Chester County Medicine Fall 2021

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YO U R CO M M U N I T Y R E S O U R C E F O R W H AT ’ S H A P P E N I N G I N H E A LT H C A R E

FALL 2021

CHESTER COUNTY

P u b l i s h e d

b y

P e n n s y l v a n i a ’s

F i r s t

M e d i c a l

S o c i e t y

The Art of Chester County

Presents LELE Galer

Youth Philanthropy Sow Good Now Developments in Physician Peer Review PAGE 6

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Top row, left to right: Karen Yoder, PA-C, Alex S. Kuryan, M.D., Carrie N. Miller, M.D., David R. Neiblum, M.D., Matthew M. Baichi, M.D., Reina P. Bender, M.D., Ashish Chawla, M.D., Linda Camlin, CRNP Seated: Albert K. Hahm, M.D., Eva Sum, M.D., David E. Bobman, M.D.

Our team of board-certified gastroenterologist is dedicated to working closely with you and your family physician to individualize your treatment plan. They are committed to compassion and understanding each patient’s needs. For more information or to schedule an appointment, please call 610-431-3122 Fern Hill Medical Campus Building B, Suite 300 915 Old Fern Hill Road West Chester, PA 19380

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Contents OFFICERS 2021

FALL 2021

Sow Good Now How Volunteerism Can Improve Mental Health in Our Youth

56

President

Bruce A. Colley, DO President-Elect David E. Bobman, MD Vice President Mahmoud K. Effat, MD Secretary Valerie G. Vilbert, DO Treasurer Winslow W. Murdoch, MD Past President Mian A. Jan, MD, FACC Board Members Brian K. Abaluck, MD Norman M. Callahan, DO Heidar K. Jahromi, MD John P. Maher, MD Manjula J. Naik, MD Richard O. Oyelewu, MD David A. McKeighan Executive Director Linda Harley Associate Director Chester County Medical Society 1050 Airport Road PO Box 5344 West Chester, PA 19380-5344 Website – www.chestercms.org Email – chestercountymedsoc@gmail.com Telephone - (610) 357-8531

Chester County Medicine is a publication of the Chester County Medical Society (CCMS). The Chester County Medical Society’s mission has evolved to represent and serve all physicians of Chester County and their patients in order to preserve the doctor-patient relationship, maintain safe and quality care, advance the practice of medicine and enhance the role of medicine and health care within the community, Chester County and Pennsylvania. The opinions expressed in these pages are those of the individual authors and not necessarily those of the Chester 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 Chester County Medical Society.

In Every Issue 4 President’s Message 16 The Art of Chester County

Supreme Court Broadens the Scope of Peer 8 Pennsylvania Review Privilege in

Leadbitter v. Keystone Anesthesia Associates

Features

12 PAMED House of Delegate Wrap Up 26 Living with Alternative Perceptions 14 Collaborative Works to Improve 29 Mysteries of Medicare Maternal and Child Health Are You Enrolled in in Greater Philadelphia Medicare or Turning 18 Chester County 65 Soon? Emergency Response 30 2021 Chester County 20 Tale of the Hahnemann Bankruptcy Medical Society Annual Legislative Clam Bake 24 Attention Private Practitioners! 25 Chester County Medical Society Presents: Financial Literacy Workshops Letters to the Editor: If you would like to respond to an item you read in Chester County Medicine, or suggest additional content, please submit a message to chescomedsoc@comcast.net with “Letter to the Editor” as the subject. Your message will be read and considered by the editor, and may appear in a future issue of the magazine. Cover: First Light, by Lele Galer. Read more of The Art of Chester County on page 16. PUBLISHER: Hoffmann Publishing Group, Inc. 2669 Shillington Rd, Box #438, Reading, PA 19608 www.Hoffpubs.com

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PR E S I DE NT’S M E SSAG E

Autumn 2021 BY BRUCE A. COLLEY, DO PRESIDENT OF CHESTER COUNTY MEDICAL SOCIETY

W

hew! We had a long, hot summer here in Chester County. But as I write this halfway into October, the weather has finally broken. Cool, dry, sunny

days and crisp evenings are welcome changes. We were treated to a beautiful harvest moon last night and leaves are just starting to turn red, yellow, and orange. These trigger memories of elementary school days when, with friends after school we would hike through the many woods in East Bradford Township. Finding a heavy stone, we would crack open black walnuts to eat (by the way, for my fellow health foodies – one of the most nutritionally complete foods known to man). We would contest to see who first spotted a flying squirrel and scavenge for the most colorful leaves then throw them in Valley Creek creating a fluid, stained glass window and sending it down stream.

D r. B r u c e A . C o l l e y

To contact Dr. Colley send email to: bacolley828@gmail.com

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We are lucky to live in such a beautiful and interesting county. I say beautiful, because of the magnificent Chester Valley with its North and South Valley Hills, and the Brandywine, Octorara and Schuylkill River Valleys. Our county possesses some of the world’s best soils under which we find a complex geology from granite to limestone and the world’s only minable quantities of serpentine. This natural beauty has generated a dynamic and world class art community that thrives off this precious piece of geography. I recall a bibliographic allegory uttered often by Arthur Hawthorne, my geography professor at West Chester University: “When God handed out the geographic goodies, He did not just look fondly on Chester County, He had hysterics over it.” I say interesting, because of Chester County’s history of achievements and firsts in agriculture, art, music, industry, science, and medicine. A short list includes our mushroom and dairy farms and the Sharpless cream separator that ended up being placed on all American destroyers built in WW II to maximize the output of the steam turbines and also used to make penicillin in the world’s first high volume penicillin lab here in West Chester; the Wyeths and their art dynasty; Samuel Barber, one of the most innovative composers of the twentieth century; Rebeca Lukens and her steel mill, now the oldest continuously operating company in the United States; G.R. Rettew, who figured out how to mass produce penicillin, saving thousands of our GI’s lives during World War II. Spend some time at the Chester County Historical Society to learn more about these achievements and be amazed.


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As beautiful and interesting as Chester County is, it is, and has been the people here that define this special place. I submit that recent times haves been challenging with floods, epidemics, and political schizophrenia all about. But Chester County hums along. Because, I believe, and I suspect we all have noted, that the citizens of Chester County genuinely enjoy and respect each other. This same spirit of Chester County shepherds the physicians of Chester County. We learn from each other and support each other, and without fail, work together to care for our patients, removing the -dis- from disease. Before signing off, I want to share a note of thanks to the Chester County Medical Society’s Executive Director on behalf of the physicians of this county. David McKeighan has been an advocate for the physicians of the Delaware Valley for almost 40 years in various positions. He has been our Executive Director for 6 years and has had our “backs” both professionally and personally. He has spearheaded innumerable initiatives the

Board has brought to him, and many of his own. A short list includes COVID teleconferences for health care professionals during the early deep, dark phase of the epidemic when reliable technical information on COVID was scarce. This forum allowed physicians in the tri-county area to communicate with each other and thus provide more focused and rational care to our COVID patients. Also, continuing medical education programs, outreach to business community, drug addiction seminars, joint county health department and medical society programs. Most of these would not have come to fruition without David. On behalf of the physicians of Chester County, thank you David! I trust all will take interest in this issue, and I urge all to enjoy the natural beauty of our home; there are dozens of parks and trails throughout Chester County. Please take time to discover them. A final note, as always, I encourage any physician or citizen of Chester County to submit articles, essays, or letters to the editor.

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Sow Good Now

How Volunteerism Can Improve Mental Health in Our Youth BY GRACE HENRY

Chester County native Mary Fischer-Nassib, mother of Carl Nassib, of the Las Vegas Raiders, the first openly gay NFL player, has created a 501(c)(3) public charity designed to provide a platform for high school and college athletes to volunteer and practice youth philanthropy through the sports they love.

P

resident and co-founder of Sow Good Now, Mary Fischer-Nassib, believes that “demanding practice and game schedules can make it difficult for student athletes to spend as much time as they would like serving others.” However, Sow Good Now breaks down the barrier of time by meeting athletes where they are on the field, in the gym, on the courts, or at the pool and have them share their time, talent, and treasures with youth from underserved areas. Athletes from Rustin, Shanahan, and Unionville High Schools, Malvern Prep, LaSalle College, Jefferson University, Villanova University, Providence College, Brandeis University, and other schools and clubs have participated in Sow Good Now programs. There has never been a more pivotal time in history than the recent battle with COVID-19. The pandemic has forced individuals, families, and communities into isolation and social distancing. Sequestered from activities and sports, some children and adolescents have been traumatized by quarantine protocols (CDC, 2021a). During 2020 through 2021, team sports were cancelled. Long awaited trips to Hershey Park, Longwood Gardens, and the zoo were delayed as families stayed home with the computer as the source of socialization. Now, with a new back-to-school routine and continued social distancing, it has been challenging to regain connection with our communities. During these unprecedented times, we have become accustomed to staying within our created bubble of family and friends who make us feel safe. We have been further uprooted with a change in routine like online or hybrid learning and parents working at home. With limited extra-curricular activities and ability to socialize with friends, it is crucial to check in with teenagers and vulnerable family and community members to see how they are coping with the ever-changing “new normal.” According to the Center for Disease Control (2021b), the pandemic has had a far-reaching impact on social, emotional, and mental wellbeing which could potentially have long-term consequences across the lifespan. Keeping our families alive and healthy were our greatest priorities this year. Now, we deal with the mental anguish caused by the quarantine. Experts agree the value of volunteerism and sharing our talent and time with the most vulnerable populations (Johnson, 2019) can minimize the effects of social isolation through human connection. Sow Good Now’s (sowgoodnow.org) mission is to grow the next generation of philanthropic athletes by offering opportunities for service through sports and partnering with their leaders and the causes they support by engaging them in a lifelong practice of giving and sharing with a spirit of generosity.

