falls, SD • Billings Clinic, Billings, MT • Fairview Health Services, Minneapolis, MN • HealthEast, St. Paul, MN • MeritCare Health System, Fargo, ND • St. Mary’s Duluth Clinic Health System, Duluth, MN • The University of Wisconsin Medical Foundation, Madison, WI

Membership requires two commitments: 1. A personal commitment from organizational leaders to actively participate in thoughtful ways and to assign financial and staff resources as needed to the Coalition’s efforts. 2. An organizational commitment to participate at one of the following levels: Cornerstone Member ($25,000): — are voting members and can identify one individual as an organizational representative on the Executive Committee 4

September/October 2006

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which oversees the overall policy and high-level design of the demonstration, budget decisions and sets the agenda for Coalition member meetings. Cornerstone members also participate in the Steering Committee, which will oversee the day-to-day development of the demonstration through the working groups. Cornerstone members can appoint representatives to serve on the three working groups (Clinical, Data/IT and Finance). Premier Member: all are voting members and can participate in the Steering Committee, which oversees the day-today development of the demonstration through the working groups. Premier members can appoint representatives to serve on the three working groups (Clinical, Data/IT and Finance). Large Health System ($15,000) Medium Sized Provider Groups ($7,500) Small Physician Practices ($2,500) *Note: these fees may be modified based on other in-kind contributions. In addition, there are non-voting members who support the efforts of the Coalition in a variety of ways. They receive special briefings on the efforts of the Coalition and are identified in public documents as Contributors. As requested, Contributors may serve on working groups of the Coalition or assist in the advocacy efforts of the group. Organizations that may become vendors of the Coalition or of the voting members of the Coalition are not eligible for membership. Significant Contributor ($10,000) Supporting Contributor ($7,500) Associate Contributor ($3,000) In total, there are different levels of membership for provider organizations. All voting member organizations must include employment of, or close collaboration with,

The Journal of the Hennepin and Ramsey Medical Societies


physicians. Each voting member organization will have one vote. The financial contributions noted above will support project management services, workgroup facilitation, external subject expertise as needed, data purchase and management, legal expertise as needed, and, ultimately, preparation and submission of the full RFP response. The contributions of staff time will support the development of the design of the demonstration. The Coalition has engaged Halleland Health Consulting to serve as the facilitators and Project Managers during the development and submission of the RFP response. The consultants at Halleland have significant experience in this area having worked with multiple CMS demonstration efforts, developing RFP responses, facilitating large, multi-stakeholder efforts and successfully meeting time and budget constraints. Community Briefing There will be an opportunity to learn more about the overall plan for the demonstration at a community briefing that will be held in Minneapolis on August 31. Letters of support for the proposed demonstration will be accepted for inclusion in the submission until September 22.

Jeanne Ripley, MBA, is vice president of Halleland Health Consulting and has experience with multiple CMS demonstration efforts, developing RFP responses, and facilitating large, multi-stakeholder efforts. For further information, please contact Jeanne Ripley at (612) 204-4178 or by e-mail at jripley@halleland.com. Dave Durenberger at ddurenberger@stthomas.edu or (651) 962-4137 is available to share his policy perspective on this effort as well.

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Why Should Health Care Organizations Apply Lean Thinking Principles?

Achieving our goals Many health care organizations have mission statements that define their “expectations of health care.” Typically, these statements mention the importance of satisfying patient needs with high-quality and safe care at reasonable costs. Health care organizations, then, understand that patients value these things. So why don’t they offer these things? Perhaps we’re taking the wrong approach. To improve quality, increase safety, and reduce costs, we must strive to: a) define a performance BY JANICE AHLSTROM, RN,BSN,CPHIMS AND MICHAEL T. PYNCH, CMA,CPA

MetroDoctors

management approach; b) develop strategies for performance improvement; c) foster a culture of continuous improvement; and d) include people, processes, and technology, as illustrated in the diagram below.

People

µ

we think about the prospect of our own or a loved one’s hospitalization — and understandably so. Our health care system provides the recommended care just 55 percent of the time, resulting in an estimated 98,000 deaths per year from medical errors. These statistics, coupled with a variety of other problems — including access-to-care difficulties, long wait times, lack of care coordination among providers, missing information, and staff shortages — make the process of seeking and receiving health care downright maddening. If health care organizations are to improve, those of us who work in the field must collaborate to improve care and reduce costs. “The challenge,” says Donald M. Berwich, M.D., the president and CEO of the Institute of Healthcare Improvement, “is to revolutionize our expectations of health care: to design a continuous flow of work for clinicians and a seamless experience of care for patients.” The question is, how do we do that?

Continuous Improvement Process

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Define Define Identify Execute Measure Strategy µ Performance µ Improvement µ Improvement µ and Monitor Metrics Opportunities Projects

Technology

Available tools As health care organizations strive to reach their goals, thereby satisfying an increasingly informed consumer, they will likely compare a number of quality improvement tools, including Total Quality Management (TQM), Six Sigma, Lean Thinking, Balanced Scorecard, and ISO 9000, to name just a few. Which of these tools a health care provider uses is not important; all will work if applied properly. But in this article we will focus on one tool in particular: Lean Thinking. What is Lean Thinking? Many aspects of Lean Thinking have been around for centuries. The Venetians understood flow production, and by 1400 could build an entire ship in a single day. The French Army understood the need for interchangeable parts by 1789. More recently, Toyota benefited from even more aspects of Lean Thinking. After World War II, Japanese manufacturers were at a considerable disadvantage to the rest of the

The Journal of the Hennepin and Ramsey Medical Societies

world. If Toyota wanted to compete, it needed to work smartly. With that goal in mind, the company developed a culture of empowerment. Employees followed a continuous improvement philosophy, and worked tirelessly to drive inefficiencies out of processes. The result included minimized manufacturing time, fewer defects, and reduced costs. This improved the company’s financial performance and satisfied its customers. Today, the ideas Toyota implemented are used by companies around the world under the moniker Lean Thinking — a set of management principles, tools, and best practices designed to identify and eliminate waste in all processes. It is important to note that Lean Thinking is neither a head-count-reduction strategy nor a cost-cutting strategy; instead, it is a tool designed to help an organization achieve operational excellence. To be Lean is to provide what is needed, when it is needed, with the minimum amount of materials, equipment, labor and space. The five principles of Lean Thinking There are five principles of Lean Thinking: 1. Define value from the patient perspective. Health care consumers have different values. A 50-year-old female with breast cancer may value seeing the most experienced oncologist. An elderly man on a fixed income may value reasonable costs. A busy mother may value an office visit with little waiting time. It is critical for health care organizations to understand their patients’ values and act on them. Virginia Mason Medical Center in Seattle, Washington, did. When the organization determined that cancer patients, who were burdened with (Continued on page 8)

September/October 2006

7


Lean Thinking Principles (Continued from page 7)

fatigue, valued simplicity, it stopped forcing them to navigate lengthy distances within the facility; instead, it brought services to the patients. Without understanding its patients’ values, Virginia Mason Medical Center could not have known what impact those improvements would have — nor can you. 2. Identify the entire value stream for each service or product. A patient’s value stream includes all of the actions, both value-added and non-value-added, required to bring the patient from admission through discharge and even follow-up. The outpatient surgery value stream, for example, consists of the components depicted in boxes in the diagram below. Each component may have many sub-processes, each of which may have many activities and tasks. As complex as this seems, if you identify the value stream in this way, you can understand the role each department plays and the impact each department has on the others. Documenting a value stream, then, creates an understanding, shared across the organization, of what is necessary to improve the organization’s services.

Follow Up Care

Discharge

Education

PAR

Procedure

Admission

Nursing Care

Scheduling

MD Orders

Value Stream: Outpatient Surgery

1) Overproduction. Examples: Lab reports printed when not needed or medications given early to suit the staff schedule.

7) Defects and errors. Examples: Filing documents in the wrong chart, medication errors, or illegible handwriting.

5. Pursue perfection through high-performance teams. Perfection means that everyone is continuously striving to improve. The key words here are “continuously” and “everyone.” Settling on past successes is not acceptable. And, it must also be understood that quality is everyone’s job. (At Walt Disney, for example, an executive was once asked how many individuals worked in janitorial services to keep the grounds so immaculate; the executive responded that everyone working at Disney was expected to pick up litter.) Indeed, implementing a continuous improvement process and motivating the entire workforce to pursue perfection is at the heart of Lean Thinking. Moreover, the employees who will have the most significant impact are not the organization’s leaders, but its staff—so they must understand what process improvement is, how it benefits the organization and its customers, and what’s in it for them. Lean Thinking must be embedded in the entire organization, from the recruitment process, through employee orientation, and even during performance reviews.

4. Let the patient pull the service or product. An organization must deliver products as soon as the customer wants them — not before and not after. Within health care organizations, this means providing access to specialty services within the appropriate time frame: Referring patients too soon could have a negative financial impact, while referring them too late could result in decreased patient satisfaction (and patients could go elsewhere). It also means having the appropriate amount of staff assigned to each shift: Having too many employees assigned to a shift could have a negative financial impact, while having too few could lead to

Who uses Lean Thinking? Many manufacturing organizations use Lean Thinking to improve business processes and shop floor operations, but the approach’s problem-solving strategies are now embraced by organizations across a wide spectrum of industries. In fact, Lean Thinking can produce significant results in virtually any setting, including the health care industry. There are many barriers to implementation in health care, however. In many cases, minimal staffing and limited training prevent smaller facilities from embracing Lean Thinking. But as more information

2) Unnecessary processing. Examples: Writing orders manually, then providing them to someone for data entry. Redundant capture of information upon admission. 3) Transportation. Examples: Standard procedures requiring that patients be moved within the facility. 4) Waiting. Examples: Patient lines at registration or staff waiting for bed assignments. 5) Excess inventory or work. Examples: Ordering more supplies because no one can find the mobile supply cart or outdated pharmacy supplies in the medication refrigerator. 6) Excess effort or motion. Examples: Walking to get equipment, medication, supplies, or access to information systems.

Figure 1

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Total = 94 min

«

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3. Make value-creating activities flow by eliminating waste. One Japanese word that has found its way into the American lexicon is muda, which means “waste.” Waste is everything in the value stream that does not add value in and of itself, i.e., that doesn’t help meet patient requirements, or that patients would not pay us to do. As an example, look at Figure 1, which shows the components of a visit to the emergency room. The lighter areas represent value-added activities. The darker areas represent a particular type of waste — waiting time. But there are other types of waste, and they can be grouped into the following categories.

8

patient safety concerns (and again, patients could go elsewhere).

There are seven types of waste:

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7

2

48 min

68 min

Waiting for diagnostic results

Waiting for attending MD callback

1 3 min

7 16 min

Total=196 min

The Journal of the Hennepin and Ramsey Medical Societies


about Lean Thinking becomes available, more resources will undoubtedly be earmarked for the approach. Indeed, over the past five years as quality, safety, and cost concerns have required health care organizations to do more with less, Lean Thinking has been used more and more within the health care industry. It is worth noting that in many cases, health care organizations are looking outside their industry for Lean Thinking consultants. That’s because in order to achieve breakthrough results, health care organizations need to leverage examples from other industries that have experienced similar problems. What can Lean Thinking do for you? Lean thinking can do nothing if it is not: a) embraced by the organization; and b) used to motivate individuals to achieve higher levels of performance via behavioral changes. But if you do apply it properly, Lean Thinking can have significant results. Consider the example of one health system in the Midwest. The health system struggled to determine where to begin process improvement. Ultimately, it gave employees the task of identifying waste, developing creative solutions to reduce the waste, and ensuring that what they did was best for the patient. Moreover, it promised its employees that there would be no widespread layoffs, and staff would only be reduced through normal attrition and turnover. Today, the health system attributes the millions of dollars it has saved by implementing a continuous improvement program to a Lean Thinking approach. Striving to be Lean Many organizations claim that they don’t have the resources to implement Lean Thinking; they are only making excuses. Other organizations claim that they have already done everything they can to improve processes; they are kidding themselves. Using the Lean Thinking approach as part of a continuous improvement process is not an event. Continuous improvement is an organizational philosophy which must be deeply embedded in the culture of your organization and used continuously. The continuous improvement journey is yours to begin; now it’s up to you to take the first step.

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Janice S. Ahlstrom is a director in Wipfli’s health care practice. She has 25 years of experience in the health care field, where she has helped a variety of organizations define business practices and technology strategies, enact operational performance improvements, and leverage lean principles for process improvement. In particular, Ahlstrom strives to help organizations in both the inpatient acute care and ambulatory medical practice environments use of electronic order communication systems, results reporting systems, and electronic medical records (EMRs) to improve performance. If you would like information about developing a continuous improvement approach within your organization, please contact Ms. Ahlstrom at (414) 431-9352 or jahlstrom@wipfli.com.

companies to assist them in achieving their performance objectives through strategic planning, process improvement, and performance management. If you would like information on developing a continuous improvement approach within your organization, please contact Mr. Pynch at (715) 858-6630 or mpynch@wipfli.com.

Michael T. Pynch is a director in Wipfli’s consulting practice. He works with a wide range of

This article is reprinted with permission from Wipfli.

Wipfli assists health care organizations with strategic planning, performance management, technology, organizational transformation, and financial solutions. Wipfli strives to help you and your organization continuously improve and cultivate performance improvement skills in your employees. Please visit Wipfli online at www.wipfli.com.

