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Medical record BERKS COUNTY MEDICAL SOCIETY
Perseverance through a persistent
NALOXONE The “Pay it Forward” Medication PAMED Congratulates Berks County’s Dr. Shawn White
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Medical record BERKS COUNTY MEDICAL SOCIETY
A Quarterly Publication
To provide news and opinion to support professional growth and personal connections within the Berks County Medical Society community.
Berks County Medical Society MEDICAL RECORD
Raymond C. Truex, Jr., MD, FACS, FAANS, Co-Editor Lucy J. Cairns, MD, Co-Editor
D. Michael Baxter, MD Shannon Marie Foster, MD, FACS Jillian Ventuzelo, DO T. J. Huckleberry, MPA William Santoro, MD, FASAM, DABAM Raymond C. Truex Jr., MD, FAANS, FACS
Need for Stress Management Exacerbated by Pandemic, An Excerpt
14 In Their Own Words 16 Poem by Johanna Kelly, MD, Pediatrician, Reading Pediatrics Group
Jillian Ventuzelo, DO President William Santoro, MD President Elect Kristen Sandel, MD Chair, Executive Council Ankit Shah, MD Treasurer Jin Xu, MD Secretary Michael L. Haas, MD Immediate Past President T. J. Huckleberry, MPA Executive Director
Berks County Medical Society Phone: 610.375.6555 | Fax: 610.375.6535 Email: firstname.lastname@example.org www.berkscms.org
The opinions expressed in these pages are those of the individual authors and not necessarily those of the Berks County Medical Society. The ad material is for the information and consideration of the reader. It does not necessarily represent an endorsement or recommendation by the Berks County Medical Society. Manuscripts offered for publication and other correspondence should be sent to 2669 Shillington Rd, Sinking Spring, PA 19608, Ste 501. The editorial board reserves the right to reject and/or alter submitted material before publication. The Berks County Medical Record (ISSN #0736-7333) is published four times a year by the Berks County Medical Society, 2669 Shillington Rd, Sinking Spring, PA 19608, Ste 501. Subscription $50.00 per year. Periodicals postage paid at Reading, PA, and at additional mailing offices.
25 PAMED Legislative Update 30 Welcome New Member Daniel Edwards, D.O.
18 Naloxone - The “Pay It Forward” Medication 20 PAMED Congratulates Berks County’s Dr. Shawn White
31 Member in the News Charles F. Barbera, MD, MBA, MPH, FACEP
21 A Sample of Physician Wellness Resources from Tower Health
32 Welcome New Member Tory Snyder, D.O.
22 Vaccinations for Children!
34 In Memoriam
24 Summer 2022 - Berks County Medical Society’s Pat Sharma President’s Scholarship
Berks County Medical Society BECOME A MEMBER TODAY! Go to our website at www.berkscms.org and click on “Join Now”
Berks County Medical Society Officers
In Every Issue 4 6 8
A Message from the Berks County Medical Society Editor’s Comments Compass Points
Content Submission: Medical Record magazine welcomes recommendations for editorial content focusing on medical practice and management issues, and health and wellness topics that impact our community. However, we only accept articles from members of the Berks County Medical Society. Submissions can be photo(s), opinion piece or article. Typed manuscripts should be submitted as Word documents (8.5 x 11) and photos should be high resolution (300dpi at 100% size used in publication). Email your submission to email@example.com for review by the Editorial Board. Thank YOU!
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Berks County Medical Society
Preaching to the Choir by T.J. Huckleberry, MPA, Executive Director
n the throws of perhaps our nation’s greatest crisis – where division, catastrophic loss of human life, sacrifice, instability, and unrest were rampant – a great man wrote this to a friend:
“I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on the earth. Whether I shall ever be better I cannot tell; I awfully forebode I shall not. To remain as I am is impossible; I must die or be better, it appears to me.” Perhaps the writing style gave it away or perhaps it was my hints to division, loss, etc., but that man was Abraham Lincoln. And if there was one person who would be able to understand the current stress and hardship facing those in the medical field, it would certainly be President Lincoln. After all, this was a leader who was tasked with trying to manage some of the most unimaginable situations in our history.
you are needed,
you are appreciated, and when history looks back on this pandemic… you will be the hero.
What I found particularly important about this quote was not that the most powerful individual in the country was dealing with depression, but it was the courage he had to put pen to paper to express his current inward state. In time of war, political upheaval, and global pressures, he spent ten minutes sharing his depression with a friend. The words “Lincoln” and “honest” are almost synonymous and — case in point — he was very much honest with himself and with his friend. I’d like to think that once the President wrote this down and sent it out, he felt a little better. And although I am not aware of any response, I’d like to think he was given some needed encouragement from his friend.
I bring up President Lincoln to a group of medical professionals because, like our leaders, people do not expect you to have burnout, or anxiety, or depression. You are the healers; you should be able to heal yourself. But we all know this is not true. Like Lincoln, you are both human and carrying burdens that perhaps you were not truly prepared to shoulder. I realize I am very much preaching to the choir; I am sure these words are insufficient. This note is an acknowledgement, not a solution, though I am trying like hell to find some for all of you. Please know from me — as your patient, as your employee, as your neighbor, and as your friend — you are needed, you are appreciated, and when history looks back on this pandemic… you will be the hero. In the meantime, please find ways to take care of yourself, perhaps follow Lincoln’s example and confide in a friend, take ten minutes to just breathe, get out and walk, do something that brings you happiness. Your mental health must be paramount. 4 | www.berkscms.org
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by D. Michael Baxter, MD, FAAFP
“Exhausted!” That is the response to the question “How are you feeling?” that I hear most frequently from colleagues, especially those on the front lines as we are about to begin our third year of the Covid-19 pandemic. While the entire health care system is in a state of duress, our front-line staff — emergency physicians, in-patient specialists and hospitalists, urgent care and primary care physicians--have practiced through an unprecedented time of illness, hospitalizations, deaths, and staff shortages, exacerbated by a distressing degree of community resistance to following public health and medical advice. These conditions have led to mental and physical fatigue, creating the perfect storm for professional burn-out. Who wouldn’t be facing such feelings in this current environment? Even under ideal conditions, physicians and our fellow health care professionals face many stressful challenges, and these times are far from ideal. As the Delta, then the Omicron variants of SARS-CoV-2 have inundated Berks County like a viral tidal wave, we have surpassed or matched the highest numbers of daily case positivity rates (1000+ daily), hospitalizations (nearly 250 between Reading Hospital and Penn State St. Joseph’s) and employee and school absenteeism since the onset of the pandemic in early 2020. Due to (perhaps) the unique characteristics of the Omicron variant and the development of proven medical therapies, as well as the distribution of safe and effective vaccines to ages five and above, only deaths seem to be underrepresented in our record-breaking statistics. However, as
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fatalities always lag behind the other statistics, this may prove to be a temporary reprieve. In this issue of the Medical Record, five Berks County physicians share their candid thoughts regarding their lives with the pandemic. One can hear as they express “In Their Own Words” not only their exhaustion but also the frustration, anxiety, and helplessness experienced as they face long hours, depleted staffs and patient denial fueled by an unprecedented atmosphere of misinformation and distrust. Public health experts are vilified, and doctors challenged by those carelessly misrepresenting facts and pursuing their own self-interest at the expense of the good of the greater community. Many with no scientific background consider themselves “experts” and are promoting actions which worsen and prolong this pandemic. Several Pennsylvania State Legislators have even proposed a change in the Pennsylvania Constitution that would create a “right to medical freedom” that would effectively outlaw all vaccine mandates, including those that have been required of children for generations. They have probably not seen a child with severe respiratory distress and intractable coughing from pertussis (whooping cough), life threatening cases of bacterial meningitis, or the sequela of childhood polio. I have, and it was devastating to the children and their parents and heart-breaking to the medical staff who provided care. The end of such vaccine mandates would set public health back 100 years.