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Incorporating volunteerism into a routine activity is an excellent approach to treating and combating depression. Volunteering can provide a sense of pride and fulfillment. Connecting teens with their community can make it a better place and improve the lives of people, animals, and organizations. Further, creating strong social connections and easing the heavy feeling of isolation, volunteering is also a holistic way to reduce stress, anxiety, and anger. The act of giving back to a community releases dopamine in the brain, increasing the feeling of positivity and relaxation while offering a sense of purpose. Sow Good Now’s impact on a community is evident in the numbers of individuals nationwide who have participated in the sports GiveBack clinics. The GiveBack clinic, spearheaded by student athletes and their coaches, shifts the focus from achievement to service. Volunteers determine how they want to share their time, talent, and treasure while working as a team to mentor community youth. Data from GiveBack clinics from volunteers and recipients suggest the encounters have changed their perspective on philanthropy, volunteerism, and giving back to a community in need. The pandemic has had a lasting impact on our minds, bodies, and spirit. With the current focus on mental distress, isolation, and depression among our youth, Sow Good Now offers volunteers a method of rejoining the community through positive interactions in underserved communities. Sow Good Now is eager to actively support your community. If you would like to learn more or want to volunteer contact us at Team@sowgoodnow.org. For more information about Sow Good Now see: www.sowgoodnow.org. References Center for Disease Control a. (2021). Get involved. https://www. cdc.gov/prepyourhealth/createcommunity/getinvolved/ Center for Disease Control b. (2021). COVID-19 Parental resources kit: Social, emotional, and mental well-being of adolescents during COVID-19. https://www.cdc.gov/mentalhealth/ stress-coping/parental-resources/adolescence/index.html Johnson, T. (2019). Six emerging volunteerism research insights for 2019. Volunteer Pro. https://volpro.net/2019-volunteerismresearch/ Editor’s Note: Sow Good Now, 501 (c) 3, was founded in July of 2018 by three mothers who are former college athletes and who have raised athletes. The founders believe that everyone has unique gifts to offer the world and they created the SGN GiveBack Model as a space for those gifts to be shared. Philanthropic Athletes are great leaders for this new approach because they understand the importance of dedication, teamwork and diversity in working toward a common goal. FA L L 2 0 2 1 | C H E S T E R C O U N T Y M e d i c i n e 7


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Pennsylvania Supreme Court Broadens the Scope of Peer Review Privilege in Leadbitter v. Keystone Anesthesia Associates BY BENJAMIN A. POST, ESQUIRE, AND JOSHUA T. CALO, ESQUIRE, POST & POST, LLC

O

n August 27, 2021, the Supreme Court of Pennsylvania issued an important ruling on the scope of the “peer review privilege” in Pennsylvania. In the case of Leadbitter v. Keystone Anesthesia Associates, the Court held that Peer Review Protection Act may protect documents generated by a hospital’s credentialing committee, to the extent that the committee was performing a “peer review function.” The Delaware County and Chester County Medical Societies participated in this important appeal, by filing an amicus brief that was authored by our firm, advocating for the Pennsylvania Supreme Court to broadly protect the confidentiality of peer review activities. The Leadbitter decision represents a significant victory for medical providers in Pennsylvania. In recent years, Pennsylvania’s appellate courts have issued several difficult decisions that potentially narrowed the scope of the peer review privilege. However, Leadbitter has recognized added protections for hospital committees to obtain candid peer evaluations regarding the performance, quality, and safety of medical care.

Background of The Peer Review Privilege In 1974, the Pennsylvania Legislature enacted the Peer Review Protection Act (“PRPA”).1 This statute created an evidentiary privilege that provides confidentiality for “the records and proceedings of a review committee.” The PRPA also confers civil and criminal immunity to individuals who, in good faith, provide information and participate in peer review proceedings. The legislature’s stated purpose for enacting the PRPA was to provide for “the increased use of peer review groups by giving protection to individuals and data who report to any review group.”2

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Medical professionals in Pennsylvania have long relied on the “peer review privilege” to allow them to candidly and openly evaluate the quality of care provided by their peers, without fear of repercussions in the event of a subsequent medical malpractice lawsuit. The purpose of promoting such candid evaluations has been to encourage “selfregulation” and quality improvement in the healthcare system. In turn, the legislature recognized that allowing such evaluations to be subject to discovery in litigation would have a chilling effect. Historically, Pennsylvania courts readily recognized the “laudable goal of the PRPA,” and broadly applied the peer review privilege. For example, in one early 1979 decision, a Pennsylvania federal district court observed the following: “Confidentiality is essential to effective functioning of these staff meetings; and these meetings are essential to the continued improvement in the care and treatment of patients. Candid and conscientious evaluation of clinical practice is a Sine qua non of adequate hospital care. To subject these discussions and deliberations to the discovery process, without a showing of exceptional necessity, would result in terminating such deliberations. Constructive professional criticism cannot occur in an atmosphere of apprehension that one doctor’s suggestion will be used as a denunciation of a colleague’s conduct in a malpractice suit.”3 Significantly, courts historically considered the review of medical staff credentials and privileges to be a quintessential form of peer review that could be entitled to protection from discovery. In fact, in 1998, Pennsylvania’s intermediate appellate court, the Superior Court, specifically recognized that: “Documents used in the determination of staff privileges are exactly the type of documents the legislature contemplated when drafting the Peer Review Protection Act. Granting,


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limiting, or revoking staff privileges is one of the strongest tools the medical profession uses to police itself.”4 Nevertheless, beginning in 2018, Pennsylvania courts began to apply a narrower interpretation of the peer review privilege in certain contexts, including credentialing and privileging review.

The 2018 Reginelli Decision, and Subsequent Credentialing Cases In March 2018, the Pennsylvania Supreme Court issued a landmark decision in the case of Reginelli v. Boggs.5 In a divided 4-3 decision, the Court described the PRPA as “a narrow evidentiary privilege,” and identified several limitations to the application of the peer review privilege. Reginelli created challenging precedent for healthcare providers, and provided the backdrop for the recent Leadbitter decision. In brief, Reginelli involved a malpractice lawsuit alleging that an emergency room physician failed to diagnose an emergent heart condition, and discharged the patient without proper treatment. During discovery, the plaintiff requested production of the defendant physician’s “performance file” that was prepared and maintained by the Director of the Emergency Department. The defendants, in Reginelli, objected to producing the performance file in discovery, asserting that it was protected by the peer review privilege. However, on appeal, the Pennsylvania Supreme Court held that the PRPA was inapplicable, and ordered production of the performance file. The Pennsylvania Supreme Court identified several reasons why the performance file was not entitled to protection. Although Reginelli did not involve credentialing or privileging, the Court suggested, in one instance, that the “peer review privilege” may not apply to a hospital’s credentialing committees. Specifically, the Court in Reginelli noted that the text of the PRPA separately refers to (1) “review committees” that engage in “peer review”; and (2) “review organizations,” which may include “any hospital board, committee or individual reviewing the professional qualifications or activities of its medical staff or

applicants for admission thereto.” The Reginelli Court stated that only the first type of “review committee” is entitled to invoke the peer review privilege, stating: “Review of a physician’s credentials for purposes of membership (or continued membership) on a hospital’s medical staff is markedly different from reviewing the “quality and efficiency of service ordered or performed” by a physician when treating patients. Accordingly, although “individuals reviewing the professional qualifications or activities of its medical staff or applicants for admission thereto,” are defined as a type of “review organization,” such individuals are not “review committees” entitled to claim the PRPA’s evidentiary privilege in its section 425.4.) In light of this language from Reginelli, lower courts in Pennsylvania subsequently held that the peer review privilege did not protect any aspect of a physician’s credentialing or privileging files.6 In other words, after 2018, Pennsylvania courts were potentially allowing discovery of any files maintained by hospital credentialing committees, even if the files reflected “peer review” – i.e., evaluations of the quality of care provided by applicants to or members of a hospital’s medical staff.