Ten Clues That You May Benefit From Lean Thinking • • • • • • • • • •

Patients have communicated that they are unhappy with wait times. Patients have a difficult time navigating your facility. You’re planning to build or renovate a facility. Equipment and supplies are never where they’re supposed to be. There are always scheduling issues. Physicians believe that they could work more efficiently with better support. Copying, filing, and processing paperwork is a full-time job. There are always too many or too few nurses available. There is significant turnover. The organization is not doing well financially.

Five Considerations When Implementing Lean Thinking 1) Those who fear change will be skeptical. It is important for the organization’s leadership to explain the objectives, the phases of change, and the expected results. 2 ) Facilities that receive cost-based reimbursement may find that costs diminish through the application of Lean Thinking — but this may result in a decrease in reimbursement amounts in some areas of the organization. 3) Improving processes may require minimizing handoffs. Consider this carefully. In some cases, handoffs are necessary to gain oversight and segregate duties, which will ensure proper internal controls. 4) When selecting a consulting firm, make sure you’re comfortable with the consultants as individuals as well as their approach. The approach should include training your staff in Lean Thinking principles, and providing the staff with tools that will help them improve independently in the future. 5) Every member of your leadership team must embrace the philosophy of Lean Thinking. If the leaders of the organization do not believe in the approach, it will be impossible for them to motivate others.

The Journal of the Hennepin and Ramsey Medical Societies

September/October 2006

9


COLLEAGUE INTERVIEW

Nick Meyer, M.D.

Born and raised in White Bear Lake, Nick Meyer attended the U.S. Military Academy at West Point upon graduating from high school. After two years, he transferred out in pursuit of a non-military medical career. He subsequently graduated from the University of Minnesota for his undergraduate and medical school degrees. He then completed an orthopaedic residency at the Medical College of Wisconsin, and a hand surgery fellowship at the University of Minnesota. Dr. Meyer has been practicing with St. Croix Orthopaedics for two and a half years. He lives in Stillwater with his wife (Karen) and two daughters (Ellie and Sonia).

Q A

providing services and donations to assist in our efforts. Now, two years later, we are trying to make a difference by helping military families in this time of need.

What is the Military Family Support League (MFSL)? The MFSL’s mission is to assist families of military personnel through logistical, technical, financial, emotional, and moral support, or any means necessary, through the creation and organization of a network of individuals interested in the well being of our servicemen and women as well as their invaluable families. The MFSL is made up of a core of 10 individuals who have volunteered their time to spearhead this effort and assist in the organization and networking of individuals interested in helping this cause.

How did you become involved in the MFSL? The Military Family Support League (MFSL) was founded in 2004 by a chance encounter of a retired Colonel and West Point graduate, a West Point attendee (myself), and a retired Army reservist/doctor. The retired Colonel, Curt Newcomb, unfortunately had an encounter with a pocketknife, which led to a laceration of his hand and subsequently an infection. He was referred to me, Nick Meyer (the West Point attendee, who left after two years at West Point to pursue a medical career), to treat his hand infection. The anesthesiologist involved in his care, Dr. Peter Boosalis (the retired reservist/doctor), came into the picture during his surgical treatment. During this series of encounters, we began talking and determined that a need existed for families of military personnel. This need consisted of monetary, logistical, and moral support for many facets of their lives, now that loved ones and often “heads of households” were deployed for long periods of time. This core group has expanded to an extremely involved and dedicated nucleus consisting of approximately 10 primary members organizing events and providing services to those in need, along with a network of interested businesses and individuals 10

September/October 2006

Were you involved in such activities prior to this meeting with the patient that prompted this group? I was not involved in any similar activities prior to this chance encounter. I, like most Americans, have often wanted to assist our country and the military personnel in some way, but never knew how. Unlike other war times, Americans are not being asked to ration, work, or otherwise sacrifice for the current military effort overseas. In this regard, many ordinary citizens want to help, but don’t know how. While attempting to minimize the use of oil products, conserve energy, and donate blood are all worthy means of supporting our country and the military indirectly, we felt that a more direct role in assisting our military would be appropriate. For those deployed overseas or in other parts of the country away from their families, the last thing they want or need to worry about is their family. Thus our involvement: We want to assure those soldiers that their families back home are being cared for appropriately while they are not available.

What attracted you to medicine versus West Point? While I received an incredible education and experience at West Point, I had a yearning for a career as a doctor. My sister, a pediatrician, was completing medical school at the time and further solidified my desire to attend medical school. Unfortunately, I was forced to make a huge decision at the age of 20: Complete my West Point education and attend medical school through the military, or transfer out of West Point and pursue medical school outside of the military. Unfortunately, with a service commitment from West Point of five years, and a two for one commitment for medical school (eight additional years of service) to be MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies


started after completion of residency, I would have been at least 45 years old before my military commitment would have been fulfilled. I wasn’t ready to commit to a relative career as a military doctor at that time. Thus, I had an incredible two-year experience at West Point, which has been invaluable.

on active duty. They came away with the knowledge that the community cares. MFSL also connects military families in need of such help as snow removal, lawn care, child care, home maintenance or banking services, with those who can provide that help free or at a reduced cost.

How do you and Dr. Boosalis find the time in your busy practice to devote enough time to this activity?

Do you know of any similar programs throughout the metro area or is this just in the Stillwater area? Are there any similar groups in other parts of the country?

Unfortunately, sometimes we don’t find enough time to devote to this organization. Fortunately, we have found some incredible individuals in the form of Curt and Sheila Newcomb, Julie Kink, and others who have been the backbone of this organization. As far as finding time to devote to this activity, it is simple: There are limited hours in the day, and priorities to be made. This is an incredibly worthwhile and deserving cause that is well worth my time. I only wish I had more time and energy to devote to the MFSL.

Who is eligible for support from MFSL? Candidates for support are any family with a member deployed for service, killed in duty, or simply in need of support. As a small organization, we are trying to primarily help members in the St. Croix River Valley, but are attempting to help any military family members in need. All support is provided on a case-by-case basis and is reviewed promptly by the members of the MFSL.

What are some of the things you do for families? Thus far, our involvement has been in two primary arenas: Helping individuals/families in need, and organizing group events to show our appreciation and support. Our individual actions have included helping with dog walking, providing school supplies, distributing phone cards, buying airfare to visit family, and bending the ears of those in the military chain of command to assure that the soldiers can travel safely (and inexpensively) back from leave. Our group activities have included a paddleboat ride down the St. Croix River, a spring get-together at the Stillwater Armory for family and children, hosting a reception at the Stillwater Veterans Memorial on Memorial Day, as well as a “Mid-Winter Blast” in Stillwater. The group events could not be made possible without the overwhelming support of local businesses and individuals, including the Water Street Inn, St. Croix Boat and Packet Company, and the local medical community. The core group has expanded to an extremely involved and dedicated team, along with a network of interested businesses and individuals providing services and donations to assist in the efforts. They share the responsibility of planning events and fielding inquiries from families in need, while raising donations to assist in the effort. This past January, thanks in large part to the local medical community, the St. Croix Valley Military Family Support League hosted a “Mid-Winter Blast” for military families. Here kids took a crack at a piñata, jumped around in an inflatable bouncer, or danced with the DJ, while their parents got massages, sampled hors d’oeuvres and sandwiches, and enjoyed the company of others who share the same situation: families with loved ones deployed MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

While we are not a part of any other groups, there are many similar grassroots organizations that have popped up throughout the country with similar goals in mind. Fortunately, by remaining small and focused in our geographic area, we are better able to serve the needs of the individuals in need. However, our smaller size has made it more difficult to get the word out, both for those interested in helping our cause as well as those in need of our services.

Are there any other retired or still active military physicians in the area doing any other activities similar or complementary to the MFSL activities? We are not aware of any other similar organizations in the area; although I am certain that many retired or still active military physicians are contributing in their own way. The military (each branch being different) usually has a “Family Readiness” group that helps families in the transition during deployment or other potentially unsettling events. Our organization works separate from this group and hopes to fill the gaps that may not be filled by these military “Family Readiness” groups.

How can other physicians and businesses help MFSL? Do you have any suggestions for other physicians who want to get involved but are not in the Stillwater area? What is the time commitment and the amount of money commitment to a physician who wants to get involved or to those who want to help out with the cause? Are contributions from individuals tax deductible? Individual or business involvement in the MFSL can vary tremendously. The easiest means of assistance is obviously monetary, and all donations are tax deductible (our paperwork as a tax-exempt charity is currently in process). Other individuals have made themselves available to assist in whatever they do best (or at least with mediocrity) ranging from handyman work to babysitting to plumbing or tax help. Businesses have helped and can help by providing services at a reduced rate (or free), supplying gift cards or certificates for prizes during our events, providing facilities for events, or monetary support. Essentially, each individual or business can choose how to help. No minimum requirement exists. For physicians or other individuals interested in becoming involved, it may only require an hour or two per month of time commitment. As well, donations from $50 to $1,000 are not uncommon, and thus we welcome any monetary assistance (but, again, there is no minimum or (Continued on page 12)

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Colleague Interview (Continued from page 11)

requirement). Monetary contributions should be tax deductible, but as always you should check with your tax consultant. As is often said, imitation is the sincerest form of flattery. We would find great pleasure in other groups springing up throughout the metro area and across the Midwest to similarly support our military and their families. Thus, for those physicians not in the St. Croix River Valley but desiring to help in some similar way, I would recommend talking to others in your community and organizing a mirror group. All it takes is a desire to help, and a willingness to contribute. In the past four years, more and more wives, husbands, children, and other loved ones have found themselves alone, often confronted with challenges that they may not be prepared to face. Many Americans feel unsure how to contribute to the military and their families in need. Whether or not you agree with the military involvement overseas, whether you consider yourself a Democrat or Republican, and whether you know someone in the military or not, the reality in 2006 and many years to come is simple: Our military is stretched thin leaving many families in need without their head of household available. If you or someone you know may be able to assist in any way, no matter how large or small, the MFSL is waiting to hear from you. The goal is to provide assistance to military families in need, often at a lower cost and potentially on shorter notice. The MFSL is currently developing

a database of individuals, organizations, and businesses interested in helping these families. Please contact the MFSL at 1-866-949-8721 extension 123 to discuss your potential contributions to military families in need. It could be a service to provide, a monetary donation, help with events, purchase of phone cards, plane fare and many other possibilities.

What type of support is needed after the person serving in the military returns home from Iraq? The first need is, of course, when the soldier leaves for Iraq or elsewhere. When the “head of household” leaves, this creates a void as now wives or fathers become single parents at home. When a soldier returns from deployment, however, the tide changes in the other direction. These men (and women) often have to re-acclimate themselves to their home life and the previously “single” spouse has to become reacquainted with working as a team. While this is usually a joyous occasion, it can be nearly as stressful as the initial deployment. Some of the greatest help comes in the most simple ways during these times: Acknowledging and thanking the soldier for their service (I have heard several comments from Vietnam-era veterans who have applauded our organization and lamented the fact that the public opinion upon their return home was very negative), providing baby-sitting services so that the couples can get reacquainted, and continuing with other general services as described previously.

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September/October 2006

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies


Courage Center: A Leader in Rehabilitation, Policy and Reform

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Since Courage Center opened its doors almost 80 years ago, it has been a voice and resource for persons with disabilities. The organization’s earliest role was as an educator and advocate. Gradually, it added rehabilitation services, including a transitional inpatient care unit licensed as a skilled nursing facility. Long a respected provider in the disability community, Courage Center is now helping to lead the larger discussion on health care reform. We share a common interest with the rest of the medical community. We are all striving to remove barriers to maximal health and independence for everyone along the continuum of conditions and degrees of physical functioning. To fulfill this shared mission requires a shift in thinking. What is a “disability”? The World Health Organization makes an important distinction between limitation in physical function and disability. A physical limitation, which includes anything from vision impairment to back pain to arthritis, is something we all experience in one form or another at some stage of life. Disability, on the other hand, is a social construct that creates an attitudinal barrier. It often prevents us from seeing beyond the limitation in order to recognize a person’s abilities. One in five Americans has a physical limitation affecting the ability to see, hear, talk, walk, climb stairs, lift or carry, or perform activities of daily living. At Courage Center,

BY JAN MALCOLM, CEO

MetroDoctors

all of our services aim to reduce, if not remove, the barriers such limitations create. Chronic health conditions frequently limit a person’s activity. In fact, the five conditions causing the most physical limitations in the United States are heart disease, back problems, arthritis, asthma and diabetes. Courage Center and the larger medical community are delivering services to many of the same individuals, just at different points along the continuum of care. A Comprehensive Rehabilitation Resource The most common perception of Courage Center is that it provides rehabilitation services for people with spinal cord injuries and traumatic brain injuries. While we are nationally known for our work in these areas, the organization offers much more. We serve a broad and diverse array of conditions, the largest categories being vision impairment, cerebral palsy, stroke, back pain and arthritis. Thirty-five percent of our current participants are older adults, and 24 percent are senior citizens. The percent of our participants over age 75 has nearly doubled since 1998. Courage Center services are equally diverse, in keeping with our holistic treatment philosophy and changing client demographics. • We offer vocational counseling and have received a presidential award for our success in helping people with disabilities re-enter the workforce. • Our driver assessment and training program is geared to meet a range of abilities, ages and needs, from behind-the-wheel instruction to preparation for the state road test. • Our state-of-the-art transitional inpatient unit prepares participants for independent

The Journal of the Hennepin and Ramsey Medical Societies

living after a median stay of only three months. • We are a leading resource for assistive technology applications that increase a person’s independence. • Our chronic pain rehabilitation program helps patients who have undergone standard medical treatment but continue to experience limitations due to chronic pain. • We weave health, wellness and fitness into our therapy regimen, with new or expanded fitness centers at all of our locations. Courage Center strives to be a one-stop resource for virtually every aspect of rehabilitation and community reintegration. We have the services and the capacity to address all the critical needs of a person with a chronic neurologic or musculoskeletal condition. Expanding Our Continuum of Care In order to provide a full range of clinical rehabilitation services, Courage Center has an expanding medical team. Dr. Jacalyn Kawiecki, our medical director, is board certified in physical medicine and rehabilitation. She oversees clinical services at all of our sites — Golden Valley, Burnsville, St. Croix, Forest Lake, and both camps. Courage Center is building outpatient practices as well and is well positioned as a resource for therapy and physician services required throughout the rehabilitation process. Following are two examples of our clinical expertise.