When facing such challenges, including the financial crisis of one of our major health systems, coupled with extreme fatigue and the knowledge that the uncertainty of a pandemic means the situation can always get worse before it truly improves, who would not be “burned out”? In fact, we are probably now facing an epidemic of healthcare worker burn-out unlike anything we have previously faced. In this edition we explore this topic with one of our expert resources, Edwin Kim, MD, the medical director for the Physicians’ Health Program (PHP) sponsored by the Foundation of the Pennsylvania Medical Society (PAMED). Dr. Kim offers an empathetic approach to the recognition and treatment of this pervasive, yet all too pernicious and debilitating condition. These are truly unprecedented times. It has been over one hundred years since our community faced the challenges of such a devastating pandemic. Of course, during the 1918-19 Influenza Pandemic, physicians had many less tools than we have. From the historical record we know that they put their own health at risk, faced long, exhausting hours of patient care, and watched patients succumb to a terrible disease in spite of their heroic efforts. Our physicians and their colleagues today face many of the same challenges but in a more demoralizing atmosphere, inundated by political partisanship and misinformation. We can expect that our current situation will improve as we evolve from a pandemic to an endemic phase; however, many questions persist. Will new variants arise and will they be more or less virulent and will they be susceptible to our current and future vaccines? Will vaccination rates rise in the US and around the world as our best chance to “manage” this virus? Will “natural immunity” from infection boost our long-term resistance to the current and future variants? What level of morbidity and mortality are we willing
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to accept as we adjust our behaviors in order to return to a “more normal life”? Will politics continue to interfere with sciencebased public health policy? We face many uncertainties; however, one thing I know for sure. Just as our
physician predecessors overcame the barriers of their time, I feel certain that our current generation of physicians, nurses, and our other essential colleagues will persevere and see this pandemic through to its eventual conclusion. Fortunately, our most important resource is each other.
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C o m pa s s P o i n t s
New Directories coming in March 2022 T.J. Huckleberry, MPA Executive Director
Physicians! JOIN NOW TO BETTER PROMOTE YOUR PRACTICE!
s a public service project, BCMS and Hoffmann Publishing continue to work together to produce our Community Health and Wellness Directory. Over the past several years this directory has been in print form and has been heavily utilized by patients and practices alike. Our Directory provides a comprehensive listing of nearly all Berks County Physicians, Physician Groups, Health Specialists, Regional Hospitals, Pharmacies, Healthcare Service Providers, Local Legislators, Assisted Living Facilities, and Area Social Service Agencies. This year, to continue providing more value for our members and Berks County we are proud to announce that an enhanced, searchable, mobile-ready digital directory will be accessible online, and available to every community resident as a community resource tool to assist in finding providers and services.
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So, please make sure your 2022 membership is in good standing. This directory will also be a substantial benefit to early career and new physicians to our area. The Community Health and Wellness Directory is produced solely with the advertising dollars generated by and from our community partners who are listed in the print and online versions. Please support and thank these partners where possible. We invite you to consider advertising/sponsorship, or other ways that you may help the BCMS extend this public service project. Contact TJ Huckleberry for further information. Advertising/ Sponsorship opportunities are still available through February 14, 2022.
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M e d i c a l R ec o r d F e a t u r e
Stress Management Exacerbated by Pandemic, An Excerpt by David A. Kostival, contributing writer to Philadelphia Medicine
s the United States exceeds 800,000 COVID-19 deaths, it’s important to recognize the number reflects only deaths resulting directly from complications caused by COVID-19.
It does not account for deaths resulting from drug overdoses or suicides as an indirect result of the pandemic. And while we look to medical caregivers to help us safely navigate through the ongoing effects of the pandemic, physicians are not exempt from the stress. The American Hospital Association says about 400 physicians die each year from suicide, and that hundreds more have serious thoughts of suicide. WebMD states that about one doctor a day commits suicide in the United States every day, which translates to the highest suicide rate of any profession. The suicide rate in the general population is 12.3 per 100,000 people, while the number of doctor suicides is between 28 to 40 per 100,000.
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Monitoring and advocacy The Foundation of the Pennsylvania Medical Society’s premier program is the Physician’s Health Program (PHP). PHP provides monitoring and advocacy for physicians who have substance abuse disorders, mental health issues, or behavioral concerns that impact their ability to practice their profession safely. Dr. Edwin Kim, MD, MRO, serves as the medical director for the PHP. Kim said that prior to the pandemic, physician burnout had already become a growing concern. “This was certainly exacerbated over the last two years,” he said. “Even physicians who are inherently resilient are at risk of neglecting their physical and mental health.” Kim said some large health systems and academic centers have started programs to provide avenues for their physicians to seek additional support. continued on page 12
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Need for Stress Management Exacerbated by Pandemic, An Excerpt continued from page 10 “This included ways to engage mental health or counseling resources available to their employees,” Kim said. But not all physicians work in a large group setting where structured support systems exist. For those situations, Kim said state and county medical societies or professional specialty associations have stepped up to create resources and toolkits for their constituencies, particularly independent practitioners and those in smaller group practices. “We have even seen grassroots, physician-led support groups arise early in the pandemic,” Kim said. “I think increasing awareness of these programs and tools is crucial.”
Dr. Kim responds to questions by David A. Kostival. 1. With the COVID-19 impact on health systems, how difficult has it been for physicians to deal with the stress? I think many physicians have felt the impact of COVID-19 both directly and indirectly. Whether they are in private practice, group settings, or in large health systems, physicians have been meeting challenges in their clinical and administrative work. An obvious strain has been placed on patient care for those on the frontline working in urgent cares, emergency rooms, hospital wards and intensive care units. Outpatient practices similarly have had to adopt new methods of delivering care to keep everyone safe. Not only are we concerned about patient care, but physicians also hold a level of responsibility for their staff members’ well-being. Executive leaders, directors, and managers have worked relentlessly to interpret guidelines and regulations while trying to provide safe working environments to best provide continuity of care. 2. What are some of the most common situations physicians have had to face during the pandemic, which often resulted in a compromise of their own mental or physical health? Our physicians who are working on the frontlines of the pandemic have shown great resilience in meeting the needs of their patients given limited resources, whether that’s clinical time, physical space constraints, equipment availability or ancillary staff support. Looking outside the walls of inpatient care, the flow of patient care continuity was disrupted. Outpatient clinics had to adopt new methods of delivering care, particularly telemedicine, to maintain safe distancing. This provided increased accessibility to care for many patients, however, there was a drop in crucial face-to-face visits for a long time. Delays in obtaining radiological or laboratory studies, which are crucial for patient care, were seen throughout most of the pandemic. We continue to see the impact of this today. We saw delays in onboarding new physicians and the early retirement of late-career physicians, and I believe we are still facing a physician shortage in key service areas of patient care. This
12 | www.berkscms.org
all contributes to increased demands on established physicians who are left to carry out the important work to ensure continuity of care. Prior to the pandemic, physician burnout has been a growing concern for many. This was certainly exacerbated over the last two years. Even physicians who I believe are inherently resilient are at risk of neglecting their physical and mental health when rising to the challenges over the last couple of years. 3. What types of support systems are available for physicians who find it increasingly difficult to practice medicine during the pandemic? I think the important issue isn’t necessarily the access or availability of resources for physicians. We have spoken with executive leadership, medical directors, administrators, and clinicians who have asked that same question. Early in the pandemic, large health systems and academic centers tasked their Employee Assistance Programs or created working groups to provide avenues for their physicians and family members to seek additional support. This included ways to engage mental health or counseling resources available to their employees. Not all physicians work in a large group or setting where there is a chief wellness officer or wellness group, who are typically the champions of creating structured support systems. We see the state and county medical societies or professional specialty societies stepping up and creating their resources and toolkits for their constituencies, particularly independent practitioners and those in smaller group practices. We have even seen grassroots, physician-led support groups arise early in the pandemic. I think increasing awareness of these programs and tools is crucial. We continue to hear about the under-utilization of programs and support systems across the board. 4. What are some of the things doctors should be doing to make sure they stay well during difficult times? Overcoming the challenges of COVID-19, workplace burnout, or mental health strain isn’t limited to ameliorating symptoms. In other words, preventative measures go a long way to help preserve physical and mental health. Maintaining healthy diet, exercise and sleep have never been more important to mitigate the effects of what can become chronic stressors. Sometimes physicians put their own health last and have forgotten that they too can ask for help. Seeking professional help, asking your peer groups and leadership for more assistance or resources is key. Doctors also have responsibilities outside patient care. Asking for help for support in their personal lives is paramount. In addition to occupational stress, we face the same challenges and concerns about our family and friends. Maintaining connection with social networks can help combat the feelings of loneliness. Even if you do not feel impacted, you may have practiced or trained with someone who could use a check-in.