The 2021 Leadbitter Decision On August 17, 2021, the Pennsylvania Supreme Court decided the case of Leadbitter v. Keystone Anesthesia Consultants, Ltd.7 The decision addressed the question of whether certain portions of a defendant physician’s credentialing file, which reflected “peer review” documents generated by the credentialing committee, were protected from discovery. The Leadbitter case involved a plaintiff’s lawsuit against a surgeon and hospital, arising from a spinal surgery performed in January 2015. Following the surgery, the plaintiff allegedly suffered a series of strokes that resulted in permanent brain damage. It was alleged that the surgeon negligently performed the procedure. Additionally, the plaintiff asserted corporate negligence claims against the hospital, alleging that the hospital’s credentialing and privileging process was inadequate, and that the surgeon continued on next page > FA L L 2 0 2 1 | C H E S T E R C O U N T Y M e d i c i n e 9


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Pennsylvania Supreme Court Broadens the Scope of Peer Review Privilege in Leadbitter v. Keystone Anesthesia Associates continued from page 9

lacked adequate experience to be authorized to perform the surgery in question. During discovery, the hospital objected to producing portions of the surgeon’s credentialing file, which contained performance evaluations and professional opinions relating to the surgeon’s competence, as well as responses to mandatory queries submitted to the National Practitioner Databank. Based on Reginelli, the trial court ordered the production of the complete credentialing file. The Superior Court of Pennsylvania, on appeal, found that the documents did meet the definition of “Peer Review,” which is defined as: “the procedure for evaluation by professional health care providers of the quality and efficiency of services ordered or performed by other professional health care providers . . . .” However, the Superior Court still concluded that the peer review privilege did not apply, based on Reginelli’s suggestion that a credentialing committee does not qualify as a protected “peer review committee” under the statute. Fortunately, the Pennsylvania Supreme Court, in Leadbitter, reversed the lower courts’ rulings. Specifically, the Supreme Court clarified the PRPA’s evidentiary privilege can potentially protect the records generated by any committee of professional health care providers that performs a “peer review function.” The Court stated: “We agree with the hospital’s core position that a committee which performs a peer-review function, although it may not be specifically entitled a ‘peer review committee,’ constitutes a review committee whose proceedings and records are protected under Section 4 of the act . . . It follows that a hospital’s credentials committee enjoys such protection if (and only if) it engaged in peer review.” The Supreme Court specified that certain aspects of credentialing review are not “peer review,” such as confirming a physician’s licensure status and other objective qualifications for appointment to a medical staff. However, the peer review privilege may protect other portions of a credentialing file, to the extent that the credentialing committee was reviewing the quality and efficiency of care provided by other healthcare providers.

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Finally, the Pennsylvania Supreme Court confirmed that National Practitioner Databank query responses are independently protected from discovery under the Federal Health Care Quality Improvement Act.

Takeaways Leadbitter represents a significant victory for healthcare providers in Pennsylvania. Although the Pennsylvania Supreme Court did not overrule Reginelli v. Boggs, it did clarify that the PRPA protects peer review activities undertaken by credentialing committees, such as retrospective performance evaluations in connection with reviewing applications for clinical privileges. We are optimistic that Leadbitter will decrease the “chilling effect” of other recent decisions like Reginelli. Leadbitter demonstrates that the PRPA provides ample room for hospitals and medical providers to engage in protected peer review and patient safety activities, when conducted through appropriate channels and committees. In particular, Leadbitter provides added protections for hospitals to seek candid peer feedback, regarding the quality of care provided by medical staff members and applicants. Thus, this decision is a step in the right direction, towards restoring the broad scope of peer review protections that were intended by the Pennsylvania legislature. 1

63 P.S. §§ 425.1 – 425.4.

2

63 P.S. § 425.1, Statutory and Historical Notes.

3

Robinson v. Magovern, 83 F.R.D. 79, 85 (W.D. Pa. 1979).

4

Young v. Western Pa. Hospital, 722 A.2d 153, 156 (Pa. Super. 1998).

5

Reginelli v. Boggs, 181 A.3d 293 (Pa. 2018).

Estate of Krappa v. Lyons, 211 A.3d 869 (Pa. Super. 2019); Ungurian v. Beyzman, 232 A.2d 786 (Pa. Super. 2020); Leadbitter v. Keystone Anesthesia Consultants, Ltd., 229 A.3d 292 (Pa. Super. 2020). 6

Leadbitter v. Keystone Anesthesia Consultants, Ltd., 256 A.3d 1164 (Pa. 2021). 7


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CONSIDER MEMBERSHIP in The Chester County Medical Society Join Us! Established in 1828, the Chester County Medical Society, founded by Dr. William Darlington, M.D., is thought to be the oldest county medical society in the State. The Medical Society is involved in all aspects of healthcare policy, practice, and education and serves to advance the health of the community and to protect and expand the healthcare resources available to its citizens. T​ he Chester County Medical Society works collaboratively with the Pennsylvania Medical Society, but our focus is on our local community. The Society’s role in Chester County is to support, protect, and advocate for our physicians and our patients. We look forward to growing an important healthcare service for our community that will benefit us all, and we look forward to hearing from you.

Member Benefits

Chester County Medicine, the official publication of the Chester County Medical Society for many decades. CCMS members receive a subscription to our quarterly magazine for their own reading and we encourage physicians to share the magazine with patients in their waiting rooms. CCMS members are also encouraged to contribute articles for publication and to purchase advertising to help promote their practices! Chester County Medicine features a popular ongoing series focusing on the art and artists of Chester County. The current and archived editions are available for readers on the society’s website: www.chestercms.org. Advocacy – the CCMS is an active supporter on many important local and regional task forces, work groups and coalitions such as the Chester County Immunization Coalition; the Regional Overdose Prevention Task Force; the Chester County Suicide Prevention Task Force; the Pennsylvania Coalition for Civil Justice Reform and more. The Clam Bake – our annual legislative dinner program is an opportunity for the physicians of Chester County to meet and enjoy a casual evening of great food and conversation with elected officials. The event also features the presentation of two scholarships to West Chester University pre-med students. PracticeBeat – an outstanding member benefit offering practices a chance to enhance their on-line presence, improve patient satisfaction and ensure practice communications and scheduling requests are IPAA compliant. PracticeBeat offers CCMS members a significant discount off their monthly base fee. Data-based insight is also provided relative to the competitive landscape in your specialty and geographic area. Leadership opportunities available – the CCMS leadership is eager to continue representing our membership and opportunities are available to serve for medical students, residents and fellows, early career physicians and our “full active” members Practice management assistance – contact CCMS staff with questions about a wide array on “business” matters pertaining to your practice. Our experienced staff at the local and state level offer outstanding assistance. Participate in our in-person and virtual programs to help guide your practice on issues such as reimbursement, credentialing, recruiting and many more important aspects of running a practice.

To learn more, join or renew, visit https://www.pamedsoc.org/about-pamed/Membership

CHESTER COUNTY COMMUNITY FOUNDATION Let your legacy make a difference, now & forever Our eternal thanks to these major philanthropists who knew where there's a will, there's a way.

Penelope "Penny" Perkins Wilson

Eva Low Verplanck, Ph.D.

1923-2021

1924-2021

Aaron J. Martin, Ph.D.

Ronald "Ronn" E. Fletcher

1928-2021

1947-2020

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House of Delegates Wrap Up

Nov 4, 2021 On October 30, the Pennsylvania Medical Society held its 2021 House of Delegates (HOD) meeting virtually due to pandemic caution. Delegates had some debate on many of the issues that face health care today. Here is a look at some of the resolutions that delegates either adopted or directed to PAMED’s Board for decision or further study. Keep in mind that this is not an exhaustive list. Information on all the resolutions addressed at the 2021 HOD will soon be available online at www.pamedsoc.org/ HOD.

Advocacy for Syringe Service Programs in Pennsylvania PAMED supports advocacy for syringe service programs across the Commonwealth. Delegates voted to support the legalization and public funding of syringe service programs and harm reduction programs throughout Pennsylvania.

Promotion of Sexual Orientation in EMR and Intake Forms PAMED supports as appropriate, the introduction and collection of gender identity, sexual orientation, chosen pronouns, and chosen names in the EMR, personal health records, and intake forms, insurance, and legal documents. PAMED will also identify

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available LGBTQ-focused cultural competency educational resources for members addressing the collection and use of sexual orientation and gender identity data in a confidential, sensitive, and respectful manner.

Remove PAMED Opposition to Single-Payer Health Care Pennsylvania Medical Society (PAMED) amended current policy 165.997 Managed Competition to remove language opposing single-payer systems.

Expanding Access to Buprenorphine for the Treatment of Opioid Use Disorder PAMED will support efforts to eliminate the requirement for physicians to obtain a waiver while continuing training requirements to prescribe and administer buprenorphine for the purpose of treatment of opioid use disorder. Additionally, PAMED is directed to support the elimination of the yearly patient cap on the number of patients one provider can prescribe buprenorphine to in the emergency room setting. Lastly, PAMED will support ACGME expanded residency training opportunities on medication-assisted treatment for opioid use disorder in the acute outpatient setting.