(Continued on page 14)

September/October 2006

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September/October 2006

Courage Center (Continued from page 13)

Transitional Inpatient Services at Courage Center Given medical advances in trauma care techniques, neonatal intensive care, and coma care, there is a greater need for transitional rehabilitation services than ever before. Fortunately, access to these services has increased. At our transitional rehabilitation facility in Golden Valley, known as the Courage Residence, our capacity to accept participants has doubled in the past ďŹ ve years as our average length of stay has declined. In 2001, participants stayed an average of 11.5 months, and we had a waiting list. Today, the median length of stay is three months, and we are able to admit most referrals immediately. About 100 people with severe disabilities enter our inpatient program every year. An average of 85 percent are discharged to a more independent living setting. The increased number of individuals with severe disabilities has created a demand for more complex services. SpeciďŹ cally, people with disabilities are living longer, thus creating a new kind of client, the person with a long-term or life-long disability. These clients have needs that differ from the older adult who acquires a disability. More clients with cognitive as well as physical disabilities are entering rehabilitation, challenging current knowledge, techniques, and practices. As people move through acute care systems very rapidly, they enter rehabilitation units and community-based settings with more medical complications as they continue to recover. Our transitional rehabilitation unit has been responsive to these changes. Four years ago, we opened a completely remodeled facility, which addresses the more complex needs of todayâ&#x20AC;&#x2122;s client. Like a skilled nursing facility, our transitional residence offers physical therapy, occupational therapy, and speech therapy, along with medical monitoring. Where we differ is in our continuum of additional therapeutic and independent living support services. We offer aquatic therapy, an adaptive ďŹ tness center, a variety of assistive technology applications, and access to chemical and mental health specialists. Our holistic approach involves therapeutic recreation specialists and complementary therapies, driverâ&#x20AC;&#x2122;s assessment and training, vocational counseling and skills MetroDoctors

training, and even tutoring for high schoolage participants. To fully support participantsâ&#x20AC;&#x2122; needs, the transitional residence averages 5.3 staff hours per patient day, higher than the norm for a typical skilled nursing facility. For every client who enters our transitional rehabilitation facility, our goal is to help maximize that personâ&#x20AC;&#x2122;s ability to live independently. We measure outcomes in four areas: functional mobility, including self-care and self-transfer; ability to move to a more independent living setting; progress toward establishing and realizing vocational or avocational goals; and quality of life, including a sense of well-being, chemical health, emotional adjustment, and familial interactions. Our targeted case management service creates a customized transition plan that addresses housing, health care, transportation and medical equipment needs. Chronic Pain Rehabilitation Program For 25 years the Chronic Pain Rehabilitation Program has been a valued service in this community. Originally located at Abbott Northwestern Hospital, this multidisciplinary residential model is now offered at Courage Center. The only other such model in the region is at the Mayo Clinic. Matthew Monsein, M.D., serves as the programâ&#x20AC;&#x2122;s medical director. Typically, clients of the program are high health care users who have failed standard medical treatment. In addition to their physical problems, these patients are frequently depressed, deconditioned, dependent on narcotic analgesics, and have poor coping skills. The focused atmosphere of our chronic pain rehabilitation program has proved to be more conducive to implementing change in our clientsâ&#x20AC;&#x2122; lives. Individuals who have completed the program showed improvements in several areas. Nearly half returned to work; 69 percent reduced or discontinued opioids; 35 percent showed reduced health care utilization; 75 percent increased their physical activity; and 62 percent experienced a reduction in pain. An impressive 84 percent reported a decrease in depressive symptoms. Research supports the Pain Programâ&#x20AC;&#x2122;s multidisciplinary approach as providing the best opportunity for these individuals to improve their health and well-being, and to return to a functional lifestyle. The Journal of the Hennepin and Ramsey Medical Societies


Policy from a Community Perspective In addition to its role as a provider of clinical services, Courage Center has a long history of shaping public policy. From urging former Governor Floyd B. Olson to provide better transportation for persons with disabilities, to advocating for legislation to remove architectural barriers to public buildings, Courage Center has participated on many fronts. In the past decade, our role in policy discussions has become more formally ingrained throughout the organization. And we have moved beyond arguing for coverage expansions for the medical services our clients need to taking a broader view of the whole health and human services continuum. In fact, there is strong overlap between the concerns of the people we serve and the issues people throughout our community have around affordable housing, transportation, access to health care and job opportunities. Courage Center has put a stake in the ground for the entire community. In helping to define what comprehensive chronic care should look like, we are applying what we know at a

tactical, patient care level to a larger, community perspective. The Minnesota Consortium for Citizens with Disabilities is a coalition of more than 40 groups, and Courage Center is a leader of that effort. John Tschida, our vice president of public affairs and research, has served as cochair of the consortium for five years, and our organization provides ongoing staff support. The Healthy Minnesotans Steering Committee is a group comprised of doctors, business leaders, labor and consumer groups, and health plan and hospital representatives. I serve on that committee, which addresses broad policy issues related to health and health care. I will bring Courage Center’s perspective, and that of the people we serve, to the table. Advocating for Change Our current health system makes it difficult for an organization like Courage Center to thrive. When reimbursements don’t support the breadth or intensity of services needed for people with chronic conditions, Courage Center gets squeezed out of what we consider a critical component of people’s health and re-

covery. Unless we can change the system, we’re not going to be able to pursue our mission as well as we know we can. The medical community is well aware that the current system often doesn’t do well by people with complex needs. Somehow, we need to break the stalemate on reform. If we don’t, many of our most vulnerable citizens will be underserved, and the providers that care for them will continue to be financially penalized. From the beginning, advocacy has been as central to Courage Center as the rehabilitation services we provide. We recognize the necessity of shifting the emphasis in the overall system from acute to chronic care. Fortunately, the issue of health care reform is back on the table, and people from every sector are coming together. Now is the time for us to define our vision for a better system and engage the community in finding a new way. Jan Malcolm is CEO of Courage Center. She was Commissioner of Health for Minnesota from 1999 to 2003, and, prior to joining Courage Center, served as senior program officer for the Robert Wood Johnson Foundation.

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September/October 2006

15


Ten Days in Haiti

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MOST AMERICANS know little about Haiti, not recognizing it as the second oldest republic in the western hemisphere. Haiti first came to the attention of Europeans when Christopher Columbus visited the island of Hispaniola in December 1492. Through the 1600s it was a Spanish colony. Then, in the 18th century, the French made Haiti her most successful colony bringing in hundreds of thousands of African slaves to produce thousands of shiploads of goods each year. At the beginning of the American Revolution, Haiti was out producing the 13 colonies. This ended with a slave rebellion and departure of many of the French. As a former slave colony, Haiti was not popular among slave owning countries such as the U.S. For much of their history the Haititan people have had to struggle against powerful North American and European countries that were expected to invade at any time. This has left them with even less resources needed for education, economic development, infrastructure building and health care. With a population of eight million in an area one quarter the size of Cuba (11 million), Haiti struggles to find answers to its social and economic problems. Many NGO’s (Non-Government Organizations) from the U.S. and Canada provide assistance, and hundreds of thousands of Haitians working abroad send money back home. Support from the U.S., United Nations and World Bank ebbs and flows with the political whims of the sponsoring countries. My interest in Haiti began a few years ago with family friends working at the Hospital Albert Schweitzer, at Deschappeles in the Artibo-

BY JAMES A. RHODE, M.D.

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September/October 2006

nite River Valley. Then in 2004, a patient of mine presented to our office for travel shots. Conversation revealed he was traveling with an organization, Healing Hands for Haiti, to film a documentary of its work with the disabled in that country. As I have had 30 years of caring for physically disabled patients at Courage Center Residence in Golden Valley, I was soon in discussion with Al Ingersoll of Winkley Prosthetics and Orthotics. Al was the leader of the Minnesota Healing Hands for Haiti teams’ 2005 trip to Haiti. The teams include rehab physicians, physical, occupational, and speech therapists, nurses and other volunteers. Permanent staff in Port-au-Prince keeps the clinic going between visits of a dozen American and Canadian teams. They also provide a comfortable guest house for 20 or more volunteers. During my fist trip with the Minnesota team, in January 2005, I spent most of my time at the Clinic Kay Kapab in Port-au-Prince. The time in clinic was spent assisting Dr. Steve Fisher, physiatrist at Hennepin County Medical Center and Regions Hospital, in evaluating 15-25 patients per day. Steve and Mark Kroll, an orthotist, were the first two Minnesotans involved in Healing Hands for Haiti, joining teams from other states in 1999 and 2000. They have since organized a Minnesota team and have been back to Haiti each January. After this trip, I made it known that I was interested in returning to Haiti with other teams and was MetroDoctors

invited to join the Jan Groves’ team from Salt Lake City. The trip scheduled for August 2005 was canceled due to security issues. I waited until May after several other teams had restored the routine and proven that Healing Hands for Haiti could work safely. I was again asked to join Jan Groves’ team. Highlights of this extraordinary trip follow. Four members of our team, including two nurses from United Hospital in St. Paul, a 19-year-old college student from Florida and myself, arrived in Port-au-Prince on the afternoon of May 18th. We were very happy to be met and led through customs by our leader Jan Groves. Each team member uses their two 50 pound luggage allotments to bring donated equipment and medications in plastic tubs and hockey bags. All one’s clothes and personal items have to come as carry on. Our first evening was spent getting acquainted and organizing the medications we had brought. The next morning was our first outreach clinic in Laogane. We had more The Journal of the Hennepin and Ramsey Medical Societies


than four large bags full of medications. These were mostly antibiotics, NSAIDs, heart meds, antihelmitics, vitamins, and skin creams. Half of the assortment was set aside for the outreach clinics and the rest sent to the central pharmacy at Kay Kapab. Over $3,000 of medications had come from MAPS, an organization that receives donated drugs from the pharmaceutical industry. These were paid for by a grant from the Hennepin Medical Foundation’s “Chairs Fund.” The next morning four team members (nurse Steph Becker from St. Paul, translator James Taylor a bilingual Canadian, a student from Utah, and myself, a family physician) traveled 90 minutes to a church in Laogone. We found the Pentecostal Church on a narrow side street in this city of 120,000. The churchyard was filled with 50 or so patients. We unloaded our bags of drugs and set up shop in the sanctuary. With very little medical care in Laogone, a couple of nurses see patients in the church periodically. They had told parishioners that on this day an American doctor would be there for free consultations and medications. This was the first for Laogone. I soon learned how much I depended on lab, x-rays and scanners for diagnoses. In the front half of the church patients were interviewed, vital signs taken, and given a number. The brief records were in English but only Kreyol (Africanized French) was spoken. Thus, the translators were critical. We soon split into two teams with Steph seeing one line of patients and me the second. A Haitian architect served as our second translator. By noon the single lines had become crowds around the doctor and nurse teams and medical care became a spectator sport. The complaints were sore eyes, poor vision, headaches, chest pain, abdominal discomfort, joints and muscle pain, weakness, dizziness, rashes and diarrhea in infants. We had to call it quits at 4 p.m. to return to Port-au-Prince leaving another 30-40 patients still waiting to be seen. By then, we had seen 100 patients in seven hours but had hopefully done some good with our limited time and resources. The high point of the third day was visiting the Wings of Hope Orphanage next to the Baptist Mission. This is one of thousands of orphanages in Haiti, but all the children and adults at Wings of Hope are all physically or

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mentally disabled. We visited with Sonni, a cerebral palsy disabled adult who, as a child, had been a “piece of the furniture” and did not walk. Children from St. Joseph’s Boys Home for Street Urchins, took on Wings of Hope and Sonni as their project and taught him to walk, and then to dance. For years he has been a member of their dance troupe that we see perform during visits to St. Joseph’s. Most Americans that work in Haiti hear about the work of Dr. Paul Farmer in the Central Plateau east of Port-au-Prince. As a medical student at Harvard in the early 80s, Paul started a clinic at Cange, a small village. While working on a doctorate in anthropology, he spent much of his time in the small village, learning the language, culture, history and medical

problems. Paul also completed an infectious disease fellowship at Harvard. With friends and other volunteers, he started Partners In Health that has since been involved in work in Peru, Russia and Rawanda (www.PIH.org). It has attracted support from the Gates Foundation and Bono. Sunday we left Port-au-Prince early traveling in a small SUV. Our four travelers included Cadet, a Healing Hands for Haiti project manager, Dr. Dave Ryser, Director of the Rehab Unit at LDS Hospital in Salt Lake City, James Taylor, translator and staff member of BIC (Bank Information Center) and myself. BIC is an NGO that monitors the activities of large development banks such as the World Bank and USAID. The three of us from the U.S. had hoped we would take the longer route around the mountain range but instead our driver (a plumber by trade) who spoke no English took us on the road over the