5. What are some of the warning signs doctors need to watch for in protecting their own mental health (as a result of the pandemic)? Doctors should be alert to low mood which persists over time. Disruptions in sleep and appetite are clear signs that there is a stress occurring either physically or mentally. Conduct a daily or weekly personal check-in. A physician may be facing burnout if one is finding it more difficult to recognize their passion for medicine, recognize increasing feelings of cynicism towards their profession, feelings of dread or unrelenting fixation on past difficult clinical situations, or a sense of distrust towards coworkers or leadership. The use of substances, increased use of alcohol, or the inability to cut down on alcohol, gambling or other uncontrolled behaviors can be warning signs of uncontrolled stress or strained mental health as well.
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6. Is the overall impact of COVID-19 on doctors improving? Or will the ongoing aspects of the pandemic continue to negatively stress and burn-out medical workers? There is a lot of resiliency in the physician population. The process of springing back takes time depending on their individual circumstance, but I believe many will learn from the pandemic and be able to reframe this in a productive way. As a whole, the healthcare system has been tested and we know our weaknesses. There are a lot of strengths to be recognized and propagated in the things that we did well. Time is key here. Staff shortages are still prevalent, and I believe it will take time to replenish the healthcare workforce. Healthcare is not only about physicians; our colleagues, valued staff members and leadership face their own struggles. Until all the parts of the whole have recovered, physicians are at risk of experiencing the negative impacts of stress or burnout. 7. What are some steps hospitals should be taking to address the overall well-being of their medical workers during the pandemic? Like I said, resources and toolkits are available to their employees. Hospitals have been aware of the under-utilization of employee resources. I think part of this is perceived stigma of asking for help, more importantly asking for help within their workplace settings. Moving forward, hospitals can aim to identify ways to increase the ways and frequency at which their employees utilize services benefitting their mental health. Perhaps this is an opportunity for our Berks County hospitals and academic centers to create an inter-institutional solution. If a hospital hasn’t done so already, the creation of a chief wellness officer, wellness group, or taskforce can be a great first step in addressing the needs of their employees.
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M e d i c a l R ec o r d F e a t u r e
In Their Own Words
Five local physicians share their feelings on the realities of a persistent pandemic. Introduction by Michael Baxter, MD
s SARS-CoV-2 resurges due to the Delta and more recently the Omicron variants, we are about to enter the third year of the
Covid-19 pandemic. The suffering and lives lost and the economic and social disruptions that we have experienced would have been unimaginable just a few years ago. In the midst of this medical and social turmoil stood thousands upon thousands of health care workers around the world who have placed their
Emergency Department (ED) staff have borne the brunt of this pandemic for over 18 months. Our staff is exhausted. Exhausted from patients refusing testing to get admitted. Exhausted of patients who refuse to get vaccinated, but then end up in the ED needing lifesaving and heroic therapies. Exhausted from seeing colleagues quit the front lines because the mental and emotional toll has been too high. Exhausted from patients and families screaming at staff because of the results of their Covid test. Exhausted from staff shortages. Exhausted at going from being a “hero” early on to being a “zero” now. Exhausted that there are people still convinced that this is no worse than the “flu” (big hint—it is worse!). Exhausted that there is no end in sight, despite a vaccine to reduce the need for ED and hospital interventions. Exhausted at a vaccination rate that isn’t “good enough” to help the population be safe from this virus. — (Prefers to remain Anonymous)
own lives and their physical and mental well-being at risk. All this while facing the trauma of watching patients succumb to this disease and experiencing endless hours/days of exhausting and exasperating work treating disease and mending the lives of countless affected patients. And after all that they have experienced, the end is not yet in sight. In this issue of the Medical Record, we have asked five of our local physicians from the disciplines of Emergency Medicine, Pediatrics, Family Medicine/ Community Health, Hospital-based Internal Medicine and Addiction Medicine to describe their experiences over the past two years. Here is their response “In Their Own Words.”
14 | www.berkscms.org
Wave four Omicron—the wave that was not supposed to be. We had the miracle vaccine and enough to vaccinate the country. Anyway these pandemics burn themselves out at 18 months, right? Yet here we are, in the perfect storm of a hospital financial crisis, critical staff shortages, following lay-offs and better salaries elsewhere, with a more infectious variant with a predilection for those who did not buy into the science behind vaccines, who now seek care while frequently challenging our medical decisions at every turn. It’s almost as if someone made a sequel to a bad movie that you disliked the first time but find yourself watching with buyer’s remorse. Same plot, mild new twists, but compounded with emotional exhaustion. — Anthony Donato, MD, MACP Associate Program Director, Internal Medicine Residency Program Reading Hospital/Tower Health
At the beginning of the Covid-19 pandemic many of us in Primary Care watched as our colleagues in long term care facilities, hospitals, and emergency rooms were overwhelmed as they struggled with the increasing number of patients becoming ill. In December 2020 when the first Covid-19 vaccine was approved under emergency use authorization, Federally Funded Community Health Centers knew we had a very important role to play in the battle against Covid-19 by providing access to the vaccine and testing— both critical steps in keeping our communities safe. Since our vaccination effort began, we have vaccinated over 20,000 patients. We realized that inequities in health care are often exacerbated during periods of crisis and we were determined to address such disparities. Recognizing that the homeless population most likely would not come to vaccine clinics we went to them. Understanding that there was distrust among underrepresented minority groups, we partnered with the Latino connection and African American churches to bring vaccines to their sites. We sent vaccine teams to the homebound, to jails, local school districts and partnered with dialysis and drug treatment centers. As Berks County’s only Federally Qualified Health Center, we did our best to address the needs of Berks County and especially our underserved population. Like many others during this pandemic, my family and I faced our own health struggles. I lost both my mother and mother-inlaw to cancer and my family battled Covid-19 infections. As Chief Medical Officer at the Berks Community Health Center, one of my primary roles was to put protocols in place to protect patients and staff from the virus; however, I never felt 100% safe. In spite
I don’t know how to put into words how busy and overwhelmed we have been. We are discouraged by all the people who are not willing to do their part to end this pandemic. The people who made masks optional at schools and the people who refuse to consider vaccinating to decrease the load of really sick people hitting our hospitals and infecting our families often don’t consider the big picture when making their “personal choices.” We are all resigned to the fact that we will get Covid this go round as it is so contagious. We just hope we don’t all get sick at once as we serve a lot of kids for many reasons besides Covid. We had an 80% positivity rate in the office the other day among the kids we tested. It is the worst we have seen. We also have so many patients struggling with their mental health. The staff at Reading Pediatrics has been
of all of my efforts, one of my children brought Covid-19 into the family. Although several of his friends developed mild cases, his was more severe with many sleepless nights monitoring his condition, listening to him cough, and watching his pulse oximetry fluctuate. Fortunately, he recovered but then my husband and I both contracted the virus and dealt with many stressful moments although we were able to recover at home. During my illness, I spent time isolated from my family and watched my mother’s health decline. I recognized that neglecting my own health put me at further risk. Why do I share this? Because I have read on social media posts about how kids were able to get together all summer and no one got sick. I know that is not true. I lived with the fear that someone in my household, even I, would become even sicker and die, an event experienced by all too many. Because I want all to recognize that these are not normal times and we all must change our behaviors to decrease our risk of Covid-19 and to understand that wearing a mask is not a political statement but a sign that you care about your community as is a decision to get vaccinated. Because I realize that every death represents a life, a story of a grandparent, a child, a spouse or a friend. Such suffering and pain are immeasurable. Finally, I share this to thank all of our medical community who have worked so hard and never stopped putting patients’ needs above their own. — Mary Kelleher, MD Chief Medical Officer Berks Community Health Center