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Use on Psilocybin in the Pennsylvania Commonwealth Delegates voted in favor of PAMED supporting the revaluation of psilocybin’s status as federal Schedule I controlled substance and further directed PAMED to support the National Institutes of Health (NIH) in implementing administrative procedures to facilitate grant applications and the conduct of clinical research into other medical utilities of psilocybin.

PAMED Support for Women’s Reproductive Health Delegates voted to have PAMED acknowledge support of women’s reproductive health and role of physicians in providing said care. More specifically, delegates directed PAMED to support decision-making with respect to reproductive rights and education so that women fully understand both the physical and psychological effects of their decisions in their reproductive health. PAMED has been directed to oppose legislative measures which interfere with medical decision-making or deny full reproductive choice, including abortion, based on a patient’s dependence on government funding. Delegates also voted to reaffirm existing PAMED policies protecting the physician/patient relationship and supporting comprehensive health coverage.

The PAMED Women’s Physician Section held its third annual Business Meeting during the Pennsylvania Medical Society House of Delegates weekend. The Women’s Physician Section Governing Counsel was joined by fellow Pennsylvania Medical Society members interested in issues related to women physicians with the goal of bringing together like-minded physicians to collaborate and strategize an approach to the House of the Delegates. Below are a few highlights. The keystone talk in the Women’s Section was a presentation on implicit bias by guest Rebekah Apple. The talk was instrumental in recognizing and addressing bias in our daily lives, providing tools that physicians can use to initiate conversations related to bias and how biases can be identified and addressed.

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Later in the meeting, the elections for Governing Counsel were reviewed and opportunity for additional candidacy was offered. Resolutions of pertinence to the Women’s Physician Section were reviewed and support provided to those who planned to offer conversation at the House of Delegates. Subcommittee reports were provided by subcommittee chairs. As the Women’s Physician Section continues to grow, they are looking for new members to learn from and with!

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Collaborative Works to Improve Maternal and Child Health in Greater Philadelphia

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BY NATALIE COUGHLIN

never knew it could get so bad,” she said. Maria, a first-generation immigrant and new mom, describes her depression in a focus group after giving birth to her son during the coronavirus pandemic, who was born premature at 7 months old. Jane, a Black woman and new mom, then shares her painful postpartum recovery and the lack of care by doctors. Like thousands of women in the U.S. every year, Maria and Jane had high-risk pregnancies. The U.S. has the highest maternal and infant mortality rate of any other wealthy country in the world, with significant disparities. Here, Black infants are three times more likely than white infants to die within their first year of life and have a higher likelihood of experiencing long-term health problems (CDC National Vital Statistics Reports 2020). Pennsylvania ranks 29th in national infant mortality rates and although Chester County fares well in economics and health overall, county-level data does not draw attention to the pockets of poverty and barriers to health care for more than 30,000 people (CDC Linked Birth/Infant Death Files 2020; U.S. Census Bureau ACS 2015-2019). In Chester County, Black and Latinx individuals are more likely to be uninsured or underinsured and for women, prenatal health care access also shows racial and ethnic disparities. There is no shortage of research and lived experiences that point to systemic oppression as a main driver of inequity. At the same time, there is a shortage of investment in community-based services to address it. Unsurprisingly, the coronavirus has only elevated these 1 4 C H E S T E R C O U N T Y M e d i c i n e | FA L L 2 0 2 1

problems. It’s what makes tackling maternal and child mortality one of the most significant and challenging issues of the day. “It takes a holistic approach,” said Milena Lanz, the Executive Director of Maternal and Child Health Consortium (MCHC), a health and social service nonprofit based in Greater Philadelphia. “Poverty is closely associated with adverse health outcomes and there are other factors that play into that. You have to look at the whole person and meet them where they are,” she said. MCHC has a 30-year history of doing just that, helping low-income families with children overcome barriers to good health and alleviating some of the pressures of high health care costs. MCHC helps caregivers access important resources like health insurance, food benefits, and school readiness programs. Their flagship home-visiting program, Healthy Start, focuses on the needs of high risk pregnant and parenting women and their children ages 0-18 months old. The program is guided by a dedicated team of bilingual, bicultural Community Health Workers who live and work in the communities that they serve. Over 1-2 years, women enrolled in Healthy Start learn about their child’s development, healthy lifestyle practices, and healthy parent-child engagement, all the while having a support system in MCHC that is equipped to meet their needs. Women are screened for Adverse Childhood Experiences and postnatal depression to determine how much support they need. Families are also enrolled into state subsidized health insurance and food benefits programs to relieve the burden of high health care costs and keep healthy food on the table.


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The organization sees about 5,000 families each year through its programs, 800 of whom are moms, babies, and participating family members in Healthy Start. The most significant and lasting success of the program has been the decrease in the prevalence of babies born at a low birth weight (< 5.8 lbs.), setting the foundation for healthy development and less likelihood of long-term health challenges. To make improving maternal and child health a collective effort, last year MCHC launched the Perinatal Periods of Risk (PPOR) Project, also known as the Strategic Partnership Initiative to Reduce Infant Mortality Trends (SPIRIT), under Healthy Start. The project was first introduced by the Pennsylvania Department of Health to help communities use data to understand why babies die before their first birthday and come up with a plan to reduce infant mortality in areas with high rates. The project calls for an organization with on-theground experience in working with high-risk populations to lead a collaborative of local hospitals, health providers, universities, and other organizations to improve pre and postnatal health services in their community. So, is it helping? Yes, but steadily. Now well into the three-year project, MCHC is leading this collaborative in Chester County. So far, focus groups have confirmed common challenges that women from different ethnic and racial groups experience in their health care that contribute to disparities. The most common response being that they do not feel listened to when it comes to their health concerns and therefore are not properly treated, leaving them with sometimes severe, yet mostly preventable, health problems for mom and baby. Focus group feedback, historical data, and county infant birth and death records all help identify the needs within four perinatal periods of risk: prematurity, maternal care, newborn care, and infant health. Over the next two years, the collaborative will identify and implement key prevention strategies, such as monitoring local health insurance coverage rates, clinical guidelines for well-woman visits, mental health support, and social support for caregivers. At the end of the focus group, a participant thanked facilitators for what they do to help the community. Every day, entire communities rely on human service organizations to meet people’s needs that our system fails to address. For women like Maria and Jane, having a support system that understands their health risks and advocates for their needs can make all the difference. To learn more about these efforts, visit ccmchc.org. FA L L 2 0 2 1 | C H E S T E R C O U N T Y M e d i c i n e 1 5


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The Art of

Chester County

LELE GALER BY BRUCE A. COLLEY, DO PRESIDENT OF CHESTER COUNTY MEDICAL SOCIETY

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ome of our featured artists have been born and raised in Chester County, others find it their home later in life. But both born and naturalized artists are nurtured by the geography, history, and people here. Then by assimilation and immersion in our special county they find themselves to be Chester County artists. Lele, one could argue, is both, as she was born in Chester County but moved to New England as a young teenager then returned. After marriage and about twenty years she found herself back in Chester County. Her husband, a neurologist and pharmacologic researcher, was brought back by serendipity to her childhood home of Chester County, as it is a world center for the pharmaceutical and biotech industry.

Now twenty years in Chester County, Lele has fully integrated herself in the art community of the Brandywine Valley. Already an artist by birth; she realized her calling to art from the first day she held a crayon. Lele majored in English Literature and minored in Art, taking classes through high school, college, and post graduate training. Though Art was not her profession, it was always her inspiration and avocation. After a series of “day jobs” and a stint in the word of finance her inborn talent and interest in art drew her to share her love art as a volunteer, teaching art to local school children and the community at large. Lele joyously described her love of sharing the world of art with children. And if I could only find words to reflect her energy it would blind you.

Icarus #2 detail

Heart Beats -Nemours 4(unedited) and detailed.

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While volunteering at local schools and community centers Lele met and worked with many other Chester County artists. In a brief time, finding herself totally immersed in the local art circles here in Chester County and finding encouragement among her colleagues to let her creativeness flower, she made art her vocation and now works as a professional artist full time. Well, not her only profession. Lele’s other full-time devotion is a Viniculturist, as Lele is founder and owner of Galer Estates Winery. It is one of the finest wineries on the east coast, known for its pioneering work in growing wine grapes in Pennsylvania and improving the wine making techniques unique to the mid-Atlantic region. I was lucky to have a tour of Lele’s studio in the Brandywine Valley near Longwood Gardens, made up of multiple “shops” in what was a long stable, now converted to her studio. It was set with dozens of windows filling the shop with natural light and overlooking her grapevine covered hills. Walking one end to the other through this 50-yard-long building one experiences a visual tour of her many oeuvres, a ceramic shop, then an oil studio followed by the watercolor area and a weld-steel sculpture shop, each area brimming with projects and works of art that are breathtaking for their variety, originality, and quality. Please spend a few minutes to enjoy a sampling of her creations from what is a true art workshop.