The Journal of the Hennepin and Ramsey Medical Societies

mountains. We had been told this “national road” was hard on the passengers and harder on the vehicle. The trip usually took 3-6 hours to cover 35 miles. After three hours in the Nissan Xtera, we stopped at the Lake Pellagree dam. This dam, built with U.S. aid in the 1950s, caused thousands of farmers to be displaced from their fertile land. Many ended up in the village of Cange. After replacing a flat tire with a tire only slightly better, we arrived at the Zanmi Lasanti (Partners In Health) compound. Abruptly along the dusty and unpaved road we came to a cement wall with a green metal gate. After a brief interview by the private security guards (universal practice in Haiti) we were allowed to enter. It was noon on Sunday and several clinics were busily seeing patients. The hospital wards were clean and airy. PIH has a larger budget then the Haitian Ministry of Health. Most of the work is medical as only two operating rooms are needed for a few dozen cases a month. Larger facilities are assigned to the work of infectious disease. Rehab does have a small therapy room and two PT techs trained in PAP by Healing Hands. They shared with us their need for more equipment and more referrals from the doctors at the Partners In Health hospital. We noted the need to network with the doctors and will try to schedule a visit to promote more use of rehab services. Back in our Xtera for a 45 minute trip to the first of four clinic visits. We arrived in Thomonde and found a small town with neatly laid out unpaved streets. The Dispensaire de Thomonde has several doctors, thousands of charts, laboratory, provides obstetrics and has a dozen or so inpatient beds. The tech helps treat stroke patients and other acute rehab problems. After a clinic tour we were driven across the village to a construction site. The beautiful new clinic is much larger then the current one with room for more inpatients. Next to it is a large community education building and the third structure is a bank, FonKoze (Shoulder to Shoulder) that makes micro loans and issues international money transfers from relatives working abroad. Probably the largest source of aid in Haiti is the diaspora living and working in North America and Europe. We see a sign (Continued on page 18)

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Haiti (Continued from page 17)

that speaks of Crushing the Cycle of Poverty. Thus the clinic is one part of bringing progress to this remote community. The next morning we are off to the second clinic on our tour, the Centre de Sante de Lascahobas. Amazingly the road from Mirebalas to Lascahobas is paved and the town appears more commercial and successful. The clinic is large and busy as Monday was maternal and child health day. Thus, the clinic waiting areas were full of young families as well as the more elderly. Our guide this time was a young Haitian physician with a red T-shirt that carried the message: Zanmi Lasanti “Where health and social justice meet.” We were introduced to other doctors from Haiti and Cuba. Though we were impressed by the labs, wards and x-ray, the high point of this tour was in the storeroom for medications. Large shelves contain many boxes of antibiotics, antihypertensives and parasite medications. What surprised us was the cabinet that contained five or six HIV/AIDS antiretroviral drugs was in good supply. PIH receives drugs manufactured in India that are generic versions of more expensive drugs developed in the U.S. and Europe. The clinic treats over 300 AIDS patients at the cost of $300 per patient per year for medications. Pregnant women are screened and, if HIV positive, are watched closely and treated during the last trimester and for at least the first year after delivery. The newborns are bottle fed, and the families are provided with bottles, sterilizing equipment, water and brushes to minimize the risk of bacterial diarrhea. Total cost of caring for an AIDS patient including visits, hospitalizations, nutrition, social work and follow-up averages $3,000 per patient per year. Many HIV positive patients are being followed for changes in their CD4 levels. The availability of treatment has lowered the stigma of this disease and prevention is a large part of the effort. For a country with a child mortatlity rate of 130 per 1,000 in the first five years of life, this level of medical care is amazing. Our third clinic visit was another hour further over difficult terrain including several shallow river crossings and ending at the Dominican border town of Belladere. We found a government hospital that has had management taken over by PIH. Considering the funding 18

September/October 2006

that Farmer and his team have available, it is not surprising that PIH is better able to provide support for a remote hospital. But even Zanmi Lasanti has limitations. On our tour of the Belladere Hospital we met Dr. David Kuwayama, a native of Wisconsin, graduate of Harvard Medical and fourth year surgical resident at Johns Hopkins. He was completing a year as the surgeon at this frontier hospital and has gained experience by doing a lot of cases. Most of the 500 or so cases he had done in his year were hernia repairs (without mesh) and other elective procedures. Not as much trauma as he expected. Running a remote surgery department does not go easily when the satellite connection with Cange fails, and sterile gowns are unavailable for a week at a time. Patients traveling long distances for elec-

tive surgery wait in the hospital for days. We noted that the wards do not have lights in the ceilings and a single battery operated bulb in the corner, which is all the illumination labor and delivery gets. David met Paul Farmer during medical school at Harvard, and despite the shortcomings has received invaluable clinical experience. He was not aware of the Healing Hands for Haiti clinic in Port-au-Prince that can make a state of the art prosthetic for his amputee patients. Our third day of travel in the Central Plateau started as usual with a difficult drive up a mountainous road to reach the fourth clinic on our tour. Very few vehicles attempt this trip and when we arrived at the Centre de Sante Saint-Michel, we were at one of the most remote of the PIH clinics. In fact, until two years ago there was only an occasional outreach clinic visit from a Tennessee medical team. However their visits led to partnering with PIH in funding a clinic. Now there is a two-story building with an operating room, x-ray, well stocked pharmacy, satellite dish and lots of patient education space. Again, MetroDoctors

hundreds of AIDS patients were being managed and thousands of HIV patients were being monitored. The operating suite gets less use because of its nearness to Cange, but obstetrics and radiology are busy. Back at Cange, and the central PIH hospital, we got another tour and now knew more questions to ask. The clinics and hospitals are monitoring 7,000 HIV positive patients and treating 2,000 AIDS patients. At dinner time we met doctors from the U.S., Cuba, and other parts of Haiti. Day seven was our return trip to Port-auPrince, but this time we took the longer route through the Artibonite Valley. This allowed us to stop at the Hospital Albert Schweitzer in Deschappeles. A parking lot full of cars prepared us for a busy organization. Started by Larry Mellon, a rancher and heir to banking and oil millions, the hospital has been a fixture in central Haiti for 50 years. Hospital Albert Schweitzer is a multispecialty organization that now has all four of its major departments headed by Haitian physicians. Near a main highway, it gets lots of trauma cases as well as the infectious and nutritional diseases. Though the buildings are showing their age, there is no question that the care here is excellent. Interestingly, one of the waiting areas at one time was a parking lot for…horses, just like the clinic we had seen the day before. The effort is to treat only the local people due to limited resourses, but city folk from Port-au-Prince try to pass as farmers from the valley. The resources and efficiency here surpass the University Hospital in Port-auPrince, which though larger, lacks the constant addition of dozens of American and European volunteer physicians. After four days in the mountains of Haiti, we headed back to Port-au-Prince. After one night at the guest house (including a warm shower and an hour in the swimming pool) I

The Journal of the Hennepin and Ramsey Medical Societies


was off to the next outreach clinic. My guide was Gina Duncan, a Haitian nurse who has been involved with Healing Hands for Haiti from the beginning and is the director of operations. Our destination was a small school at the plantation owned and operated by her mother-in-law, “Mommy” Duncan. Haiti does not have a functioning public school system or many of the government run social services. Most schools and orphanages are privately run and supported. Several other team members had gone up to the plantation the afternoon before, and had set up the clinic that morning. As usual, patients were waiting patiently for the “American doctor” to arrive. This time we had two nurses from St. Paul, Steph, who worked with me at Laogone, and Erin Bell. Both had taken a month off from their jobs at United Hospital in 2005 to work in Sri Lanka on the Tsunami disaster. They then went online looking for an organization they could volunteer with and found Healing Hands for Haiti. They were quite prepared for the type of medical problems we encountered in Haiti. Learning from our experience in Laogone, they had streamlined our pharmacy by counting out and labeling a number of drugs ahead of time. Each had a station and I moved back and forth consulting with the nurse and patient through translators. This time, one of our translators was Sheila, a 19-year-old college student from Florida. Born of Haitian parents she had learned the Kreole language well enough to be a certified translator for Florida courts. But until now she had never visited Haiti.

MetroDoctors

Over the next several hours we saw 80 patients. The clinic patients were similar to those seen in Laogane with perhaps less diarrhea and dehydration. As I consulted with each patient I took a picture for future reference. This gave us a record of the number, gender, age, and somewhat the illnesses of our clinic populations. Our final outreach clinic was held the next day at another school in a village near the Dominican border. This was a village that had no regular source of medical care and we were the first outreach clinic. One would expect horrendous medical problems, but most seemed healthy with good teeth and little obesity. Occasional untreated hypertension was noted. The school appeared well built but had limited equipment and supplies. Children peered in thru ventilation windows, as again medical care was provided with a minimum of privacy. Benches worked better then chairs as then the patient could lie down for an abdominal exam if needed. The next and last day in Haiti, I had set aside for visiting several hospitals in Port-auPrince. As a member of the Healing Hands for Haiti committee assigned the task of building a rehab hospital, we needed to familiarize ourselves with existing and planned hospital facilities. The first hospital was a mediumsized institution that caters to the middle and upper economic classes. Most hospitals are private and provide quite varied services. This hospital had a new wing for private patients, with air conditioned single rooms and private bathrooms. What they lacked were the more highly qualified staff. The second hospital visited was the new home for St. Damien’s Children’s Hospital. This is a two-story structure under construction for three years. When completed it will have 66,000 square feet of space and start with 100 beds that can be expanded to 140. Emergency, intensive care, newborn nursery, oncology, surgery, radiology with CT scanner,

The Journal of the Hennepin and Ramsey Medical Societies

and rehabilitation are planned. The site also contains a water tower, two generators, housing for volunteers, a nursing dormitory and a chapel. The beautifully built campus is walled in and also contains a clinic for HIV/AIDS and TB out-patient care. It should open this fall and equipment is already being moved in. The last hospital visited was that of the Foundation Bernard Mevs, a busy general hospital built and run by two surgeons — twin brothers Marlon and Jerry Bitar, born and educated in Haiti but residency trained in France. They have another hospital in the elite section of town but this is their pride and joy. Near Cite Soleil it has many trauma and medical emergencies. Gunshot wounds are taken to the operating room rather than being stabilized in the ER. Healing Hands for Haiti has arranged many operations for disabled children and a few weeks before our visit, had brought in a neurosurgical team from Miami to operate on 21 hydrocephalic children. These procedures were performed in two days at the Mevs facility. Extra beds had to be brought in and then removed. Two of the children remained in the pediatric ward. They do elective surgery such as gastric bypass on Haitians living in the U.S. They can perform the procedures cheaper in Haiti and still make a profit that supports their hospital. The work of Healing Hands for Haiti International Foundation has an evolving and ever-expanding group of projects. We have plans to develop a clinic in Gonaives, a city north of Port-au-Prince by 3-4 hours, that was struck by a hurricane two years ago with over 2,000 dead. The hospital was badly damaged, as was most of the city, and much remains to be done to rebuild. The Minnesota team of Healing Hands for Haiti will return to Haiti in mid January 2007 and can be accessed through their Web site www.healinghandsforhaiti.org or by contacting Sue Kodadek at skodadek@ healtheast.org. Haiti is rich in history, culture and opportunities to volunteer. Many Minnesota organizations have projects in this island country. Any physician, health care professional or support volunteer can find innumerable opportunities to contribute to the health and well being of people in Haiti and other countries.

September/October 2006

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Minnesota Immunization Information Connection

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HENNEPIN MEDICAL Society (HMS) and Ramsey Medical Society (RMS) have joined forces to assist metro-area hospitals in the electronic access of immunization data and TB status on physicians who are on their respective medical staffs. As you may know, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and other regulatory bodies require that hospitals inquire as to the immune status of their health care workers. What we have dis-

covered is that all hospitals ask for the immune status of their physicians, but from hospital to hospital, what they do with the information varies greatly. There was a need identified through our Metropolitan Hospital Physician Leadership committee, which is comprised of metro-area hospital vice presidents of medical affairs, chiefs of staff, chiefs of staff-elect, and medical directors to address this issue both as an enhancement to regulatory requirements, but

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September/October 2006

also as a tool to better equip our metro-area hospitals with an important tool in knowing the immune status and TB status of their physicians. HMS and RMS identified an existing database called the Minnesota Immunization Information Connection (MIIC) which exists now to capture patient-specific immunization information. Working under our suggestion, this database is going through enhancement by those who administer MIIC, the MN Department of Health, in order to meet our needs as it relates to additional security, adding a section related to TB status, and the ability for medical staff coordinators to run adhoc reports based on a multitude of criteria. HMS and RMS are putting forward seed money to get the project off the ground, and will begin to raise funds from various hospitals that have already provided their endorsement of the project. We have identified four hospitals that will be test-piloting the electronic access to the data and will provide the Metropolitan Hospital Physician Leadership committee with a report back on how it works later this summer. Our plan is to offer this data to metro-area hospitals first, then move outside of the metro area to ease the data collection burden for those hospitals as well. Look for an additional article on the progress of the immunization database project in a future edition of MetroDoctors. To learn more, call Sue Schettle at (612) 623-2889, or e-mail her at sschettle@metro doctors.com.

www.triium.com Email: info@triium.com 952.883.3288

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies


HMS and RMS Resolutions Being Submitted to MMA House of Delegates Editor’s Note: On September 14-15, 2006, delegates from the Hennepin and Ramsey Medical Societies will propose and testify on the following 23 resolutions before the MMA House of Delegates. Each resolution, in full, can be viewed online at www.metrodoctors.com. If you are interested in becoming a delegate or observing the House of Delegates, please contact Kathy Dittmer, HMS, at (612) 623-2885 or Katie Anderson, RMS, at (612) 362-3704.