absolutely incredible and has stepped up in ways that would amaze everyone. We cannot meet the need right now for answering phone calls or seeing all the patients that need to be seen. We need understanding and support from the community. We had 90 calls at 5:00 PM recently and only two appointments left. People will be disappointed but all the choices we have made collectively as a community have brought us to this point. I have been inspired by all of my medical colleagues all over Berks County and hope for everyone’s sake that this surge settles quickly and that people can bounce back from the extreme stress it has brought upon all of us. — Johanna Kelly, MD, Reading Pediatrics
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In Their Own Words continued from page 15
As the omicron variant became the dominant viral strain during the Covid-19 pandemic, people were already very “COVID fatigued.” Perhaps due to the success of vaccination efforts, the easing of mask requirements and restrictions on businesses and schools or the perception that omicron appears less lethal than previous variants, the public has become less vigilant and more accepting of Covid disease. What they do not realize is that because omicron is more transmissible, more people are getting sick, and even though more may not be dying, the healthcare system remains very strained with an increase in the number of hospitalized patients. And these patients are spreading the virus to others, including healthcare workers. Getting patients to continue to wear a mask and socially distance while in the office seems to become more difficult at just the time that we need to be hypervigilant to get through this. As a physician who specializes in Addiction Medicine, I know all too well that drug dealers do not socially distance when making their transactions. We already know that patients in this field
have not made good choices in life and many of them choose not to be vaccinated. But with the rest of the community socially isolating, we have asked these people to isolate as well. Isolation has always been a red flag for addiction, and this is exactly what we are telling these patients to do. Meetings, social support, and peer support disappeared due to the need for social distancing. All of this has resulted in more relapses and more drug overdoses. We are all tired of COVID-19; we are all tired of mandates. But the one who is not tired at all is the virus. The virus does not think; the virus does not plan. The virus simply multiples and adapts to the environment it is placed in. We will ultimately defeat this pandemic, that is not the question. The real question is what will be the ultimate cost in human life? — William Santoro, MD FASAM DABAM Chief, Section of Addiction Medicine Reading Hospital/Tower Health
Poem by Johanna Kelly, MD, Pediatrician, Reading Pediatrics Group
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M e d i c a l R ec o r d F e a t u r e
The “Pay It Forward” Medication N
by Dr. William Santoro
aloxone is a life-saving medication that can reverse an overdose from opioids including heroin, fentanyl, and prescription opioid medications. Its effects begin within two minutes when given nasally or intravenously and within five minutes when injected intramuscularly. Because of the speed of onset, the ease of administration and lack of needle needed, it is often given as a nasal spray. The effects of naloxone last from about 30 seconds to 24 hours with an average of about 15 minutes. Multiple doses may be required, as the duration of action of most opioids is greater than that of naloxone. Finding drugs to counter the addictive and potentially fatal use of heroin, morphine and other narcotics was an area of increasing research in the late 1950s and early 1960s. While some solutions were found to be somewhat effective, they had strong and even dangerous side effects and could themselves cause addiction. One researcher, Dr. Harold Blumberg of Endo Laboratories on Long Island, New York, concluded that a safer, more effective drug could be derived from a new synthesized form of morphine. At the time, Dr. Jack Fishman was on staff at the Sloan-Kettering Institute for Cancer Research and also worked at a private pharmaceutical lab run by Dr. Mozes J. Lewenstein. Dr. Fishman and Dr. Lewenstein helped figure out how to make the drug Dr. Blumberg had described. Tests showed the drug, naloxone, to be far more powerful and to pose far fewer side effects than its predecessors. Naloxone was patented in 1961 by Dr. Lewenstein and Dr. Fishman.
request a naloxone kit. In Berks County any citizen who cannot afford the cost of a naloxone kit can contact the Counsel on Chemical Abuse (COCA) and be given help in getting a naloxone kit free or at a cost that is affordable. A more personal history about this life-saving medication is far more interesting, and sad, than its pharmaceutical history. Jonathon Fishman, Dr. Jack Fishman’s stepson, was born in 1972, 11 years after his stepfather developed naloxone and 1 year after it was approved for use in the United States for opioid overdose. In the 1990s, Jonathan became addicted to heroin. Living in Florida, where the law still prohibits selling needles without a prescription and possessing them can result in charges for drug paraphernalia, he was arrested several times for stealing needles from pharmacies. He contracted Hepatitis C from sharing dirty needles. Then, in 2006, at age 34, Jonathon Fishman died of a heroin overdose. At the time of his stepson’s death, Dr. Jack Fishman was still unable to obtain the medication he helped invent that would have saved his son. Dr. Jack Fishman died on December 8, 2013, at his home in Remsenburg, N.Y., at the age of 83. Today many people believe that naloxone should be distributed to patients with an opioid use disorder so that they would have it on hand in case they were to overdose. This, however, is not the real use or distribution need of naloxone. In the sad event that a patient with opioid use disorder overdoses, that patient will be unable to administer to themselves the life-saving medication naloxone.
Naloxone was approved for treating opioid overdose in the United States in 1971. It is on the World Health Organization’s list of essential medicines. After its approval in the U.S. in 1971, opioid overdose prevention kits began being distributed by many states to medically untrained people beginning in 1996. The CDC estimates that Dr. Fishman’s discovery of naloxone reversed over 26,000 cases of opioid overdose between the years 1996 and 2014.
It is my opinion, and the opinion of many other physicians, that every person has access to naloxone. While the medication will never be administered by the patient overdosing, it can be administered to a patient who is overdosing by a loved one, friend or perfect stranger. In the end naloxone is primarily a “pay it forward” medication. And I believe in my heart that Dr. Jack Fishman would be very supportive of this “pay it forward” mentality.
While paramedics have carried naloxone for decades, law enforcement officers in many states throughout the country now carry naloxone to reverse the effects of heroin overdoses when reaching the location before paramedics. As of July 12, 2015, law enforcement departments in 28 states are allowed to, or are required to, carry naloxone to quickly respond to opioid overdoses. In April 2021, the U.S. Food and Drug Administration (FDA) approved a higher dose of naloxone hydrochloride nasal spray product (Kloxxado) to treat opioid overdose.
Please consider obtaining a naloxone kit and safely storing it where it would be readily available to be used in the case of an emergency. Storing it at home in the closet will not do anyone any good while it would likely be needed when one is simply traveling to a department store or convenience store. Naloxone kits are small enough to store in a car’s glove compartment. To protect it from extreme temperature changes, it should be placed in an inexpensive thermal envelope. The inhalation device itself is small enough to be carried in a woman’s pocketbook or purse.
Here in Pennsylvania, Dr. Rachel Levine, the state’s Physician General and Secretary of Health, issued a standing order for naloxone. A standing order is a prescription written for the general public. Any Pennsylvania citizen can walk into a pharmacy and
Obtain naloxone, learn how to easily use it, keep it handy and use it when needed. The life you save will certainly be someone’s child. Do it in honor of Jonathon.
18 | www.berkscms.org
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M e d i c a l R ec o r d F e a t u r e
December Everyday Hero Award PAMED congratulates Dr. Shawn White on being the December 2021 Everyday Hero Award recipient. This monthly award recognizes physicians who go above and beyond helping their patients and colleagues.
Your colleagues deserve recognition! Nominate a deserving physician for a PAMED award at www.pamedsoc.org/awards.