Lele Galer Studio address: 1740 Lenape Rd., West Chester, PA 19382 Email: galerfamily@comcast.net Website: ww.lelegaler.com Artist Statement: Lele Galer is a multi-media artist who works in oil, clay and welded steel. She regularly exhibits in galleries and numerous shows throughout the year in the Chester County area. Her paintings try to capture the magic and dynamic forms and textures of nature’s gardens and forest environments. Known for her steel metal hearts that range in size from 12 inches to 10 feet, Lele enjoys working with an uninhibited style within a structured form. The heart is a recognized symbol and shape that carries positive emotions and personal connections that make it an ideal form to work through in which she can explore sculptural abstractions and concepts. The heart shape is the structural foundation for the work, and the loving sentiments that are connected to the symbol, are likewise the foundation for the artist’s personal inspiration and creativity.

Magical Garden of Hestercombe House

She graduated from Wesleyan University in Connecticut and the University of California at Berkeley. She studied metal sculpture with steel sculptor Stan Smokler and steel sculptor Rob Sigafoos. Her works are always on display at the Galer Winery and shown throughout the year at regional galleries. She will have a solo show at the Blue Streak Gallery in Wilmington, Delaware in the Spring of 2022.

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Chester County

Emergency Response BY MICHAEL IVERS

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n just two short years, the United States of America has confronted, sometimes reluctantly, some ugly truths about itself: A nation divided by polarizing politics, incendiary rhetoric that culminated in an assault on our democracy on January 6th, the fallout from which is only now just beginning to be understood. It is important to recognize that this attack on the Capitol pitted Americans against Americans, not wholly unlike skirmishes that preceded the Civil War, including protestors violently assaulting uniformed police officers. In the days and weeks following the insurrection, three police officers, from the US Capitol Police and the DC Metropolitan Police Department, killed themselves. One of the ugly truths about America and its law enforcement systems is that this nation’s emergency mental health and crisis is unnecessarily stigmatizing and it criminalizes individuals in crisis, some of whom may be living with a serious and persistent mental illness, some of them simply unable to cope with a life struggle or stress. This is not opinion; it is fact, and it is easily proven without any citation, footnote, or statistic. Who responds to psychiatric emergency/emotionally disturbed person calls in America? It’s the police.

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Why? Is being mentally ill in America a crime? If you peek outside of your blinds during a psychiatric emergency playing out across the street, you will certainly understand that, yes, it is as you watch three or four police cars roll up to the neighbor’s house, and you see Sarah or John being led out of their house with their hands cuffed behind their back and placed in the back seat of a radio car. Why? Did they commit a crime? In many instances, no, they didn’t, but this is how America has decided that it’s appropriate to respond to people who need emergency psychiatric treatment. Nationwide, it is estimated that roughly 20% of all radio calls coming in to police dispatch centers are mental health or substance related. Research revealed that 84% of police agencies surveyed said mental health call volume is only rising, and 63% responded that on-scene call time has increased. Police resources are strapped and, shockingly, not all officers are trained in how to appropriately respond to a psychiatric emergency and de-escalate the situation at hand. Some even argue that just the presence of a police officer on-scene, with their firearm and handcuffs and power to take away liberty and life is, de-facto, an escalation, regardless of whatever crisis intervention training they have had.


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Speaking of that firearm, it is estimated that, since 2015, 25% of all people killed by law enforcement officers have had a mental illness—far more are injured by officers in violent takedowns, though stats aren’t as carefully tracked. The National Alliance of Mental Illness states that the average length of time between first onset of mental illness symptoms to initial accessing treatment is eleven years. It is well established that one of the barriers to treatment-seeking is the fear of stigma. “What will people say?” What will the neighbors think? This is exacerbated by the fact that it’s the cops who pull up and create a frightening hubbub on the street when someone is in crisis. But there is another way; we do not have to accept this as “just how things are” in America. Chester County Emergency Response (CCER) is a burgeoning non-profit psychiatric emergency response system that, once fully licensed, funded, and supported, aims to integrate itself into the emergency response community in Chester County and respond to psychiatric emergencies and mental health crisis situations.

policies, procedures, and directives. CCER’s EMTs will also be deputized and authorized to execute 302 (involuntary psychiatric hospitalization) warrants. It is imperative to understand CCER’s role in psychiatric emergency response: its aim is not to replace law enforcement, but to work in concert with them. Police will still have to respond to the vast majority of calls for aid, but officers will be on-hand in a secondary capacity, merely to ensure scene-safety and resolve conflict with combative/violent individuals. CCER’s vision is to de-emphasize law enforcement’s role in “EDP” calls and allow them to leave the scene expeditiously so they can be freed to respond to other calls in the community. Officers will no longer need to be tied up waiting with patients for an open bed, file 302 petitions, etc. — that will be CCER’s designated responsibility. CCER is enthusiastic about assisting Chester County in revolutionizing mental health emergency and crisis response, and serving the residents of Chester County with dignity, respect, and compassion, and ensuring that they access the care they need, because anybody in Chester County could need emergency psychiatric care; anybody. And everybody deserves to access it in a way that is as devoid of stigma, shame, and guilt as possible.

The system will ensure that, whenever appropriate, a Basic Life Support (BLS) ambulance staffed with specially trained Emergency Medical Technicians (EMTs) will be the primary unit responding. These EMTs will be fully trained and certified by the Pennsylvania Department of Health, with supplemental training on psychiatric emergency response, to attempt to de-escalate crises and handle and talk to and support individuals in distress in a trauma-focused, recovery-oriented manner. The bottom line is this: human beings in need of help don’t need a police car, they don’t need handcuffs, they need a stretcher and an ambulance in order to get to a hospital. Nobody in America should arrive at a hospital for psychiatric treatment in the back seat of a police car. Period. CCER will be funded by a mix of public, private, individual, foundation, and corporate support and will not be a part of any hospital/health system but will operate independently, governed by Pennsylvania Department of Health and EMTALA rules and regulations; it will have a Medical Director and clear objectives,

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TALE OF THE HAHNEMANN BANKRUPTCY SUMMER OF 2019 TESTED OUR PATIENCE, ENDURANCE By Sharon Griswold, MD, MPH Previously Printed in Philadelphia County Medical Society’s Philadelphia Medicine, Fall 2021

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he summer of 2019 seemed like the orchestra scene of James Cameron’s “Titanic.” I felt like the violinist trying my best to preserve calm and dignity as we endured the inevitable.

As many in the region know, Hahnemann University Hospital (Hahnemann) had been a clinical patient care hub affiliated with different academic centers in Philadelphia since 1848. Hahnemann’s heritage was significant. Over time, it evolved into a safety net institution for the underserved. One in 72 physicians currently practicing in the United States graduated from or trained within Drexel University or its legacy schools: Hahnemann University Hospital and the (Women’s) Medical College of Pennsylvania. Hahnemann had influence on health care in the area for generations. It will now be remembered as the epicenter of the largest graduate medical education a disaster to date.

subsidiaries filed for Chapter 11 bankruptcy protection in the United States Bankruptcy Court for the District of Delaware. At the time of original purchase, the assets of Hahnemann were split into different corporate entities in a deliberate and calculated process. The entities had many different names, including Center City Healthcare LLC, American Academic Health System, the Debtors as referenced in bankruptcy filings, and others. Asset splitting is a common practice in private equity acquisitions, in part, to shield liability. Hahnemann and multiple other subsidies with placeholder names filed for bankruptcy with billions of unpaid debts and the owner retaining the Center City property footprint for future sale.