1. Alcohol Health Impact Tax (HMS) RESOLVED, that the Minnesota Medical Association should legislatively and actively advocate increasing the excise tax on beer, wine and spirits by $.10 a drink which would generate an estimated $224 million per year in additional revenues that would be dedicated to public safety, law enforcement, treatment, detox services, and prevention of alcohol problems because the health impact costs of alcohol use in Minnesota far exceeds alcohol revenue; and, be it further RESOLVED, that the Minnesota Medical Association support the legislative principle that alcohol excise taxes be increased to keep pace with inflation because Minnesota’s alcohol excise taxes have not kept up with inflation and revenue has declined by nearly 40 percent in real value since 1987; and, be it further RESOLVED, that the Minnesota Medical Association adopt and emphasize as one of their public priority health care issues, the informing and educating of the legislature, the news media and the general public about the appropriateness of increasing the alcohol excise tax in order to adequately fund the real health impact costs of alcohol use by Minnesotans.

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2. An MMA Physician Finder to Link the Public to MMA Member Practice Web sites (HMS & RMS) RESOLVED, that the Minnesota Medical Association establish an MMA Web site linkage with a search engine designed to link public inquiries to MMA member Web sites for all MMA members desiring to do this. Charge the MMA Committee on Communications to develop and recommend to the MMA Board of Trustees and staff specific strategies to encourage MMA members to set up their practice Web sites, suggest parameters of the MMA Physician Finder for technical help to achieve the search engine prompts, announce and promote the MMA Physician Finder MD-linkage service to the general public, and inform key patient advocacy and patient support organizations (e.g., diabetes, mental health, breast cancer, etc.) about the availability of this valuable MMA service. 3. Clinic-Level Access to Quality Data Reports Via Electronic Medical Records (EMR) (HMS) RESOLVED, that the Minnesota Medical Association advocate for the use of electronic medical record data to improve the value of quality reporting for patient care by working with health plans, professional medical groups, the Institute for Clinical and Service System Improvement (ICSI), and the Minnesota Community Measurement Project to develop quality measures with specified data standards which allow direct reporting from an electronic health record; and, be it further RESOLVED, that the MMA advocate the use of electronic health records (EHR) to provide data for reporting on disease registries, preventive care screening, and chronic disease management criteria that can be used internally

The Journal of the Hennepin and Ramsey Medical Societies

by medical clinics as well as by health plans, and MN Community Measurement as the reportable data; and, be it further RESOLVED, that the MMA support payment to providers for delivery of standardized quality data obtained electronically from the clinical record to health plans and the MN Community Measurement Project and other entities that need this data. 4. Complete Immunization Data Availability for Children, Infants, Adults and Geriatric Patients (HMS) RESOLVED, that the Minnesota Medical Association, its component medical societies and members support immunization data availability through support of the 2010 Strategic Plan of Minnesota Immunization Information Connection; and be it further RESOLVED, that the Minnesota Medical Association encourage hospitals, health care providers, and long term care facilities to enter immunization data into this database to maintain complete patient data that can be queried by patients and health care providers to assure complete immunization and avoid duplication of immunization; and, be it further RESOLVED, that Minnesota Medical Association members choose EMR products that are functionally interoperable with out-state immunization registries, or include in their vendor contracts a commitment to program for this functionality. 5. Dysmetabolic Syndrome and Type 2 Diabetes in Children (HMS) RESOLVED, that the Minnesota Medical Association work with the obesity task force to develop and promulgate information about this problem to the physicians of Minnesota; and, be it further (Continued on page 22)

September/October 2006

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Resolutions (Continued from page 21)

RESOLVED, that our AMA study the circumstances associated with this new onset of insulin resistant Diabetes Mellitus in children and recommend methods of prevention and treatment of this new public health threat. 6. Electronic Medical Records (HMS) RESOLVED, that the Minnesota Medical Association lobby insurance companies to increase the conversion factors for those clinical practices that have fully implemented electronic medical records and electronic prescribing. 7. Excessive Executive MD Pay (HMS) RESOLVED, that the Minnesota Medical Association set as policy that an MMA member should not accept excessive executive compensation, in line with the salary survey of the American College of Physician Executives. 8. Fair Pay for Clinic and Hospital Pay for Performance Services (RMS) RESOLVED, that the Minnesota Medical Association adopt a policy that advocates for health plan or other entity reimbursement or payment of costs related to pay-for-performance process and outcome data collection and reporting for hospitals and clinics impacted by such plans.

9. Generic Rx P4P, Formulary Sunshine, and Medicare Part D Regulation (HMS & RMS) RESOLVED, that the Minnesota Medical Association: 1) Oppose pay-for-performance (P4P) contract clauses in Minnesota health plan provider and insurance provider agreements which link increased physician or clinic reimbursements to physician prescriptions for generic medications v. branded products. 2) Lobby for MN State legislation to require online, user-friendly, public access to current information on all Minnesota health plan and insurance patient co-payments and detail on coverage for specific drugs covered by medication formularies in Minnesota, with accurate information about provider prior authorization requirements and procedures. 3) Carry a resolution to the AMA to support federal efforts to require that all Medicare Part D medication plans determine their covered drugs and medication copayments on a yearly basis rather than change coverage at will, unless there are immanent pharmaceutical patient safety concerns.

Save the Date Saturday, October 28, 2006 8:00 a.m. – 4:00 p.m.

“Infectious Diseases: Stop the Spread, Contain the Threat” Location: Continuing Education and Conference Center University of Minnesota St. Paul Campus 1890 Buford Place

Sponsored by the Ramsey Medical Society Foundation Endorsed by Children’s Physician Network and Hennepin Medical Society Check www.metrodoctors.com for registration information and additional details.

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September/October 2006

MetroDoctors

10. Health Plan Regulatory Accountability (RMS) RESOLVED, that the Minnesota Medical Association develop and lobby for legislation that 1) Allows the Board of Medical Practice to hold makers of health plan referral and treatment decisions accountable to the same regulatory review standards as other providers delivering medical services, and 2) Defines referral and treatment decisions by health plans as medical practice. 11. Health Savings Account (HSA) or Health Reimbursement Account (HRA) Payments for Physician Services (HMS) RESOLVED, that the Minnesota Medical Association work with insurance companies to clarify that HMO or PPO contractual allowances are not appropriate for any HSA or HRA payments that are the patient’s responsibility, if the billing and collecting process is not the same and if the payments to the physician are not as timely. 12. High Deductible Health Plan (HDHP) Combinations for Medicaid and Other Public Programs: “Medical IRAs” for the Poor (RMS) RESOLVED, that the Minnesota Medical Association develop and lobby for a plan to use high deductible health plans (HDHPs) for applicable Medicaid populations and for other public sector programs. 13. Improve Beverage Selection in Vending Machines and Cafeterias in Health Care Facilities (HMS & RMS) RESOLVED, that the Minnesota Medical Association recommend removing sugaradded pop (non-diet pop), sport drinks, and sugar-added juices from vending machines in health care facilities and hospital cafeterias, and replace them with healthier options. 14. Improving Health Literacy (RMS) RESOLVED, that the Minnesota Medical Association work with interested parties including MHA, MAPS, to develop a model of informed consent documents that may be used by Minnesota health care institutions that are written at an approximate sixth grade reading level; and, be it further

The Journal of the Hennepin and Ramsey Medical Societies


RESOLVED, that the Minnesota Medical Association work with the interested parties to implement more readable and understandable informed consent forms throughout Minnesota health care facilities so as to improve patient safety and understandability of decisions; and, be it further RESOLVED, that the Minnesota Medical Association direct its AMA delegation to submit a similar resolution to the AMA House of Delegates to develop nationwide awareness and efforts through national patient and safety organizations, Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and other interested parties to improve informed consent forms for patients with low and marginal health literacy. 15. The Independent Practice of Medicine (RMS) RESOLVED, that the Minnesota Medical Association form a task force to explore the reasons why physicians are abandoning the independent practice of medicine and are moving to an employed medical staff model of medical practice, and to make recommendations to help preserve the ability of physicians to independently engage in the practice of medicine; and, be it further RESOLVED, that the Minnesota AMA delegation carry a resolution to the AMA House of Delegates calling on the AMA to study all facets of the problems faced by independent physician-owned medical practices and to report back to the AMA House of Delegates with a series of recommended AMA policies to help preserve the ability of independent, physician-owned medical practices to survive and prosper. 16. Mandatory Drivers’ Testing (HMS & RMS) RESOLVED, that the Minnesota Medical Association support efforts to require that Minnesota drivers 70 years and older cannot renew their drivers license by mail; 75 years and older be required to take a driving test at least every third year, and those 80 years or older to take a driving test yearly to prove continued competency to drive. 17. Maternity Care Carve Outs (HMS) RESOLVED, that the Minnesota Medical Association introduce and support legislation MetroDoctors

that prevents health insurance plan discrimination against maternity coverage. 18. Patient Care Management Fee (HMS & RMS) RESOLVED, that the Minnesota Medical Association: 1) Recommend as a viable payment option a monthly case management fee for primary care services which include case management and ongoing care for patients suffering with chronic illness. 2) In collaboration with the Minnesota Academy of Family Practice and other specialty organizations, develop criteria and guidelines for such case management retainer agreements with patients. 3) Encourage MMA members to market retainer arrangements, when appropriate to patient need and market demand; and, be it further RESOLVED, that the Minnesota Medical Association ask its American Medical Association delegation to carry a resolution that the AMA lobby Congress and the CMS to allow physician retainer agreements for Medicare enrollees. 19. Pharmacist Refusal to Fill Prescriptions (HMS & RMS) RESOLVED, that the Minnesota Medical Association introduce and support legislation that requires pharmacies to promptly dispense FDA approved medication for emergency contraception after receiving a valid prescription from a physician; and, be it further RESOLVED, that the Minnesota Medical Association work with the Minnesota Pharmacists Association regarding this issue. 20. Physician Education (RMS) RESOLVED, that the Minnesota Medical Association endorse the American Medical Association policy on the relationship between physicians and industry; and, be it further RESOLVED, that the Minnesota Medical Association educate physicians in Minnesota and our patients on the fact that physicians, and pharmaceutical and biotechnology companies, must work together to continue to improve patient care, and their association is not undesirable, immoral, unethical or illegal, but rather the standard of medical care; and, be it further

The Journal of the Hennepin and Ramsey Medical Societies

RESOLVED, that the Minnesota Medical Association establish a dialogue with the Pharmaceutical Research and Manufacturers of America (PhRMA) and the Office of the Attorney General to remove the significant bias that this office has introduced into the State of Minnesota, so that the working relationship between pharmaceutical and biotechnology companies, and physicians, may return to normal; and, be it further RESOLVED, that the Minnesota Medical Association convene a pharmaceutical and biotechnology company advisory group to help our Minnesota Medical Association sustain its mission of advocacy on behalf of physicians, ensuring access to all available forms of information for all physicians in the State of Minnesota. 21. Seminars on the Emerging Market of High Deductible Health Plans (HDHPs) for Providers, Employers, and Public (RMS) RESOLVED, that the Minnesota Medical Association involve the component medical societies, the Minnesota Medical Group Management Association (MMGMA), and others to actively organize seminars and conferences to educate providers and the public about dealing with the emerging High Deductible Health Plan market and variations of High Deductible Health Plans. 22. Teenage Drivers Licensing (RMS) RESOLVED, that the Minnesota Medical Association endorse and introduce legislation in the Minnesota Legislature requiring the successful completion of a crash avoidance course and a more rigorous skills test before issuing a drivers license to anyone age 16 through age17; and that drivers age 16 through age 17 would not be allowed to have other teenagers in the motor vehicle without the supervision of an adult; and that drivers age 16 through age 17 would be prohibited from driving after 11 p.m. 23. Universal Health Insurance Coverage (HMS) RESOLVED, that the Minnesota Medical Association introduce and support legislation requiring all Minnesotans to be covered by a very basic health care coverage plan, as determined by the legislature.

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Members in the News Editor’s Note: The “Members in the News” section is used to recognize HMS and RMS members who have received awards and/or honors, as well as announcements of election to office. Please send your news items to: Editor, MetroDoctors, 1300 Godward Street NE, Suite 2000, Minneapolis, MN 55413, fax to (612) 623-2888 or e-mail: dhines@metrodoctors.com for consideration by the editorial board.