Dr. Shawn White
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M e d i c a l R ec o r d F e a t u r e For Release: Tuesday, Dec. 21
Berks County Physician Recognized as “Everyday Hero” by Pa. Medical Society
hawn White, MD, FACS, a board-certified urologist and partner at the Center for Urologic Care of Berks County and Chief of Urology at Reading Hospital, has been recognized by the Pennsylvania Medical Society as an Everyday Hero Award winner. Upon receiving the award, Dr. White said he was honored and thanked his team for their hard work. “This award is really reflective of the work of our practice. My partners and I are blessed to work with fantastic staff that genuinely treat our patients like family. While I am the one accepting this award, this is really our award.” Dr. White received his medical degree at Temple University School of Medicine and stayed in Philadelphia for his urology residency at the University of Pennsylvania. Having grown up in Lititz, PA, he wanted to stay in the region after completing his training and, in 2011, he joined the Center for Urologic Care of Berks County. Being an independent physician, he is also on the staff of the Reading Hospital and Penn State Health St. Joseph’s Medical Center. He lives in Berks County with his wife, Meghan, and three children; Teddy, Winn, and Jane, saying his family “provides the balance in my life.” He attributes his success to a long list of influencers in his life, both past and present, highlighting his colleague and friend, Dr. John Henry, who passed away in July 2021. “John’s technical skill, impeccable clinical judgement, and wit are a constant source of inspiration as I transition into my new leadership roles. If I can care for this community even half as well as John did, I’ll have done something right.” PAMED’s Everyday Hero Award, launched in 2018, is designed to showcase talented physicians who go above and beyond in their profession and in providing patient care. Patients and medical colleagues can nominate PAMED member physicians for this award at www.pamedsoc.org/EverydayHero. ### Media Contact: Myla Merkel, Pennsylvania Medical Society (717) 909-2654
A Sample of Physician Wellness Resources from Tower Health Opt-in Emotional Support Services Physician Hotline: Confidential mental health support line: 484-628-9898. Mayo WBI (Wellbeing Index): Internal and external mental health resource repository and self-survey for burnout. This tool can be used to track your wellbeing over time, compare your burnout scores to others nationally, and access free resources both online and local across multiple categories and topics. EPA: Quest Behavioral Health; employee and all immediate family members may access certain free services by calling 1-800-3646352. Whil: Employees have access to this leading digital training platform for mindfulness, resilience, sleep, and mental and emotional wellbeing. Virgin Pulse: This digital wellness platform is designed to track healthy habits and provide guidance and coaching in various health realms. Schwartz Rounds: Similar to grand rounds but with a focus on the emotional toll of medicine. Held monthly in conjunction with The Schwartz Center for Compassionate Healthcare. WINTER 2022 | 21
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Vaccinations for Children!
Berks County COVID-19 vaccinations Based on the latest data from CDC (as of 1/15/22)
100% 90% 80% 70%
229,200 residents 18 +
60% 50% 40% 30% 20%
At least one dose: 257,676 – 78.6% Fully vaccinated 219,981 – 67.1%
Helpful Links https://www.vaccines.gov/ https://www.cdc.gov/ https://www.fda.gov/ https://www.historyofvaccines.org/ https://covid.cdc.gov/covid-data-tracker/ #cases_casesper100klast7days https://www.health.pa.gov/topics/programs/ immunizations/Pages/Immunizations.aspx https://www.immunizepa.org/ https://www.vaccinatepa.org/ https://wecandothis.hhs.gov/
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Summer 2022 Berks County Medical Society’s Pat Sharma President’s Scholarship Special note: Thanks to the generosity of Dr. Ray Truex the BCMS will be accepting two students for the 2022 internship program. Time commitment: 6 weeks full-time, Monday through Friday, June 6 through July 15. Stipend: $2000 for each of TWO students Eligibility: College students who will have completed at least 2 years of college at the end of the current semester and who have demonstrated an interest in a career in medicine or other field in the realm of health care, public health, or health policy. Priority will be given to students who are from Berks County or who are attending college in Berks County. Primary activity: Research and write an article on a clinical topic or public policy issue in the healthcare field. (We are not able to offer clinical or lab research experience.) The article will be published in the quarterly magazine of the BCMS, the Medical Record. The topic will be chosen in consultation with the Editorial Board and close supervision and mentorship will be provided by BCMS physicians and community experts in the field. Additional activities will be determined by the intern’s interests and skill set AND by the effects of the COVID-19 pandemic on our ability to return to normal activities, but could include:
Observing clinical practice, including surgery.
Assisting the Executive Director of the BCMS for a few hours a week to learn about the operation of this nonprofit organization and the many ways it serves our members and our community.
Shadowing members of the Pennsylvania Medical Society Governmental Affairs Office.
Participating in panel discussions with practicing physicians and with medical students, to gain insight into the process of becoming a physician and the variety of career paths available.
Attending didactic sessions at Reading Hospital in the Student Summer Trainee program. |
Application materials: 1.
Personal statement of no more than about 500 words describing the student’s career interests and how this experience would further those interests
An example of written scholarly activity (an essay or research paper)
Letters of recommendation are not required, but will be considered.
Please indicate whether you are related to a Berks County Medical Society member and let us know how you learned of this internship.
Deadline to submit applications: Monday, March 7 (Notification will be by March 25) Forward applications to Mr. T. J. Huckleberry, Executive Director, Berks County Medical Society at: Email: email@example.com Fax: (610) 375-6536
M e d i c a l R ec o r d F e a t u r e
PAMED Legislative Update
DECEMBER 16, 2021 Midway Point 2021-2022 Regular Session of the Pennsylvania General Assembly
s we come to a close on the 2021 calendar year, we also reach the midway point of the 2021-2022 regular legislative session of the Pennsylvania General Assembly. 2021 saw a return to a bit of normalcy at the state Capitol amidst the COVID-19 pandemic, but a new normal has certainly arrived. While many legislators are present on session voting days, remote voting is an option that many legislators have decided is the safest way for them to represent their constituents. Many offices, which had previously been easily accessible, are now locked or require advance appointments. Across the country we’re seeing tensions rise in state capitols, and in Washington, over election reforms, mask and vaccine mandates, over-crowded hospitals, and the overall impact COVID-19 has had on businesses and our economy. It has been challenging for all, especially those dedicated to patient care.
As we look to 2022, politics may very well trump policy as legislators and legislative candidates eye the May primaries and November General Elections. 2022 also marks the creation of new legislative district maps that could potentially change the composition of the General Assembly and leave some legislators to decide if they should bow out of office or face the harsh reality of running against a colleague. Further, the eyes of the nation have shifted to the Commonwealth as we near a primary election for an open U.S. Senate seat in addition to the election of a new Governor. At last count, there are currently ten announced candidates seeking the republican nomination for Governor while Attorney General Josh Shapiro stands as the only democratic candidate. Despite the current political environment, the Pennsylvania Medical Society (PAMED) continues to work tirelessly to defend the practice of medicine, protect the physician-patient relationship and ensure that we are always mindful of legislation and regulation that could potentially impact the practice of medicine. The pandemic continued on next page WINTER 2022 | 25
PAMED LEGISLATIVE UPDATE continued from page 25
continues to provide policy issues and challenges in addition to the existing priority issues that PAMED advocates on behalf of, which include scope of practice and prior authorization. The first year of the current legislative session provided a few highlights for PAMED. Among these were the enactment of Senate Bill 425 as ACT 61 of 2021. ACT 61 was a PAMED-supported effort to provide a remedy to the Pennsylvania Supreme Court ruling which had changed how consent was obtained in hospitals and other clinical settings by attending physicians. PAMED was able to support or provide neutrality on various agreements with Advanced Practice Providers including the passage of Senate Bill 416 (CRNAs) and Senate Bills 397/398 (PAs). Another key issue that saw movement was Senate Bill 225, an extensive effort to reform the prior authorization process. While this effort has a long road ahead, it advanced out of the Senate Banking and Insurance Committee for the first time and there is some level of optimism that it may be taken up before the full Senate early next year. House Bill 681 seeks to provide a fair approach to both employed physicians and provider employers while setting specific requirements for when the use of restrictive covenants is appropriate. This bill has advanced out of the House Health Committee and is awaiting final consideration before the full House. Lastly, Senate Bill 705 that seeks to provide legislative framework for the practice of telemedicine has advanced out of the Senate. We have seen this effort reach the Governor’s desk in the past only to see it vetoed. We are hopeful that this effort might reach a compromise in the second year of this session. While these are only a few highlights of the current legislative session, detailed below is a list of other issues that we are actively monitoring along with a brief summary. PAMED continues to engage in a number of legislative issues as well as participating in a large coalition to prevent any changes to the current Pennsylvania Supreme Court Civil Procedure rules regarding venue in medical malpractice professional liability cases.