Thankfully, the Philadelphia County Medical Society (PCMS), Pennsylvania Medical Society (PAMED), American Medical Association (AMA) and the Educational Commission for Foreign Medical The two-year anniversary of Hahnemann University Hospital’s Graduates (ECFMG) stepped up to advocate for the physicians in cataclysmic closure is upon us. Within weeks of the hospital bank- training (though most weren’t even members of these organizations). ruptcy announcement, thousands of patients were left to scavenge for The trainees’ careers were jeopardized by Hahnemann’s owners either care elsewhere. Hundreds of physicians in training were “orphaned” because of a negligent due diligence process, at best, or a cost-saving or forcibly displaced from their training programs at Hahnemann ploy at worst. University Hospital. Hahnemann’s demise has been featured in The New Yorker.1 Several articles were published in Academic Medicine 2-7 As Dr. Pinsky of the ECGMG stated, “with any other hospital and I wrote an article for Health Affairs.8 bankruptcy or closure in history, the well-being of the physician trainees was always a priority of the institution. This was not the case with Hahnemann’s closure.” The disastrous loss of Hahnemann illustrates the story of many injustices and is emblematic of the moral Background and ethical dilemmas associated with the rapidly changing U.S. health 5 On June 30, 2019, the private equity company, Philadelphia care environment. If regulators and policy makers do not disincenAcademic Health System LLC (PAHS), and its wholly-owned tivize exploitation in health care, by making substantive change, a Graduate medical education is the additional training required of physicians after medical school to prepare for specialization in a field of medicine. 2 0 C H E S T E R C O U N T Y M e d i c i n e | FA L L 2 0 2 1


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Trainees’ careers were jeopardized by Hahnemann’s owners either because of a negligent due diligence process, at best, or a cost-saving ploy at worst. history is destined to repeat itself.

entity at any time (including those who previously graduated from Hahnemann and St. Christopher’s Hospital for Children, along with Thank you to the Philadelphia County Medical Society and the those who were displaced by the bankruptcy), were left to seek out American Medical Association. and finance their own tail insurance coverage. Some were quoted more than $50,000 for an individual tail policy. Others, including The Hahnemann trainees were going to be left without comsome first- and second-year residents, were considered “uninsurable” plete professional liability insurance coverage despite regulatory so were not even eligible to purchase the coverage. requirements of the Accreditation Council on Graduate Medical Education (ACGME) and the debtor’s contractual obligation to If not for the efforts of individuals such as Mark Austerberry, those doctors. In Pennsylvania and many other states, physicians David Aizenberg, William Pinsky, and other individuals, including must have professional liability insurance to maintain a license to attorneys who anonymously advocated behind the scenes, the fate of practice medicine, including uninterrupted insurance coverage for all the physicians employed by the entity formerly known as Hahnemann periods of medical practice. (See table for explanation of professional could have been very different. liability insurance terms.) Type of Professional Liability Insurance

Explanation of Coverage

Occurrence

Covers the insured at any time a claim is made regardless of whether the individual is still insured by the carrier.

Claims-made

Covers the provider only while s/he is an insured of that company. If the provider ceases to be an insured, any claim made after that is not covered. This is true no matter how long the provider was insured by that carrier.

Tail coverage

A policy purchased from the same carrier that effectively converts a claims-made policy to an occurrence. The time window for tail-coverage purchase is very limited.

Nose coverage

A policy purchased from a new carrier that provides coverage back to the initial effective date of any prior claims-made policy(ies). Nose coverage can sometimes be included as part of a new made policy. Nose coverage may not be available in certain circumstances.

The residents and fellows had signed contracts with Hahnemann The physicians in training were organized into an Ad Hoc per ACGME institutional requirements so they would be covered for Resident Committee and represented by an attorney funded by professional liability regardless of when a claim would occur. That is, the AMA. Fortunately, the surge of assistance from the PCMS and the trainees were contractually promised occurrence coverage, but a AMA helped elevate the trainees’ plight. The following is an excerpt different, cheaper type of insurance (that is, claims-made coverage) from the public court record: was purchased by Hahnemann instead, necessitating the purchase The Ad Hoc Resident Committee brings this Motion because the of tail coverage. The residency spots were auctioned to the highest Debtors have willfully created a crisis that threatens the livelihood of bidder and the debtors claimed that funds from the sale of the resinearly 1,000 Residents and poses a severe threat to the Pennsylvania dency positions were expected to cover the expensive tail insurance medical system. The Residents need relief from this Court immecost. Without purchase of the tail coverage to provide continuous diately. The professional liability insurance that covers their time retroactive professional liability insurance coverage, the doctors faced at Hahnemann expires on January 10, 2020. Unless the Debtors potential sanctions from licensing boards, including loss of licensure honor their contractual obligations to purchase tail insurance for the and potential inability to participate with third party payers such as Residents, the Residents will have no professional liability insurance the Medicare Program. As a result of this breach of Hahnemann’s covering their work at Hahnemann from January 10, 2018 through contractual obligation, any physician trainee employed by the continued on next page > FA L L 2 0 2 1 | C H E S T E R C O U N T Y M e d i c i n e 2 1


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Tale of the Hahnemann Bankruptcy continued from page 21

The disastrous loss of Hahnemann illustrates the story of many injustices and is emblematic of the moral and ethical dilemmas associated with the rapidly changing U.S. health care environment. the closure of Hahnemann. The consequences are dire. Without tail coverage, the Residents may no longer be licensed to practice medicine. The cost of obtaining tail coverage on their own ranges from prohibitive at best to impossible depending on their specialties. These are newly practicing doctors with modest salaries and for many, hundreds of thousands in debt. This is an emergency solely of the Debtors’ making. The origins of this emergency started in January 2018 with the Debtors’ decision to ignore their contractual obligations to purchase occurrence-based insurance. Instead, they prioritized cost savings over contract and purchased cheaper claims-made insurance. The emergency became more acute as the Debtors abjectly failed this fall to give all affected Residents adequate notice that their professional liability coverage was ending and that tail insurance needed to be procured and that Hahnemann would not honor its obligations to do so. Upon information and belief, despite the extraordinary efforts of certain Residents, the Philadelphia and Pennsylvania medical communities and the various professional and accrediting associates have undertaken, many Residents remain unaware that their ability to practice medicine is in peril as of January 10, 2020.b Some of the physicians with Hahnemann credentials were employed by the bankrupt entity, some were in private practice and some of us were Drexel employees. At the time, we had our patients, residents and fellows foremost in our mind as the Titanic was sinking. Fortunately, the housestaff were placed in alternative training environments in the few weeks that felt like eternity. The Hahnemann physicians within the practice plan were ultimately grouped together with the physicians in training as they also lacked tail coverage, albeit for a different reason. Eventually, in March 2020, the required tail coverage was finally purchased for the displaced Hahnemann physicians. Whether it was purchased as a consequence of pressure from the ACGME to withdraw accreditation from St. Christopher’s Hospital for Children (which the Debtors also owned), the Delaware bankruptcy judge threating to turn the bankruptcy from Chapter 11 to Chapter 7 bankruptcy (which would have jeopardized the fate of the real estate),

the advocacy and interventions of the Pennsylvania Department of Public Health or the realized funds purported by the Debtors, we will likely never know.

Realigning house of medicine In early 2020, I attended a presentation on the Hahnemann closure to learn more of the role each of the alphabet soup of physician organizations played in coming to aid the displaced physicians. In addition to the ACGME, AMA and the ECFMG, presenters included the Association of American Medical Colleges (AAMC), Federation of State Medical Boards (FSMB) and others. It seemed to be the first time that the national organizations that influence the house of medicine had collaborated to achieve a substantial common goal. Private equity now controls many hospitals, emergency departments and nursing homes.9 As more hospitals become subletters of property where they provide care, this scenario is likely to repeat. It is terrifying to realize how the property where a hospital sits becomes more “valuable” than the hospital itself. The Hahnemann trainees had signed contracts stating they would comply and abide by Hahnemann’s policies and procedures related to the prevention of fraud and abuse. Who will hold private equity accountable? In the wake of the pandemic, the reckoning of racial injustice and tremendous loss of life, our existence has been forever altered. Many of us just want to move on. We want to get back to “normal.” As the Hahnemann saga remains in bankruptcy court, it is imperative to recall the saga and plead for accountability. As then presidential candidate Bernard Sanders was quoted in July 2019: “If an investment banker like Joel Freedman is able to shut down Hahnemann and make a huge profit by turning this hospital into luxury condos,” he said, “it will send a signal to every vulture fund on Wall Street that they can do the same thing, in community after community after community.”

b Debtors defined as CENTER CITY HEALTHCARE, LLC d/b/a HAHNEMANN UNIVERSITY HOSPITAL, et al. Taken from court documents Case 19-11466-KG Doc 1134 Filed 12/11/19. Philadelphia Academic Health System and its wholly owned subsidiaries declared bankruptcy. American Academic Health System and the PA Risk Retention Group (professional liability insurance company) did not declare bankruptcy.

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Save Money With This Free Discount Savings Card It’s been a challenging year so we’re giving you complimentary access to this $500 discount savings program - no membership, activation or user fees - to thank you for reading our publications. The PA Alliance of Professional Associations (PAPA) is affiliated with thousands of leading appa apparel, electronics, jewelry, and furniture retailers, attractions and museums, overnight and destination travel, and 57,000 local, regional and national restaurants and service providers. Use of this card affords attractive savings, discounts or cash back on every shopping, dining and travel purchase, and it supports local community initiatives.