BLANTON BESSINGER, M.D. was elected to the American Medical Association Council on Constitution and Bylaws at the AMA Annual Meeting in Chicago on June 13. Dr. Bessinger, who specializes in pediatrics and pediatric cardiology, was the director of child advocacy and child policy for Children’s Hospitals and Clinics, Minneapolis and St. Paul.

September/October Index to Advertisers AmeriPride...................................................4 The Birkeland Group .......Inside Back Cover Children’s Physician Network.......................6 Classified Ad/Volunteer Opportunity .........14 Courage Center ................Inside Back Cover Crutchfield Dermatology ............................5 MMIC .......................................................15 Minnesota Healthcare Network and Triium ...........................................20 Minnesota Oncology Hematology, P.A. ......... Inside Front Cover Minnesota Physician Services, Inc. .............12 University of Minnesota CME ....................... Outside Back Cover Weber Law Office ......................................14 Whitesell Medical Locums, Ltd....................5

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PRAMOD KELKAR, M.D. was recently appointed as the Chair of the Cough Committee of the American Academy of Allergy Asthma & Immunology. The committee will focus on education and research in the area of chronic cough in children and adults. Dr. Kelkar practices Allergy and Immunology at Allergy & Asthma Care, P.A. in Woodbury.

DR. JON HALLBERG is a specialist in family medicine and an assistant professor at the University of Minnesota Primary Care Center. Dr. Hallberg is also creative director of the University of Minnesota Center for Medical Humanities. He will focus on honing his health communications skills so that he can more effectively influence the health of the state, region and nation.

RICHARD F. KYLE, M.D. has been elected president of the American Academy of Orthopaedic Surgeons. Dr. Kyle is currently chairman of the Department of Orthopaedic Surgery at Hennepin County Medical Center; professor of orthopaedic surgery at the University of Minnesota; and medical director of the University’s biomechanics laboratory, specializing in trauma and adult reconstruction orthopaedics.

DR. LINDA KRACH practices pediatric rehabilitation medicine at Gillette Children’s Specialty Healthcare in St. Paul. She also is director of research administration at Gillette. Her fellowship goal is to have a positive impact on the lives of children with disabilities by improving the education of medical residents and developing an understanding of qualitative research.

RANDALL T. SCHAPIRO, M.D. has been named medical director for Fairview Multiple Sclerosis Achievement Center, a specialized, state-licensed day program providing chronic disease management and outpatient rehabilitation services for people with advanced MS. Dr. Schapiro, a neurologist specializing in MS, is director of The Schapiro Center for Multiple Sclerosis at the Minneapolis Clinic of Neurology and a clinical professor of neurology at the University of Minnesota. The Bush Foundation awarded 2006 medical fellowships to the following RMS and HMS members to help them develop skills to improve the health of their communities by learning new clinical and leadership skills. DR. AMY GILBERT is the medical director of the Family Tree Clinic in St. Paul. She will acquire additional skills in the public health area in order to work more effectively in the nonprofit sector on issues involving women’s reproductive health. MetroDoctors

DR. JUNE LAVALLEUR is an associate professor in the University of Minnesota’s Department of Obstetrics, Gynecology and Women’s Health. She will work to improve the health care of menopausal women by developing a web-based curriculum and enhancing her writing abilities. DR. JANE WILKENS is a family practice physician at Stillwater Medical Group. She will study chronic pain management. The University of Minnesota Medical School has presented awards to six residents as this year’s winners of the Arnold P. Gold Foundation Humanism and Excellence in Teaching Awards. They are KEVIN BROWN, D.O., neurology; HARLEY DRESNER, M.D., otolaryngology; ANGELA FISCHER, M.D., ob-gyn; ALLISON HOLT, M.D., psychiatry; KAMBIZ KOSARI, M.D., surgery; and PAUL VIETZEN, M.D., surgery. U of M third- and fourth-year medical students selected the winners.

The Journal of the Hennepin and Ramsey Medical Societies


PRESIDENT’S MESSAGE JAMES J. JORDAN, M.D.

A Clarion Call

R

RECENT NEWS STORIES highlight a

President James J. Jordan, M.D. President-Elect V. Stuart Cox, M.D. Past President Charles G. Terzian, M.D. Treasurer Peter B. Wilton, M.D.

problem most Minnesota psychiatrists face: a squeeze play that too often forces patients to choose pharmaceutical intervention rather than a comprehensive approach to mental health care. Simply put, too many patients choose pills rather than psychotherapy for the simple reason that is all their insurance providers will cover. Apparently, health insurance providers would rather pay for a relatively quick pharmaceutical fix than for longer-term psychotherapy because they see medication as more cost-effective. But, as with most everything else in life, the shortcut isn’t always the best choice. Drugs often improve symptoms while ignoring an underlying problem. Psychotherapy, on the other hand, affords a long-term cost-benefit in assessing and addressing the root of the trouble and possibly eliminating the need for drugs. Yet that means spending sufficient time taking a history and talking with patients to develop an alliance as they make sense of the problems in their lives. And time is of the essence in a medical insurance system that too often restricts doctors to 15-minute patient visits that end up being little more than med checks. As a result, too many patients are taking drugs without a careful assessment and outpatient mental health care is losing the human dimension so necessary to understanding a patient’s depression and anxiety. Insurance providers don’t allow doctors the time to talk with patients about their current difficulties. In response, some psychiatrists are rebelling and opting out of managed care plans — a dozen or so in Minnesota and more than onethird nationwide, according to news reports. These doctors prefer to practice the way they have been trained: to use comprehensive assessment and treatment, including psychotherapy. This approach fosters the human connection between patient and physician. A patient needs a human relationship with a physician in order to have trust and confidence that medications — if necessary — will be helpful and to

RMS-Board Members

Todd D. Brandt, M.D., At-Large Director Charles E. Crutchfield, III, M.D., At-Large Director Laura A. Dean, M.D., Specialty Director Andrew S. Fink, M.D., At-Large Director Ronnell A. Hansen, M.D., Specialty Director Thomas J. Losasso, M.D., At-Large Director Robert C. Moravec, M.D., At-Large Director Jane C. Pederson, M.D., M.S., Specialty Director Lon B. Peterson, M.D., At-Large Director Thomas D. Siefferman, M.D., Specialty Director Stephanie D. Stanton, M.D., Resident Physician Jacques P. Stassart, M.D., At-Large Director Christina J. Templeton, M.D., Specialty Director David C. Thorson, M.D., Specialty Director Kimberly C. Viskocil, Medical Student RMS-Ex-Officio Board Members & Council Chairs

Blanton Bessinger, M.D., AMA Alternate Delegate V. Stuart Cox, M.D., Communications Council Chair Kenneth W. Crabb, M.D., AMA Delegate Robert W. Geist, M.D., Ethics & Professionalism Council Chair J. Michael Gonzalez-Campoy, M.D., Ph.D., MMA Immediate Past President Frank J. Indihar, M.D., AMA Delegate Neal R. Holtan, M.D., Community Health Council Chair Mark J. Kleinschmidt, Clinic Administrator Anthony C. Orecchia, M.D. Education Resource Council Chair Lyle J. Swenson, M.D., Public Policy Council Chair Richard W. Anderson, M.D., Sr. Physicians Association President RMS-Executive Staff

Roger K. Johnson, CAE, Chief Executive Officer Katie R. Anderson, Executive Assistant Doreen M. Hines, Manager, Member Services

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The Journal of the Hennepin and Ramsey Medical Societies

provide the necessary support in struggles with conditions marked by conflict, depression and anxiety. These psychiatrists are refusing to take insured patients, and will accept only patients who can pay out of their own pockets, or who are willing to deal with insurance companies on their own. Hamm Clinic, an independent, nonprofit mental health community clinic located in downtown St. Paul, has a working solution to the problem and we have evidence that our comprehensive approach works. At Hamm Clinic, which has had a psychotherapy base since its inception 51 years ago, we carefully evaluate patients’ conditions and provide personal support along with medication, when needed. This integrated care approach has proven itself, and we are able to measure the effectiveness of our work with each patient with valid reliable measures. In contrast, uninsured persons and people not receiving such comprehensive outpatient mental health care are flooding hospital emergency rooms and causing a health care and financial crisis, further raising health care costs for all Minnesotans. Further, family practice doctors and internists who often have initial contact with these patients see them returning again and again to their offices because these patients have not received adequate mental health assessment or treatment. Clearly, these are symptoms of a broken system. The solution lies with insurance companies. They must provide coverage for comprehensive mental health assessment and treatment on a par with other medical conditions. The psychiatrist rebellion should serve as a clarion call for all Minnesota physicians to speak up and demand equity for mental health patients.

September/October 2006

25

Ramsey Medical Society

RMS-Officers


RMS UPDATE

Introducing New Employees for Dakota County Smoke Free Community Partnership

Julie L. Johnson is the new Project Coordinator for the Dakota County SmokeFree Communities Partnership. She recently moved to Minneapolis from New Orleans, where she had been part of several public health and social justice initiatives. Julie graduated from Tulane School of Public Health and Tropical Medicine with a Master of Public Health degree in 2000. She worked with the State of Louisiana Office of Public Health HIV/AIDS Program for three years. At the Office of Public Health, she helped to coordinate a statewide behavioral research study, HITS, for the Centers for Disease Control and Prevention assessing the reasons why at-risk populations seek or defer HIV testing. From there, she worked at Catholic Charities Archdiocese of New Orleans where she served as a special projects coordinator for the Office of Justice and Peace. She was involved in legislative advocacy, program development and grant writing at Catholic Charities, as well as serving as part of several community initiatives. Some of the initiatives she served on included the Jefferson Parish Federally Qualified Health Center (FQHC) Initiative Steering Committee, Archbishop Hughes Racism Pastoral Taskforce, Social Justice Commission of the Archdiocese of New Orleans, and Governor Blanco’s Solutions to Stop Poverty Community Coalition. At the same time, she served St. Bernard Parish as an FQHC consultant. After Katrina, she helped to coordinate wrap-around case management services for FEMA trailer evacuee communities in Louisiana in partnership with Catholic Charities, FEMA and the Louisiana Department of Social Services. 26

September/October 2006

Diane Tran is a recent graduate of the College of St. Scholastica with a self-designed International Social Policy major and double major in Humanities, with minors in Spanish, Women’s Studies, Philosophy, and Applied Economics. Diane has been working to raise awareness of, and create connections between, local and national groups working on a plethora of issues for over 11 years. She has spoken to a number of youth, community groups, and government officials, particularly about the marketing tactics of the tobacco industry and Target Market, a grassroots anti-corporate tobacco campaign she helped to lead in numerous ways on the statewide level as a youth spokesperson. She was recognized in 2002 by the Minnesota State Health Commissioner for her youth tobacco prevention work with Target Market, which helped reduce teenage smoking by 21 percent statewide in two years, and received the 2002 Dakota County Youth Public Health Achievement Award. Diane has also served on the National Coordinating Committee of the Student Campaign for Child Survival for the past four years, in the capacities of National Partnerships Coordinator, National Grassroots Co-Coordinator, and National Advocacy Co-Coordinator. The Student Campaign for Child Survival is the only grassroots lobby of high school, college, and graduate students nationwide focused on advancing an agenda to change statistics around child mortality and international health. When not busy working to create smoke free and otherwise healthy communities, Diane enjoys photography and eating ice cream. MetroDoctors

Julie and Diane will be meeting with as many physicians, hospital leaders, health care providers, business leaders, education leaders, and community leaders in Dakota County to complete community smoke free assessments. They will be working together for the Dakota County Smoke Free Communities Partnership funded by a grant from the Minnesota Partnership for Action Against Tobacco (MPAAT). We are very grateful to Midwest Ear, Nose & Throat Specialists for providing very favorable lease terms for office space in their Eagan office for the project.

Doreen Hines Recognized for 25 Years of Service The RMS Executive Committee and staff hosted Doreen Hines and her husband, Roger, at WA Frost in St. Paul on Thursday, August 10, 2006 to recognize Doreen Hines’ 25 years of service to the Ramsey Medical Society and to its members. Doreen was presented with a gift and a letter of thanks from Dr. James Jordan, RMS president. Doreen lives in St. Paul with her husband, Roger, and their two children, Stephanie and Kevin.

Doreen pictured with (from left) Stuart, Cox, M.D., President-Elect, James Jordan, M.D., President, and Charles Terzian, M.D., Past President.

The Journal of the Hennepin and Ramsey Medical Societies


RMS Staff to Expand

D

The RMS leadership and staff welcomes Sue Schettle back to the RMS staff as of August 16, 2006 in her position as Director of RMS Smoke Free Projects. In that role Sue will be coordinating the Partnership for Healthy Air in Washington County. The Partnership is funded through a contract awarded to RMS by the Blue Cross and Blue Shield of Minnesota Healthy Communities program. Sue will also serve as an advisor for RMS smoke free programs in Dakota and Ramsey Counties. Sue lives in Hudson, Wisconsin with her husband Rob, her son Adam, age 11, and her daughter Maranda, age 8. The RMS Executive Committee considers Sue to be an excellent candidate to become the RMS CEO when Roger Johnson, the current RMS CEO, retires in the next year.

r. Peter Bornstein, Board chair of RCMS, Inc. announced that the Boards of RCMS, Inc. and RMS approved amendments to the Articles of Incorporation and to the Bylaws of RCMS, Inc. to change its name to Minnesota Physician Services, Inc. to better reflect its mission to provide quality services to physicians and their practices at an effective cost. Minnesota Physician Services, Inc. will continue to provide medical garment services

through AmeriPride; OSHA compliance services through SafeAssure; group health and disability along with human resource planning through the Stanton Group/Schwarz Williams Companies, Inc.; coffee and supplies through Berry Coffee; revenue enhancement services through IC System; and credit card services through MBNA. Please call the RMS office if you have any questions or if you are in need of these services.