26 | www.berkscms.org
House Bill 245 – (Kaufer) – International Medical Graduates (IMGs). Seeks to modernize the process by which graduates of international medical schools become licensed. Passed the House (201-0) and has advanced out of the Senate Consumer Protection & Prof. Licensure Committee and now awaits action from Senate Appropriations. We anticipate this bill to get to the Governor’s desk in the near future. Senate Bill 705 – (Vogel) – Telemedicine -This legislation was voted favorably out of the Senate (46-4) and has been referred to the House Insurance Committee. PAMED supports this effort and will work to move this bill through the legislative process once again. Senate Bill 416 – (Gordner) – This legislation officially recognizes certified registered nurse anesthetists (CRNAs) in the Commonwealth of Pennsylvania as well as outlining requirements for certification of CRNAs. PAMED followed the anesthesiologists’ lead in supporting this effort. This legislation has unanimously passed both the Senate (50-0) and the House (201-0). Signed into law as Act 60 of 2021. House Bill 931 – (Toohill) – House Companion legislation. Senate Bill 425 – (Gordner) – Informed Consent - PAMED supported this effort to provide a remedy to a court ruling which had changed how consent was obtained in hospitals and other clinical settings by attending physicians. PAMED supported this effort which passed the Senate (50-0) and the House (201-0). Signed into law as Act 61 of 2021. House Bill 1420 – (Thomas) – Health Care Heroes Act - PAMED supports this effort to establish a public awareness campaign to provide information regarding the programs and services available for first responders, healthcare workers, and other workers suffering from mental health issues related to COVID-19. Having unanimously passed the House (202-0), this bill now awaits a vote in the Senate Health and Human Services Committee. House Bill 1082 – (DelRosso) – PAMED supports this legislation, which establishes an education program for providers on early diagnosis of Alzheimer’s disease and other dementias and incorporates information about the disease into existing public health outreach programs. This bill passed the House (201-1) and is now awaiting final consideration by the full Senate.
House Bill 1280 - (Jozwiak) - Patient Test Results - PAMED will be working with the cardiologists to advance this bill through the House after it recently was voted favorably out the House Health Committee. This bill amends the Patient Test Result Information Act in addressing how patients receive notifications after certain tests, etc. Senate Bill 397 – (Pittman) – Physician Assistants (PAs); seeking to help physician assistants work and practice with increased efficiency. The bill allows for modernization for physician assistants to practice while maintaining their role under supervising physicians. This legislation has recently passed the Senate (50-0) and House (200-0); signed into law as Act 78 of 2021. (DO ACT) Senate Bill 398 – (Pittman) –This legislation has passed the Senate (50-0) and House (200-0) and has been signed into law as Act 79 of 2021. (MD ACT) Senate Bill 225 – (Phillips-Hill) – Prior authorization reform bills. There is a large coalition with multiple provider entities and patient advocacy groups seeking to make wholesale changes to the prior authorization process in the Commonwealth. PAMED has played an integral role in developing this legislation and working to advance it. While this legislation will require ongoing efforts to continue to advance it through the legislative process, it was voted out of the Senate Banking and Insurance Committee. PAMED continues to work with a broad coalition to pass this important legislation. House Bill 225 – (Mentzer) – House Companion legislation. Senate Bill 25 - (Bartolotta) – PAMED opposes this legislative effort which seeks to grant CRNPs independent practice authority. PAMED has long opposed these efforts, but last session agreed to listen/negotiate a pilot program where CRNPs would be granted independent practice with specific guidelines and restricts. This bill was recently voted out of the Senate Consumer Protection and Prof. Licensure Committee, but it is not anticipated that this bill will advance beyond the Senate in its current form. Likely, any movement on this issue would come in the form of a bill/ amendment that starts from the agreed upon pilot program. (HCO2108) – (Hickernell) – Co-sponsorship memo recently introduced to advance the pilot program legislation.
House Bill 681 – (Ecker) – PAMED has worked closely with the sponsor of this bill, Rep. Ecker, to advance legislation dealing with restrictive covenants in health care practitioner employment contracts. This effort would seek to provide a fair approach to both employed physicians and provider employers while setting specific requirements for when the use of restrictive covenants is appropriate. This bill has advanced out of the House Health Committee and is awaiting final consideration before the full House. House Bill 958 – (Zimmerman) – PAMED opposed this effort that would prohibit pediatricians from deciding not to provide care to unvaccinated patients or patients whose parent or legal guardians choose to utilize a vaccination schedule that varies from the vaccination schedule recommended by the CDC. While this bill advanced out of the House Health Committee, PAMED does not believe this effort will advance beyond there. House Bill 1033 – (Rapp) – This bill requires health insurers to cover treatment plans of Lyme disease or related tick-borne illnesses as prescribed by a health care practitioner; issues over what type of treatments could be covered (experimental long-term antibiotic for example). Although PAMED opposed this effort, this legislation has passed the House (136-66) and has been referred to the Senate Banking and Insurance Committee. Senate Bill 621 – (Brooks) – Publishing of vaccine availability by physicians-PAMED opposed this legislation which would require physicians that provide the COVID -19 vaccine to pay for the weekly publication of vaccine data, such as the number of vaccines they have available, in local newspapers. Further, it would require that physicians in private practice vaccinate any individual who shows up even when an established relationship does not exist. This bill failed at the Senate Health and Human Services Committee level and has been referred to the committee by a motion to reconsider. Senate Bill 671 - (Hutchinson) – Retaining Health Care Innovations Act - PAMED opposes this effort to extend the emergency administrative regulation changes granted to health care facilities, practitioners, and providers by Governor Wolf during the COVID-19 pandemic. This bill has advanced out of the Senate Health and Human Services Committee and has been referred to Senate Appropriations. continued on next page
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PAMED LEGISLATIVE UPDATE continued from page 27
House Bill 1700 – (Sonney) – Disclosure of disingenuous physician complaints - This bill would no longer require physicians to acknowledge the existence of a complaint filed against their medical license if the case were closed without any formal action. PAMED supports this effort and will advocate to advance these bills. This legislation has been referred to the House Professional Licensure Committee. (DO ACT) House Bill 1701 – (Sonney) – (MD ACT) House Bill 192 – (Topper) – Interstate Medical Licensure Compact Act-PAMED supports this effort which would allow Pennsylvania to fully join the Interstate Medical Licensure Compact Act (IMLC). The IMLC provides a streamlined process that allows physicians to become licensed in multiple states with a mission of increasing access to health care. This bill has passed the House (2010) and now awaits consideration in the Senate Consumer Protection and Prof. Licensure Committee. House Bill 1774 – (Flood) – PAMED support this effort to extend the sunset date for the Achieving Better Care by Monitoring All Prescriptions Program. This bill as signed into law as Act 72 of 2021. House Bill 1319 – (DelRosso) – This legislation is intended to curb the predatory practices of Pharmacy Benefit Managers (PBMs) by targeting the practices being used by them to interfere with the funding stream health centers and 340(b) plans use to fund the care they provide to low-income, uninsured residents. PAMED supports this effort and anticipates a committee vote in House Health during early 2022. House Bill 1440 – (Millard) – PAMED supports this legislation that would establish a Medical Imaging and Radiation Therapy Board of Examiners which would license and establish qualifications for individuals in the Commonwealth of Pennsylvania who perform medical imaging or radiation therapy procedures. The House Professional Licensure Committee held an information hearing on the topic and the bill awaits action by this committee. House Bill 1562 – (Pickett) – PAMED strongly worked to oppose this effort to expand access to the PDMP and as of this time, this legislation has yet to be brought up for a committee vote. It is currently sitting in House Insurance and at this time we do not anticipate movement on this bill that grants private health care insurers access to the PDMP, when they have no enforcement abilities and no compelling rationale as to why they should have access to this hypersensitive information. 28 | www.berkscms.org
House Bill 1005 – (Cox) – PAMED is opposing this effort that would require emergency physicians to provide information that is frequently not available during the time in which care to a patient is being delivered. Specifically, this bill requires information to be added to the PDMP when Narcan/Naloxone is used to combat an overdose by emergency responders or medical professionals. This bill advanced out of the House Health Committee and PAMED will continue to work to prevent this effort from becoming law. House Bill 1959 – (Pennycuick) – This legislation authorizes the clinical study of the efficacy and cost/benefit optimization of the psilocybin-assisted therapy in the treatment of PTSD, traumatic brain injury and various mental health conditions. PAMED has new policy to support clinical studies to determine the full efficacy of the use of psilocybin as appropriate. This bill is currently awaiting a vote by the House Health Committee. Senate Bill 196 – (Ward) – Co-pay accumulator legislation; requires insurers or pharmacy benefit managers to count any amounts paid by the enrollee or paid on behalf of the enrollee by another person when calculating an enrollee’s overall contribution to the plan’s deductible. PAMED is still working through this effort to determine a position while the bill awaits action from the Senate Banking and Insurance Committee. House Bill 1664 – (Gleim) – House companion legislation House Bill 605 – (Ecker) – This COVID liability legislation specifically requires certain cases alleging personal injury damages because of exposure to COVID-19 to be subject to expedited compulsory arbitration programs. Having passed the House (10794) this bill now awaits action from the Senate Judiciary Committee. Should this legislation advance to the Governor’s desk, it is likely it would be vetoed as similar legislative efforts have ended in the same result. House Bill 1186 – (Quinn) – Legislation to amend the Acupuncture Licensing Act to provide for the title protection for licensed acupuncturists and practitioners. PAMED worked to provide language on amending this bill that resulted in a position of neutrality. HB1186 advanced as amended out of the House Professional Licensure Committee and is to now before the full House.