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Mark Austerberry, Karen E. Davidson, Esq., and anonymous informed Experience of Moral Injury in Academic Medicine. Academic Medicine. 2020;95(4):485-487. individuals for their contributions andAssociations revisions to this(PAPA) document. The PA Alliance of Professional is affiliated with thousands of leading appa apparel, electronics, jewelry, and furniture retailers, Griswold S. Graduate Medical Education Should Not Be A Commodity. 1. Pomorski C. and The museums, Death of Hahnemann The Newtravel, Yorker.and8.57,000 attractions overnight Hospital and destination Health Affairs. 2021;40(3):536-539. June 7, 2021. www.newyorker.com/magazine/2021/06/07/the-deathlocal, regional and national restaurants and service providers. Use of this of-hahnemann-hospital. Accessed June discounts 22, 2021. or cash back on every shopping, card affords attractive savings, 9. Morgenson G, Saliba E. Private equity firms now control many dining and travel purchase, and it supports local community initiatives. 2. Aizenberg DJ, Logio LS. The Graduate Medical Education (GME) hospitals, ERs and nursing homes. Is it good for health care? In. NBC Gold Rush: GME Slots and Funding as a Financial Asset. Academic News. May 13, 2020. https://www.nbcnews.com/health/health-care/ private-equity-firms-now-control-manyMedicine. 2020;95(4):503-505. hospitals-ers-nursing-homes-n1203161. of Activate your FREE e lvania Allianc nnsy ns 3. Pe Berns JS, Coull S, Paskin D, Spevetz A, Boyer WC. Reflections on Accessed June 22, 2021. tio cia so PAPA™ benefits today. As Professional a Crisis in Graduate Medical Education: The Closure of Hahnemann Click the QR Code, or visit Program Benefits Savings https://travnow.com/, on University Hospital. Medicine. 2020;95(4):499-502. ingsAcademic $500 Discount Sav Griswold is an vel Tra & then click on Dr. ‘JustSharon Got a Card’, ing Din , ing Shopp emergency medicine physician enter code HPT500, and start 4. HamiltonCoRJ. The Hahnemann University Hospital Closure and de: HPT500 Activation saving today! in Philadelphia and is affiliated w.com What A Department Chair’s Perspective. Academic Medicine. ivate @ travno ActMatters: with Penn State Health Milton S. 2020;95(4):494-498. ery County Benefits Montgom Hershey Medical Center. Initiatives Social

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Attention Private Practitioners! New Member Benefit – PracticeBeat

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benefits.

e’re excited that the Chester County Board of Directors has voted to support a partnering relationship with PracticeBeat alongside many other medical societies across the state and country who have seen a high level of member

PracticeBeat helps practices GROW their patient volumes, improves patient satisfaction (online reputation) and ensures practice communications and scheduling requests are HIPAA compliant. The PracticeBeat technology platform aligns to the hundreds of Google criteria used to “rank” your website ensuring that patients find you when searching for your types of services. Google “tweaks” thousands of these criteria monthly so your website & digital strategy need to be aligned with a partner capable of continually monitoring and adapting to ensure your practice is highly optimized to attract new patients. All of this, likely for less monthly cost, than you spend today with multiple companies/technologies doing some, but not all, PracticeBeat capabilities. The Chester County Medical Society has selected PracticeBeat for these reasons: • We want to deliver value to our members to help them grow their practices. • Your evaluation process will be educational and valuable whether you decide to use their service or not. • PracticeBeat offers our members a significant discount off their monthly base fee. • Our county medical society earns revenue when members elect to contract with PracticeBeat, so it helps fund some of our programs and services. PracticeBeat has agreed to offer a FREE review of your online presence and why patients may not be finding you when searching for care online. Keen data-based Insight is also provided relative to the competitive landscape in your area in your specialty area. We are happy to connect you with PracticeBeat staff to schedule a one-hour review of your specific information or you may reach them directly to schedule this review via their website https://www.practicebeat.com. Questions? Call the CCMS Staff at (610) 357-8531 during business hours.

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Chester County Medical Society Presents:

Financial Literacy Workshops

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he staff of our county medical society has been working with a team of financial and legal advisors to present a series of “Financial Literacy” modules for medical students, residents/fellows and early career physicians. The first two programs have been held and are now archived on the www.chestercms.org website for viewing by our members. The next scheduled module entitled “Creating Your Team of Advisors: Attorneys; Financial Advisors & Accountants/Tax Professionals” will be a live Zoom program on Wednesday evening December 1, 2021. To participate in the live session see the flier on our website. This module will also be recorded and archived on our website. Module #1 “Physician Employment Contracts: Pillars, Pitfalls & Tips” was held on September 21, 2021. The program was designed for physicians in transition from one employment contract to a new employer as well as the aforementioned target group of early career physicians. This program features veteran healthcare attorney Karen E. Davidson, Esq., and was moderated by Financial Advisor Rory Sullivan with CCMS Executive Director David McKeighan. Ms. Davidson’s presentation

featured “Four Pillars” of employment contracts for physicians including a focus on: compensation & benefits; professional liability insurance coverage and non-compete clauses. It’s a terrific primer for physicians who are considering an employment contract. Module #2 “Managing Student Debt, Budgeting and Understanding Employer Benefits” was held on October 6, 2021. Karen Davidson, Esq., served as the moderator and Rory Sullivan from Mass Mutual of Greater Philadelphia and Brian Walters from GradFin were panelists. Mr. Walters discussed some recent major changes in public service loan forgiveness programs of the US Department of Education. It was noted that eligibility has increased for physicians who are employed by non-profit hospitals and health centers. It was also noted that the Department of Education is planning to make additional improvements in the process of applying for loan forgiveness and will simplify the requirements for a payment to be considered a qualifying payment. The Department is also planning on allowing some types of deferments and forbearances to count toward loan forgiveness. These changes will be made by issuing new regulations.

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Living with Alternative Perceptions

By Eric Ayers, CPS

An Alternative Perceptions Experience In 1980, with only a few months left in 9th grade on a beautiful spring afternoon, I heard the voice say “Get out of Here! Leave your newspapers NOW, go home and wait for your dad to get back from work. He will help you get through this. He will know what to do.” Prior to this voice and for some time after, I was terrified of listening and…not listening to the voice.

Alternative Perceptions

Looking back now, I understand and I’m thankful for that inner voice of common sense and good reasoning. At 13, I had no idea of what would transpire in the next few years or the decades to come. The situation of hearing the inner voice had been proceeded by early childhood trauma and then later by three separate attacks from groups of bullies in my neighborhood over a 3-year period during adolescence.

meetings are self-directed, self-designed social environments of hope for persons who see, sense, hear and feel unusual, spiritual, or extreme experiences.

The first was in 6th grade when I had shared my football with some schoolmates. When the ball was not returned, I received a severe concussion when my head was repeatedly struck on a sidewalk while trying to regain possession of the ball that was given as a gift from my parents. Additional incidents occurred of having rocks thrown at me while delivering newspapers and the 9th grade “experience of warning” after fighting a bully in the street a few weeks before hearing the voice. An “I can’t beat them, might as well join them” attitude followed in the next several years where I began attempts to make friends through mutual drug and alcohol use as well as trying to quiet the experiences I began to see, sense, feel and hear as an awkward teen. By 17 years old, having distressing as well as spiritual experiences otherwise diagnosed by professionals as psychotic episodes, I had a suicide attempt and a psychiatric hospitalization during the first three years of a self-deprecating, self-abusive and self-inflicted 14-year period of active addictions. At 28 years old and by the grace of God, I found lifesaving twelve step programs, supportive friends, intensive outpatient groups and individual therapy to get me started on a road to recovery. Four relapses, four psychiatric and co-occurring hospitalizations, unemployment then public assistance occurred until 1997. Social Security Insurance, occupational vocational rehabilitation and continuous sobriety followed. In 2000, I obtained full-time employment at a Montgomery County Pennsylvania D&A rehab for the next 16 years. In 2011 I was encouraged, certified, and became the first Certified Peer Specialist at that facility. There I was introduced to the local county’s support groups for persons who see, hear, and feel unusual or extreme experiences. Gratefully, my recovery excelled to the next level through the kindness of my peers. May 2016, I was hired as the Delaware County Peer Advocate, CPS. By July 2016, we as members co-founded and began to facilitate the Upper Darby Alternative Perceptions Groups. As a group we thrived and grew during the COVID-19 Pandemic, adding two

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weekly virtual support groups to our schedule. Celebrating more than five years of community support we are now meeting again in person at Five Points Coffee. I hope you enjoy the following information about Alternative Perceptions! “We’ve been there, We dare to care about you!” – AP Group

Goals of our Alternative Perceptions Meetings Since July 2016 Alternative Perceptions (AP) has strengthened our community by creating, maintaining, and facilitating meeting spaces for our self-care groups. We offer a closed virtual and an in-person closed meeting for self-identifying members who see, sense, hear, or feel unusual, spiritual, or extreme experiences. We also offer a weekly open virtual meeting for persons with lived experiences and all interested supporters. Additional goals are self-reflection and self-interpretation of events, or emotions. We develop organizational, self-stabilizing growth, and coping techniques for past, present, traumatic, spiritually startling, or distressing challenges. AP encourages mutual communication between group members, allies, families, friends, service providers, health systems staff, administrators, and physicians. We continue to develop this collaborating effort towards strategies for the understanding of valid reactions to occurring varieties of human experiences, and sometimes traumatizing events. No diagnosis, referrals, insurance, donations, or fees are needed to attend.