RCMS, Inc. CEO Roger Johnson (right) presented the 4GB Ipod Nano to Ron Klemz, administrator of Associated Eye Care, in front of the new Associated Eye Care clinic in Stillwater, which had its grand opening on August 12, 2006. The 4GB Ipod Nano was the prize for registering at the RCMS, Inc. exhibit booth, featuring AmeriPride medical linen services, at the 2006 Summer Minnesota Medical Group Management Association (MMGMA) Meeting in Duluth, July 26 to 28.

RMS Welcomes New Board Member

Photo by Scott Smith

RMS members (from left) Dr. Thomas Kottke, cardiologist at Regions Hospital; Dr. Brian Rank, medical director for HealthPartners; and Dr. Charles Crutchfield, Associated Ob & Gyn, P.A. spoke during a news conference at the American Lung Association of Minnesota offices called on June 27, 2006 to highlight the U.S. Surgeon General’s report on secondhand smoke. Dr. Crutchfield pointed out that the Surgeon General concluded that any exposure to secondhand smoke is hazardous. Dr. Rank stated that secondhand smoke causes death and suffering and that bans on indoor smoking saves lives. Dr. Kottke reported that secondhand smoke causes heart disease and sudden deaths due to cardiac arrest.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Kimberly Viskocil is serving as the Medical Student Representative on the RMS Board of Directors. She is currently a second year medical student at the University of Minnesota Medical School. Ms. Viskocil is active in the AMA Chapter at the U of M Medical School as Recruitment Chair and the director for the Glaucoma Screening Project. In this role she arranges site visits for glaucoma screening in at-risk communities, trains new volunteers, and communicates with area ophthalmologists. September/October 2006

27

Ramsey Medical Society

RCMS, Inc. Board Opts to Become Minnesota Physician Services, Inc.


In Memoriam KAREN E. BRUGGEMEYER, M.D. died at the age of 45 on June 12. Dr. Bruggemeyer received her medical degree from the University of Minnesota and then specialized in forensic psychiatry at the University of Rochester in New York. She was currently attending Hamline University’s weekend program for law and practicing medicine at Prairie St. John’s Hospital in Minnetonka. Dr. Bruggemeyer joined RMS in 2005. EUGENE GEDGAUDAS, M.D. died in July. He was 81. Dr. Gedgaudas was born in Lithuania and in anticipation of the Soviet Occupation of Lithuania, he moved to Germany and received his medical degree from the University of Ludwig Maximillian in Munich. He immigrated to Canada where he completed his internship and radiology residency at St. Boniface Hospital in Winnipeg. In 1963 Dr. Gedgaudas was invited to the University of Minnesota as an assistant professor in the Department of Radiology. He rose to become chairman of the department in 1969, where he remained until his retirement in 1986. Dr. Gedgaudas was an enormously popular lecturer and made multiple presentations throughout the world. His bibliography includes over 50 scientific articles and the very successful book “Cardiovascular Radiology,” of which he is senior author. Dr. Gedgaudas joined RMS in 1968. MERTON A. JOHNSON, M.D. passed away on June 27 at the age of 89. He received his medical degree from Loyola University in Chicago. Dr. Johnson completed an internship at Ancker Hospital. He served in the Army during WWII, was discharged from active duty in 1946 and retired from the active reserve as a Major in 1952. Dr. Johnson practiced family medicine for many years and then completed a residency in anesthesiology at the University of Iowa Hospitals. He retired from St. John’s Hospital in St. Paul in 1984 as an anesthesiologist and moved to enjoy the warm weather in Sun City, Arizona. Dr. Johnson joined RMS in 1979. ALBERT G. MILLER, M.D. died at the age of 83 on August 2. Dr. Miller received his medical degree and completed a pediatric residency at the University of Minnesota. He then served in the U.S. Army in Korea. Dr. Miller retired from private practice in Roseville in 1991. He joined RMS in 1953. 28

September/October 2006

New Members

Chandy C. John, M.D. Pediatric Epidemiology University of Minnesota Physicians

RMS welcomes these new members to the Society. Schools listed indicate the institution where the medical degree was received.

Active Aviva Abosch, M.D. University of Pittsburgh Neurosurgery University of Minnesota Physicians

Lara P. Nelson, M.D. St. Louis University School of Medicine Pediatric Critical Care University of Minnesota Physicians Tracy L. Prosen, M.D. University of Minnesota Obstetrics & Gynecology University of Minnesota Physicians

Ellen Buchanan, M.D. University of Illinois College of Medicine Psychiatry University of Minnesota Physicians

Christopher J. Shepela, M.D. Tulane University Gastroenterology/Internal Medicine University of Minnesota Physicians

Kristin K. Christiansen, M.D. University of Minnesota Family Medicine Bethesda Clinic

Stefano M. Sinicropi, M.D. Columbia University Spine Surgery (ORS) Midwest Spine Institute, LLC

Glenn R. Gourley, M.D. Pediatric Gastroenterology University of Minnesota Physicians

Paul J. Swan, M.D. University of Colorado School of Medicine Internal Medicine University of Minnesota Physicians

Jennifer G. Hines, M.D. Mayo Medical School Internal Medicine HealthPartners Midway Clinic

Ruth O. Szajner, M.D. Akademia Medyczna, Bialystock Family Medicine HealthEast Medical Care for Seniors

Alvin C. Holm, M.D. University of Iowa Internal Medicine Bethesda Rehabilitation Hospital

Medical Students (University of Minnesota)

Kimberly C. Viskocil Cynthia R. Howard, M.D. University of North Carolina Pediatrics University of Minnesota Physicians

RMS Senior Physicians The RMS Senior Physicians Association held its quarterly lunch meeting on July 20 at Bethesda Rehabilitation Hospital. Dr. Richard W. Anderson, President, had arranged for Carol Falkowski, Director of Research Communications at the Hazelden Foundation, to speak to the group about current trends in drug abuse and how it has changed from past years. Fifteen attendees benefited from the program and had many questions for Ms. Falkowski. The next Senior Physicians meeting will be held on Thursday, October 19 in the MetroDoctors

boardroom at Bethesda from 11:30 to 1:00 pm, where Dr. Terrance Capistrant will talk about the Capistrant Parkinson’s Center. Invitations to Senior Physicians meetings are sent out one month prior to the meeting date to each member age 62 and older. The cost is $12/person for lunch and the program, and physicians may bring spouses or other guests. For more information on the Senior Physicians meetings, contact Katie Anderson at (612) 362-3704 or kanderson@metrodoctors.com.

The Journal of the Hennepin and Ramsey Medical Societies


CHAIR’S REPORT JAMES A. ROHDE, M.D.

Much at Stake in an Off-Year Election

HMS-Officers

HMS-Board Members

Alan L. Beal, M.D. Carl E. Burkland, M.D. Peter J. Dehnel, M.D. Sundeep Dev, M.D. Laurie Drill-Mellum, M.D. Raymond A. Gensinger, Jr., M.D. Kenneth N. Kephart, M.D. Frank S. Rhame, M.D. Richard D. Schmidt, M.D. Janette H. Strathy, M.D. Thomas C. Tunberg, M.D. David J. Walcher, M.D. James A. Young, II, M.D. HMS-Ex-Officio Board Members

Michael B. Ainslie, M.D., MMA-Trustee Beth A. Baker, M.D., MMA-Trustee Karen K. Dickson, M.D., MMA-Trustee David L. Estrin, M.D., AMA Alternate Delegate Eleanor Goodall, Co-Presiding Chair, HMS Alliance Donald M. Jacobs, M.D., MMA-Trustee Dawn Lunde, MMGMA Representative Jason Meyers, Medical Student Representative Richard K. Simmons, M.D., Sr. Physicians Association Representative Karin M. Tansek, M.D., MMA-Trustee Trish Vaurio, Co-Presiding Chair, HMS Alliance Benjamin H. Whitten, M.D., AMA Alternate Delegate HMS-Executive Staff

Jack G. Davis, Chief Executive Officer Sue Schettle, Director, Marketing & Member Services Kathy R. Dittmer, Executive Assistant

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NOVEMBER 7, 2006 will be the off-year Election Day here in Minnesota, as well as the rest of the United States. I was looking at that date on a Haitian calendar and it reminded me how fortunate we are to live in a country where we will be participating in our 110th consecutive biannual election. In countries, such as Haiti, which is a republic almost as old as we are, these elections are often postponed due to violence and political unrest, and elections are sometimes invalidated by military or other forces. Even though it is an off-year election, and thus no presidential candidates lead their parties, there is still much at stake. Every Minnesota federal, state constitutional and legislative office is up for grabs except for the Senate seat held by Norm Coleman. Having visited our nation’s capitol each of the last three years, I have learned how much gridlock has developed in both houses of our legislative body. Many reasons can be given, such as the fact that so much weekend time is spent back at home taking care of one’s constituents that Congressmen and Senators do not develop the relationships and rapport that they used to. Also, the political climate has become one of extremes with the two parties being farther apart than they used to be. Whatever the cause, plus the fact that there is usually very little change in Congress, makes for a lack of political progress on some of the issues facing our country. Some of these are quite obvious, such as Medicare and Social Security reform, the National Debt, and now immigration reform. In the statewide races, we should see considerable change due to resignations and an underlying dissatisfaction on the part of the voters. Also, there will be changes in constitutional offices as there is reshuffling going on at that level. We, in Minnesota, are promised almost as much television and radio advertising as we had in the last election when the Presidential race took place and we were a swing state. Lawn signs should be almost as numerous as leaves this fall. So what should we do besides vote on November 7th? First of all, join MedPAC, the MMA’s political voice. Membership starts

The Journal of the Hennepin and Ramsey Medical Societies

at $150 per year and your dollars and names are needed to give us clout with the various politicians. As one of the 24 board members for MedPAC, I have a voice in how your money is spent. At a June meeting we decided that the #1 issue in deciding who got our support would be: Clean Air in the Workplace. We hope to get out a voter’s guide on the stand of the various incumbents and challengers on this issue. If we are effective, we should be able to get a vote on the floor of the State House and Senate, something that has not happened in the past two years that this legislation has been proposed. With a significant change in the legislature we might even get a bill passed and thus join the other 14 states that have “Clean Air” statewide. We are certainly not one of the largest groups financially in the state; however, we are a white hat organization with a good reputation and, thus, our voice may make a difference in a number of races. Secondly, I would recommend that you find a candidate who you find attractive, on whatever level, and contribute time and money to their campaign. An open house is a very big deal for a candidate and most of us would probably be able to do that. As we get involved in the political process, we learn a little more about the issues. It is often our ignorance of the political process and the people running, that has more to do with our dislike for politics rather than the personal traits of our office holders. These people give a lot of their time and effort for something that they believe in and could use a little help from the rest of us. It takes a lot of work to run a successful political campaign and, almost as much or more to run an unsuccessful one. Third, know who your representatives are. Let them hear from you on occasion. This goes for federal, state and local officials. They have to get their information somewhere. If you do not agree with them, still attend their meetings and ask questions, such as why Minnesota is not one of the states that has adopted clean air legislation, (Continued on page 31)

September/October 2006

29

Hennepin Medical Society

Chair James A. Rohde, M.D. President Paul A. Kettler, M.D. President-elect Anne M. Murray, M.D. Secretary Edward P. Ehlinger, M.D. Treasurer Eric G. Christianson, M.D. Immediate Past Chair Michael B. Belzer, M.D.


HMS IN ACTION JACK G. DAVIS, CEO

HMS in Action highlights activities that your leadership and executive office staff have participated in, or responded to, between MetroDoctors issues. We solicit your input on these activities and encourage your calls regarding issues in which you would like our involvement.

MMA, HMS and RMS have established a Pandemic Committee to assure opera-

tional continuation in the event that we experience an avian flu pandemic. The objective is to assure that the three organizations are able to continue serving the members in the event that employees are home bound. Richard D. Schmidt, M.D. orthopedic surgeon at the Veterans Administration Medical Center has been nominated as president-elect by the HMS Nominating Committee. Peter Dehnel, M.D., Isis Stark, policy staff for the American Cancer Society, Sue Schettle and Jack Davis participated in a physician training session in Hudson, Wisconsin. Several Hudson-based physicians are committed to take a leadership role toward a secondhand smoke ordinance in Hudson.