31 S T A N N U A L
April 1-10, 2022 Reading, PA JAZZ AT LINCOLN CENTER ORCHESTRA with WYNTON MARSALIS
BÉLA FLECK: MY BLUEGRASS HEART
BRIAN CULBERTSON MARCUS ANDERSON
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Welcome New Member Daniel Edwards, D.O.
r. Daniel Edwards earned dual degrees in Clinical Psychology and Creative Writing from Saint Joseph’s University in Philadelphia before completing premedical studies at Temple University. After earning his medical degree at the Philadelphia College of Osteopathic Medicine, he trained for one year in General Surgery at Hahnemann University Hospital before undertaking a residency in General Urologic Surgery at Lankenau Medical Center/Bryn Mawr Hospital in Wynnewood, PA, where he served as Chief Resident and was a founding member of the residency program. He pursued additional graduate training in Pediatric Urology at Alfred I. DuPont/Nemours Hospital in Wilmington, DE, and in Urologic Oncology at Roswell Park Comprehensive Cancer Center in Buffalo, NY. A fellowship in Urologic Oncology at Levine Cancer Institute in Charlotte, NC, where he focused on minimally invasive surgery for cancers of the bladder, kidney, and prostate, completed his training. His specific interests include roboticassisted surgery of the bladder, minimally-invasive urinary diversions, and renal-sparing surgery in the setting of complex tumors. He has authored over twenty peer-reviewed publications and has presented at national meetings of the American Urologic Association and the Genitourinary Cancer Symposium of the American Society of Clinical Oncology. We welcome Dr. Edwards to membership in the Berks County Medical Society and look forward to the contributions he will make to the health and welfare of our community. To get to know him a little better, we asked him to answer a few questions:
Describe the focus of your practice and any areas of special interest/ expertise. While I was initially drawn to urology for the inherent variety of general practice, I had always been and continue to be most interested in urologic oncology. The nature of cancer
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treatment often requires a multidisciplinary approach necessitating collaboration among medical and radiation oncologists, pathologists, radiologists, and urologists, among others, which I have always enjoyed. Research within urologic oncology also continues to evolve rapidly and I am regularly impressed with the paradigm shifts and innovations even within the past decade that have dramatically improved length and quality of life in our patients. While I practice to some extent within aspects of urologic oncology, the treatment of urothelial carcinoma of the bladder is of particular interest. The majority of my fellowship training focused on treatment of patients with bladder cancer, and I have been well-trained in minimally-invasive (Robotic) techniques for cystectomy and urinary diversion, when and for whom it is appropriately indicated. I continue to see a variety of urologic oncology patients, and my practice currently involves a blend of urologic oncology and general urology, namely the treatment of benign prostatic hyperplasia and kidney stones.
What has brought you to Berks County? I grew up in Philadelphia and my wife Victoria’s family is from Montgomery County. We wanted to settle in a location within a comfortable driving distance from both of our families so that our son, Owen, and any future members of our family would have the benefit of proximity to grandparents, aunts, uncles and cousins that we both enjoyed while growing up. We evaluated numerous practices and practice locations. While still a resident, I met the late John Henry in the fall of 2019/winter of 2020 and I was awestricken by both him and the practice he had built. Driving around Museum Park in Wyomissing, my wife and I saw a community wherein we could envision the life we wanted to build for our family with close knit neighborhoods, strong public school systems, and within proximity to the best aspects of urban, suburban and rural Pennsylvania. Ultimately, the practice John had built, independent but strongly
connected to the local hospitals and surrounding communities and providing academic-level care within a private practice setting, was the greatest draw for me.
What do you like best about practicing medicine? The personal interaction with patients and their family members is certainly the greatest draw for me, and I do appreciate both the intense responsibility and joy inherent in curing disease and improving quality of life, and also the humbling inevitability that sometimes, despite our best efforts, our attempts to achieve those things fall short. I also find the challenging and technical aspects of surgical management to be invigorating and I enjoy the problem-solving aspect within that space.
Charles F. Barbera, MD, MBA, MPH, FACEP
If you could change one thing about the current practice environment, what would it be? I am very happy with our personal practice environment. Within the general practice of medicine I feel that there is currently an ongoing struggle to continue to provide high levels of care despite issues with staffing shortages, which is likely due to both economic factors and impacts from the current pandemic environment. I would be happy to see healthcare systems doing more to retain high quality clinical staff, but I understand the current challenges they are facing.
Are you involved in any nonprofit/community groups at this time? I am not, but would love to be! Do you have any suggestions? My wife has always worked within the non-profit sector and is actively exploring this space as well.
Please tell us a little about your family and the activities you enjoy outside of work. My wife, Victoria, and our young son, Owen, live in Wyomissing with our beagle-terrier, Mamba. We continue to love exploring all that the region has to offer, although our initial few months here have been mostly spent getting settled and getting our house in order, which has been mostly enjoyable with a few “new homeowner surprises” sprinkled along the way. We enjoy most spending time outdoors and have tried hiking many of the local trails. In the spring we look forward to spending some days fishing on the local waterways and some nights camping under the stars. When not enjoying nature’s bounty, we love cooking or baking together at home and are certainly fond of movie nights on the couch or game nights around the table. Being close to both of our families means many visits to and from the grandparents, which is much easier since my parents have moved to Lititz. So far we are quite happy with our new home and look forward to building our life here.
harles F. Barbera, MD, MBA, MPH, FACEP, has been named Chair of the Pennsylvania Trauma Systems Foundation (PTSF) Board of Directors for a one-year term that began on January 1. His service on the Board began in 2013, when he was nominated by the Pennsylvania College of Emergency Physicians. For the past two years he has held the position of Vice Chair. Dr. Barbera is the first Emergency Medicine physician to be selected as Chair of this organization. A long-time member of the BCMS, Dr. Barbera served as the BCMS President in 2005. The Pennsylvania Trauma Systems Foundation is the accrediting body for trauma centers throughout the Commonwealth of Pennsylvania. The Foundation was created through the combined efforts of the Pennsylvania Medical Society and The Hospital & Healthsystem Association of Pennsylvania, along with the Pennsylvania State Nurses Association, the Pennsylvania Emergency Health Services Council, and the Pennsylvania Department of Health. “The Pennsylvania Trauma Systems Foundation is an important organization for the health and safety of all individuals in the commonwealth,” said P. Sue Perrotty, Tower Health CEO. “It is an honor to have Dr. Barbera, one of Tower Health’s physician leaders, be the first Emergency Medicine Physician to serve as Chair. I know he will work tirelessly for patients in every community.” Dr. Barbera said, “It is a privilege to serve as Chair of the Pennsylvania Trauma Systems Foundation Board. During my tenure I am committed to promoting trauma center development, advocating for legislation to improve the trauma system in the state, and working with industry partners to improve trauma care in the areas of EMS, injury prevention, clinical care, and trauma system enhancement.”