Jack Davis attended the introduction and launch of the Medical Arms Race Syndrome (MARS) Series put on by former U.S. Senator Dave Durenberger and the National Institute of Health Policy. The series is designed to examine how advances in medical technology contribute to the rapid rise in health care costs. The Minnesota Medical Group Management Association held its summer meeting in Duluth, Minnesota on July 26, 27 and 28. The Hennepin Medical Society and the Ramsey Medical Society again this year paired with the Minnesota Medical Association as a Gold Sponsor of the event. All three organizations had a booth in the exhibit hall of the conference with Sue Schettle staffing the 30

September/October 2006

booth. Both she and Jack Davis also attended a number of educational sessions that were offered throughout the three day conference. Sue Schettle attended the 13th annual World Conference on Tobacco or Health in Washington, DC July 11, 12, 13 and 14. The conference attracted tobacco control advocates from across the globe and provided further evidence of the need to continue on the road of tobacco prevention. Much of what the United States has experienced over the past 40-50 years in terms of the tactics that are used by the tobacco industry are clearly happening in other parts of the world. This conference allowed those working on tobacco prevention to share from each others’ experiences and to learn best practices. Over 4,000 advocates, physicians, scientists, elected officials, educators and many others attended the conference despite the sweltering heat. In 2007, the National Conference on Tobacco or Health will be held in Min-

neapolis, Minnesota, which happened as a direct result of the smoke-free ordinance that HMS physicians were so crucial in helping to enact. Sue Schettle, Director of Marketing and Member Services for HMS, provided a presentation to a group of physicians and other health care workers at Queen of Peace Hospital in New Prague, MN. Sue was accompanied by staff from the Minnesota Medical Association who provided a legislative overview of health care issues. Ms. Schettle advised the physician group about the work that HMS has been involved in, and also made note of HMS’ upcoming plan to work on secondhand smoke prevention in Scott County, where New Prague is located.

I

t’s my unhappy duty to inform you that Sue Schettle has decided to leave the Hennepin Medical Society and pursue an opportunity at the Ramsey Medical Society. Sue will be taking over Ramsey’s tobacco projects in Dakota and Washington Counties and their for profit and membership activities. Roger Johnson, current RMS CEO, is planning to retire in 2007. We will miss Sue’s strong work ethic, terrific organizational skills, her knowledge of the medical community and her professional attitude. The good news is that Sue will continue to be involved in HMS and RMS’s important joint activities. It’s my expectation that Hennepin and Ramsey will continue, and look for additional opportunities, to expand the collaboration we’ve developed over the last several years. Working together has created significant dividend and value for the combined membership. I’m sure that you will all join me in congratulating Sue on her new position, wishing her good fortune and thanking her for the terrific job she’s done on behalf of the membership of the Hennepin Medical Society. Jack

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The Journal of the Hennepin and Ramsey Medical Societies


HMS NEWS

Erik N. Cressman, M.D.

Brian T. Sick, M.D. Pediatrics

Kathryn J. Curdue, M.D.

New Members HMS welcomes these new members to the Society.

Active

Angela K. Fitch, M.D. Fairview Eagan Clinic Internal Medicine Mohammed I. Hussain, M.D. Timothy P. Singleton, M.D. University of Minnesota Dept. of Lab. Med. & Pathology Pathology-Anatomic/Clinical Lisa A. Spatz, M.D. Fairview Hiawatha Clinic Family Medicine

University of MN Physicians Indu Agarwal, MB,BS Neonatal-Perinatal Medicine Rafael S. Andrade, M.D. General Surgery

Robert M. Sweet, M.D. Urology/Urological Surgery

Daniel A. Duprez, M.D. Cardiovascular Diseases

Marcie R. Tomblyn, M.D. Hematology/Oncology

Jeffrey A. Dvergsten, M.D. Pediatrics

Alexander M. Truskinovsky, M.D. Pathology-Anatomic/Clinical

Ronald A. Furnival, M.D. Pediatrics

Herbert B. Ward, M.D., Ph.D. Cardiovascular Surgery

Daniel H. Gruenstein, M.D.

Alison M. Warford, M.D. Family Medicine

Chadwick P. Huckabay, M.D. Urology/Urological Surgery Farha S. Ikramuddin, MB,BS Bariatric Surgery

Patricia L. Judson, M.D. Gynecologic Oncology Harsohena Kaur, M.D. Anne E. Kilby, M.D. Kenneth S. Koeneman, M.D. Urology/Urological Surgery Sanjiv Kumra, M.D. Karen B. Larsen, M.D. Pathology-Anatomic/Clinical

John S. Andrews, M.D. Afshan Anjum, MB, BS Psychiatry

Diane J. Madlon-Kay, M.D. Family Medicine

Ioanna Apostolidou, M.D.

Antoine A. Makhlouf, M.D.

Johanna S. Archer, M.D. Reproductive Endocrinologist

Scott B. Marston, M.D. Orthopaedic Surgery

Joseph J. Arcuri, M.D. Internal Medicine

David H. McKenna, Jr., M.D. Pathology-Anatomic/Clinical

Jonathan P. Braman, M.D. Orthopaedic Surgery

Peter V. Milev, M.D. Psychiatry

Lawrence Chinsoo Cho, M.D. Radiation Oncologist

Brandon M. Nathan, M.D.

Adina M. Cioc, M.D. Pathology-Anatomic/Clinical

MetroDoctors

Cristina A. Baker, M.D. Internal Medicine

Lyle D. Joyce, M.D., FACS Thoracic Surgery

Michael S. Lee, M.D. Ophthalmology

Catherine L. Chun, M.D. Phy. Medicine & Rehabilitation

Resident Physicians

Jennifer L. Petrie, M.D. Family Medicine Richard C. Prielipp, M.D. Anesthesiology Aseem R. Shukla, M.D.

The Journal of the Hennepin and Ramsey Medical Societies

In Memoriam DAVID M. HOLTH, M.D. died recently at the age 56. He graduated from the University of Minnesota. Dr. Holth practiced family medicine. He joined HMS in 1981.

(Continued from page 29)

such as New York, Florida, Arizona and California. Finally, when this is all over, get out and vote on November 7 and encourage your office staff, family members and friends to do the same. So often our off-year elections are poorly attended and it is the minority that decides our political agenda for all of us. It was exciting to see, in Haiti, with violence and illiteracy underlying the political process that people were still at the polls hours before they opened and the lines were often ½ mile or longer. People stood in line into the night to cast their vote in conditions that were much less pleasant than in our typical precinct. As this is my last column, as your Board Chairman, I would like to thank all of you for the opportunity these past three years in representing Hennepin Medical Society and, especially, for the opportunities to go to Washington and learn more about the political process.

HMS Senior Physicians Association

S

ixty-three people turned out at the June 13 meeting to hear Joel Maturi, Director of Athletics of the University of Minnesota. This was one of our largest groups in quite a while. He energized the group with his enthusiastic presentation and shared his challenges and adventures throughout his career. Maturi has led a department that has produced 412 Big Ten All-Academic selections the past two years, the highest two-year total in the history of athletics at Minnesota. Over 50 percent of Gopher student-athletes maintain a grade point average of 3.0 or higher. To become a member of the Senior Physicians Association or to learn more about membership in this association, contact Kathy Dittmer at (612) 623-2885 or e-mail her at kdittmer@ metrodoctors.com. You can Richard E. Streu, M.D., President, Sr. also visit our Web site at Physicians Association and Joel Maturi, www.metrodoctors.com. Director of Athletics at the U of M. September/October 2006

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Hennepin Medical Society

Stanley E. Davis, M.D. Obstetrics & Gynecology

Thiruvenkatasam Dhurairaj, M.D.

HMS Chairâ&#x20AC;&#x2122;s Report


HMS ALLIANCE NEWS ELEANOR GOODALL

Why Do We Belong to the Alliance?

I

INTERESTING QUESTION. Why do we belong to the Alliance? We all lead busy lives and, as I’ve heard it said, we all work, with some of us punching a time clock for others, and some punching it for ourselves. So, with everything else that’s going on in our lives, why do we volunteer our time, effort, energy to the Hennepin Medical Society Alliance? I can only speak for myself but, in general, I think I probably speak for most of our members. In very broad terms, I’d like to leave the world a little better place for my having been here. Too big a goal to chew on? Let’s break it down into bite-sized pieces. We are a country rich in resources — natural resources, industrial and manufacturing resources, intellectual and cultural resources. But, perhaps our most important resource is our children. We all want to ensure that this resource, children, has the best possible opportunity to thrive and realize its potential. These kids are the future of our country. We need them to grow into strong, productive citizens. It is a huge job and we’re not the only ones working on it. But, the Alliance has, over the years, been in a position to influence kids, to

Dianne Fenyk was intstalled as the 2006-07 AMAA president-elect in June in Chicago.

get them thinking about healthy choices that lead to strong bodies and clear minds. Over the years, thousands upon thousands of kids went through the booths at the HMSA Health Fair, and hopefully gained some knowledge about how their bodies work and how to keep them in good working order. Even more thousands of kids, with generous help from the Hennepin Medical Society Foundation, continue to receive the HIV/AIDS folder, and hopefully absorb the messages about healthy and wise

lifestyle choices. Are we solving all these problems? Of course not. But we can say that we are trying! This is one of the reasons why we do what we do. This is why we volunteer our time, energy, talents and resources to the Alliance. I spent 25 years working in the non-profit sector and I’ll always recall the words of my first employer, who stated very simply: “We all want to leave the woodpile a little higher.” I’d like to take this opportunity to encourage all spouses of physicians in the Metro area to come to the Hennepin Medical Society Alliance opening event. We invite you to participate in the Alliance at whatever level best fits with your life at this time. Help us “leave the woodpile a little higher”! Oh, I forgot to mention, in addition to doing good works, we also have fun. Come on out and spend a little time with us. We welcome all of you.

Join us for the

HMS Alliance Opening Event

HMS CEO Jack Davis, Conrad Schiebel, 2006-07 MMAA president and Eleanor Goodall, 2006-07 HMSA co-president at the HMSA 2006 Annual Meeting.

Friday, September 29 10:00a.m.—1:00p.m.

Arneson Acres Park, 4711 West 70th St., Edina, MN For more information, contact Kathy Dittmer (612) 623-2885

32

September/October 2006

HMSA member Marlene Ellis receives the 2006 MMAA Karen A. Tourdot Community Service Award.

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies


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Awesome 2-Story Loft

Available for the 1st time in over 50 years! Features include exquisite original details with grand public rooms, expansive gardens and breathtaking views of park and Lake of the Isles. A distinguished residence with amazing grandeur. 6 bedrooms, 9 baths. $3,795,000

One of the finest contemporary homes found in Minneapolis. Features unparalleled custom finishes, roof top entertainment room with skyline views, courtyard, fantastic master and renovated lower level with wine/humidor room. 4 bedrooms, 5 baths. $2,295,000

Award winning ASID home completely renovated with all the bells and whistles you can imagine. Features grand public rooms, superb master, a true gourmet kitchen, wine cellar, billiards room and rare park-like back yard. 6 bedrooms, 7 baths. $3,195,000

Elegant Lake of the Isles home with ornate original woodwork and leaded windows. Large public rooms, new baths, porch and roof. Great 3rd floor family room/amusement room, awesome lake views, landscaped yard and more. 5 bedrooms, 5 baths. $2,195,000

Magnificent Humboldt Loft with panoramic views of downtown and the new Guthrie Theater. Features floor to ceiling windows, hardwood floors, vaulted ceilings, gourmet kitchen with stainless appliances and pantry, spacious closets and patio. 3 bedrooms, 3 baths. $1,995,000

Sophisticated Urban Oasis Dramatic views over downtown Minneapolis skyline and Walker gardens. Polished finishes detail this exclusive 4,300 sq ft. home in the much acclaimed 301 Kenwood Parkway building. 3 bedrooms, 3 baths. $3,250,000

Think outside

the box... THINK COURAGE CENTER FOR • Neurorehabilitation–specializing in spinal cord and brain injuries and stroke • Medical conditions causing pain and/or activity limitation–arthritis and fibromyalgia • Individualized care plan for your patients’ needs • Trusted and experienced professionals Courage Center partners with all healthcare systems throughout Minnesota. Use our professional staff and nearly 80 years of experience to help your patients improve quality of life. Visit courage.org or call 763.520.0312

Call: Bruce Birkeland

612-925-8405 www.brucebirkeland.com


Continuing Medical Education Promoting a lifetime of outstanding professional practice

PRIMARY CARE FOCUS

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ALSO OFFERED

Neuropathic Pain: Mechanisms, Evaluation, and Management September 8, 2006

Endorectal Ultrasonography Workshop September 6, 2006

Annual Psychiatry Review: ImpulsiveCompulsive Spectrum September 25-26, 2006

Geriatric Trauma Summit September 15-16, 2006

Hand-Assisted Laparoscopic Colon Resection Workshop September 6, 2006

E. T. Bell Fall Pathology Symposium November 3, 2006

Twin Cities Marathon Sports Medicine Conference September 29-30, 2006 Internal Medicine Review and Update 2006 October 11-13, 2006 Obstetrics, Gynecology and Women's Health October 12-13, 2006 Emerging Infections in Clinical Practice and Public Health November 2-3, 2006

Colon & Rectal Surgery: Current Principles and Practice September 7-9, 2006 Endourology & Urologic Laparoscopy October 9-10, 2006 Pancreas Transplantation Symposium December 8-9, 2006

For more information contact: Office of Continuing Medical Education 612-626-7600 or 1-800-776-8636 email: cmereg@umn.edu Check out our full course calendar or register online!

www.cme.umn.edu

Borderline Personality Disorder - Clinical and Family Perspectives November 4, 2006 Thoracic Oncology and Primary Care November 10, 2006 Lysosomal Disease Network: WORLD Symposium 2006 December 7-9, 2006 *In Orlando, Florida

237550.final.optimized  

patients, because we do the same. We take the fight well beyond. oncology — all working together to treat the whole patient, not therapeutic...