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Welcome New Member Tory Snyder, D.O.
r. Tory Snyder graduated from Florida Southern College in Lakeland, FL with a B.S. in Biology before going on to earn a M.A. in Biology from Drake University in Des Moines, IA. She then completed her medical degree at the Des Moines University College of Osteopathic Medicine, followed by an internship in Internal Medicine at Geisinger Medical Center/PCOM in Danville, PA and a residency in Emergency Medicine at Central Michigan University in Saginaw, MI. From 2004 to June of 2020, Dr. Snyder served as an Attending Physician at Covenant Healthcare in Saginaw, MI—a high-acuity medical and Level 2 trauma center and community teaching hospital. There she supervised and taught Central Michigan University Emergency Medicine residents and CMU medical students, in addition to caring for her own patients. In September of 2020, Dr. Snyder embarked on a fellowship in Addiction Medicine at Tower Health (Caron – Reading Hospital), leading to her current position as a Staff Physician at the Caron Treatment Centers in Wernersville. At Caron she provides detox services to adult and adolescent patients, inpatient care to patients enrolled in Caron’s Primary, Relapse, and Executive programs, and inpatient medication therapy with buprenorphine and Vivitrol. The Berks County Medical Society is proud to count Dr. Snyder among its members and our community is fortunate to have her expertise available. To get to know Dr. Snyder a little better, we asked her to answer a few questions:
Describe the focus of your practice and any areas of special interest/ expertise.
What has brought you to Berks County? I came to Berks County to complete an Addiction Medicine Fellowship and stayed on at Caron.
What do you like best about practicing medicine? Best part of my job at Caron: seeing people recover from addiction and get their lives back on track.
If you could change one thing about the current practice environment, what would it be? No, but I am open to opportunities.
Are you involved in any nonprofit/ community groups at this time? I am not yet involved in nonprofit groups since I just moved to the area, but in the past, I volunteered at the Ronald McDonald House and a free health clinic serving West Philadelphia. I look forward to engaging in the Berks County community!
Please tell us a little about your family and the activities you enjoy outside of work. Outside of work I enjoy travel, especially international travel with a focus on mountain adventures.
Inpatient substance abuse detox, medication treatment with buprenorphine, naltrexone, and Vivitrol, and medical care of inpatients (adolescent, adult, and geriatric). “Caron’s treatment philosophy aligns with the goals I have as a physician: to look individually at each patient in order to treat not just the disease but the underlying contributors to that disease and the qualityof-life issues it creates. Our ability to provide medical, psychological, and spiritual care with compassion and empathy can turn lives around. I have seen it in action.” — Dr. Snyder 32 | www.berkscms.org
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M edical R ecord F eature
In Memoriam James H. Jewell, Jr. M.D. by D. Michael Baxter, MD FAAFP
reat doctors are also great human beings. They demonstrate the best of our profession and serve their patients and society with the full breadth of their character and skill. Such was certainly the case of James H. Jewel, Jr, M.D., who entered this world born on April 22, 1932, and passed from us on October 30, 2021. Dr. Jewell was a Phi Beta Kappa graduate of Lehigh University and a graduate of Columbia University Medical School in 1959. He practiced as a Thoracic Cardiovascular surgeon from 19761991 on the medical staffs of the St. Joseph’s Hospital, Community General Hospital, and the Reading Hospital where he served as Chief of Thoracic Surgery from 1988-1991. That alone would have been a significant career; however, for Dr. Jewell that was only the beginning and perhaps his most important work lay ahead. After achieving recognition as a distinguished surgeon in Berks County, Dr. Jewell was led by his Christian Faith in 1991 to accept a call to medical missions in Zambia, Africa where he served as the Medical Director at Luampa Mission Hospital in Kaoma, Zambia from 1991-1995. He continued this calling as a senior lecturer in the Department of Surgery in the School of Medicine at the University of Zambia until 2017. He was a founding member of the Pan-African Academy of Christian Surgeons and was chosen “Missionary of the Year” by the Christian Medical & Dental Association, USA, in 2002. He is survived by his wife and mission partner, Eleanor, seven children, sixteen grandchildren, and twelve great-grandchildren. I had the pleasure of meeting Dr. Jewell during a few of his return visits to Berks County when he would speak to groups of the Reading Hospital Medical Staff about his work in Africa. His sense of commitment and indeed his evangelical enthusiasm in support of his work with both his patients and his students was clear to all in attendance. It is not trite to say that Jim Jewell was a true gem of a doctor and a person, whose skills, compassion, and faith reflected the very best of our profession and a passion for serving others. He will be missed but his legacy will certainly live on in the lives of his patients and in the work of the students and peers whom he inspired.
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Nicholas Bybel, Sr., MD
by D. Michael Baxter, MD FAAFP
r. Nicholas Bybel, Sr., who died at the age of 89 on December 11th, served the Berks County Community for over 50 years in a multitude of roles. He graduated from Mt. Penn High School in 1950 and Albright College in 1957. He completed his medical school training at Hahnemann Medical College in 1961 and then returned home to pursue his Family Practice Residency at St. Joseph’s Hospital. He completed additional training at Allegheny General Hospital in Pittsburgh, Wills Eye and the U.S. Naval Hospital in Philadelphia. In addition to practicing Family Medicine in Muhlenberg Township for many years, he also served as the physician for several Reading area businesses including Windsor Service Corporation, Metropolitan Edison and Dana Corporation. Serving his community beyond his traditional medical practice and corporate work, Dr. Bybel volunteered many years as the physician for the Muhlenberg High School football team and served as Chairman of the Muhlenberg Township Board of Health. He was an active Rotary member and was a 32nd degree Mason serving as Past Master of Masonic Lodge 62 and as a member of the Directors staff of Shriners Hospitals. However, many residents of Berks County may best remember Dr. Bybel as the Berks County coroner from 2002-2006. He also served as an advisory board member of the International Association of Coroners and Medical Examiners. Dr. Bybel is survived by his wife of 65 years, Gretchen, 3 children, 5 grandchildren and 10 great grandchildren. We offer our condolences to his family and our gratitude for his many years of service to his community.
Francis Plucinsky, M.D. by Robert F. Early, M.D., Anesthesiologist, Tower Health Medical Group
r Francis “Frank” Plucinsky, 82, passed away on December 12, 2021, at the Reading Hospital. He was the husband of Priscilla Plucinsky. Born in Cementon, PA, he was a graduate of Allentown Central Catholic High School in 1957. After high school Frank served from 195761 in the US Army. Subsequently, he attended Bloomsburg University and graduated in 1965 earning a bachelor’s degree Summa Cum Lauda in Education and Biology. He continued as a teaching fellow at Williams College and earned a master’s degree in biology. He graduated from Temple Medical School in 1971 and interned at Reading Hospital in 1972 before completing an anesthesia residency at the Hospital of the University of Pennsylvania. Dr. Plucinsky practiced as an anesthesiologist from 1972 until his retirement in 2002 at the Reading Hospital. He was a member of Reading Anesthesia Associates where he was the president for fourteen years, also having served as Chairman of the Department of Anesthesia for two years. He took great pleasure in teaching students and served as a clinical instructor at the Reading Hospital School of Anesthesia. Frank enjoyed being outdoors and especially fly fishing. He had a life-long fascination with photography and natural history. He made annual pilgrimages to the mountains of the western United States, a trout fishing heaven and photographer’s dream. He was a member of the Mengel Natural History Society, Baird Ornithological Club, Berks Photography Society, and a life member of Trout Unlimited. Frank was truly one of the pioneers and leaders of the modern anesthesia department at Reading Hospital. He was an excellent clinician as well as an educator whose legacy will forever be part of the Reading Hospital. WINTER 2022 | 35
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