Self-help and peer support Peer support is based on the idea that often the best people to help us through difficult times are those who have journeyed before and with us. Alternative Perception meetings are about getting together, sharing experiences, finding ways of coping with those experiences, and growing from them. In Alternative Perception meetings you can be yourself with people you trust at a level of trust that you decide on.

Joining a peer support group can be a key step in directing our destiny! Alternative Perceptions meetings are an anonymous place to talk about uncommon experiences and can be a first step towards liberation. Sharing personal life experiences often reduces isolation and is also one of the most successful ways to reduce anxiety and distress. In living with Alternative Perceptions, we do not have to do what the origins of our experiences might suggest, we have our own opinion and our own power over our actions always. We realize we can work with others for support and not have to keep to ourselves, hide or suppress our perspectives.

Alternative Perceptions meetings are self-directed, self-designed social environments that strive to promote: Self-empowerment, interdependence, and a realistic perspective of members as experts by personal experience. Alternative Perceptions meetings provide acceptance and a sense that one is not alone, a safe accepting place to talk about feelings, visions, voices, and personal reflections. AP meetings also provide an opportunity to learn and gain skills from others, to conquer stressful experiences as well as build stronger friendships and supports.

Members share lived reflections and benefits of attending Alternative Perceptions Meetings: • I am exchanging experiences of coping, gaining perspective, and improving the quality of my personal, professional, and spiritual life. • I realize I can react positively, that I have my own opinion and my own power. • I realize that I can relate with others, connecting with people with similar human perceptions and feelings. • I feel more in tune with others as well as the world around me. • I have met others who take an interest in my experiences and me as a person. • I have met people who accept my perceptions, impressions, and perspectives as real to me. • I am actively interested in the experiences of others. • I give and receive support and respect to and from others.

Variations of lived experiences at Alternative Perceptions Meetings include, though are not limited to: • Seeing unexplainable: Auras, orbs, shadows, sparkles, persons, and animals’ faces changing shapes into demon faces, solid objects expanding and contracting or “breathing” such as floors and walls. • Sensing: Being watched, being listened to, or recorded, intuition, deductions or assumptions based on past personal experiences or being able to “read” people, reading minds and or having one’s mind being read. • Hearing Internally: Inner dialogue, responding out loud, repeated positive or negative memories of conversations with negative or positive persons, repetitive auditory memories of personal trauma, repetitive memories of dialog from TV or movie violence. Having racing thoughts and multiple auditory stressors. • Hearing Externally: “Clear as a bell” shouting or whispering voices – sometimes calling one’s name, also In-audible backcontinued on next page > FA L L 2 0 2 1 | C H E S T E R C O U N T Y M e d i c i n e 2 7


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Living with Alternate Perceptions continued from page 27

ground conversation or noise, like “radio static,” the sounds of an individual talking or multiple persons talking at once, voices giving specific direction to complete detailed necessary, religious, or spiritual tasks. • Feeling: Being physically touched, hyper-realistic dreams or memories of being touched (appropriately or inappropriately). • Visions: Unexplained (pleasant and/or unpleasant) images or scenarios of present, past, or future events, Déjà vu and prophesizing. • Aliens, Angels and Demons: Guardian angels, internal and external battles with good and evil, wrestling with internal personal, civic, and criminal behavior, voodoo, and feelings of being cursed or possessed. • Spiritual and Empath Experiences: Sensing/feeling the presence of a family member, friend or enemy after a person has passed away (pleasant and unpleasant), rearrangement of one’s actions or core beliefs. Being able to sense the energy of a room upon entering or a person’s thoughts or mood without asking.

For more information and our virtual meeting links contact Eric Ayers: AyersE@delcohsa.org or 484.983.4379. Supported by The County of Delaware Department of Human Services, 20 S. 69th Street, Upper Darby, PA 19082 www.delcohsa.org

More About Eric Ayers - Alternative Perceptions Co-founder, Group Co-Facilitator Eric Ayers’ formal art training began at the age of 8. He is a 1987 Alumni of Philadelphia’s Hussian School of Art. Eric’s crafts as an illustrator, graphic designer, logo conceptualist, photographer, videographer, website development professional, writer, and peer educator can be referenced at EricAyers.com and MiraclesWorkshop.com. Eric currently serves as the webmaster for the Chester County Medical Society’s website: www.chestercms.org.

• Trauma: Circumstantial, verbal, mental, or sexual abuse, exposure to violence or having been subjected to violence.

When, where and how do Alternative Perceptions groups meet? MONDAYS 3:15 pm - 4:30 pm - Open Virtual Meetings: For persons with a lived-experience willing to share their experiences and for all interested supporters. WEDNESDAYS 3:15 pm - 4:30 pm - Closed Virtual Meetings: For persons with a lived-experience only. THURSDAYS 12:15 pm - 1:30 pm - Closed In-Person Meetings: For persons with lived-experience only. Meeting at Five Points Coffee 47 Long Lane, Second Floor Upper Darby, PA 19082 (Septa Bus Routes 109 & 107).

Please Call Eric at 484.983.4379 to confirm that the meeting is being held in-person on the day you wish to attend day.

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Eric Ayers’ 1986 Self-portrait #3 Damaged and recovered in 2011 after 25 years in lost storage Eric Ayers’ 1986 Self-portrait #3 was the last painting in a series of a self-portraits – a student project at his alma mater Hussian School of Art.


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MYSTERIES OF MEDICARE

- ARE YOU ENROLLED IN MEDICARE OR TURNING 65 SOON?

Previously Known as the APPRISE Program – PA MEDI Is Here in Chesco to Help Seniors!

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n either case, PA MEDI, the State Health Insurance Assistance Program (“SHIP”) of Pennsylvania, can help people to understand health care coverage options so patients can make sound choices – both when new to Medicare and on an ongoing basis. PA MEDI counselors are specially-trained volunteers who can answer questions about Medicare, Medigap plans, Medicare Advantage Plans, Medicare Prescription Plans and more. Our services are confidential and unbiased. In Chester County, PA MEDI operates under the Chester County Department of Aging Services. They are funded through the Administration for Community Living under the US Department of Health and Human Services. Most people are overwhelmed by the deluge of information sent to them when they become Medicare eligible. A “Medicare 101” presentation provided by a PA MEDI counselor can help you understand when and how to enroll and your options for coverage in addition to basic Medicare. Services from PA MEDI go beyond the patient’s initial enrollment. They can help evaluate coverage during the Annual Open Enrollment Period (AOEP), October 15th through December 7th, help file an appeal if a claim is denied, help low income individuals apply for and navigate various assistance programs such as Medicaid and PACE, and generally answer your questions on Medicare and related health insurance.

PA MEDI offers one-on-one meetings with a counselor at ten convenient locations across Chester County (see below), and patients can also contact us by phone (610-344-5004, option 2) and email (smilam@chesco.org). During AOEP, they will hold special counseling sessions at senior centers, libraries and other locations. Chester County PA MEDI counseling locations and contact numbers: Brandywine Valley Active Aging (Coatesville Campus) 610-383-6900 Brandywine Valley Active Aging (Downingtown Campus) 610-269-3939 Church of the Good Samaritan (Paoli) 610-344-6035 East Goshen Township Bldg. (West Chester) 610-344-6035 Government Services Center (Westtown Road, West Chester) 610-344-6035 Kennett Area Senior Center 610-444-4819 Oxford Senior Center 610-932-5244 Phoenixville Senior Center 610-935-1515 Surrey Services for Seniors (Devon) 610-647-6404 West Chester Senior Center 610-431-4242

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2021

Chester County Medical Society Annual Legislative Clam Bake The 2021 Clam Bake was held on Thursday evening September 23rd at the Downingtown Country Club. CCMS President Bruce A. Colley, DO, welcomed the crowd of over 125 members and guests after a delightful indoor/outdoor reception. Mian A. Jan, MD, Legislative Chair for the society, served as the master of ceremonies for the evening, introducing the elected officials and assisting Dr. Colley in presenting scholarship certificates to two West Chester University pre-med students. As part of the awards ceremony, Drs. Colley and Jan also presented the society’s “50 Years in Medicine” award to Leonard C. Giunta, DO. Elected officials in attendance included: Senator Carolyn Comitta; Senator John Kane; Representative Tim Hennessey; Representative John Lawrence; Representative Melissa Shusterman; Representative Dan Williams; Representative Craig Williams; Representative Dianne Herrin; Chester County Commissioner Marion Moskowitz; Sheriff Freida Maddox and Prothonotary Debbie Bookman. Also in attendance were physician leaders and executive staff from the Pennsylvania Medical Society, the Delaware, Montgomery and Philadelphia County Medical Societies; leadership from the Chester County Historical Society; the society’s auditor and publisher and the pre-med advisor from West Chester University. The 2021 scholarship recipients are Joanna Maurer (William Darlington Scholarship) and Olanmide Olaniyi (Mian A. Jan, MD Scholarship). Retired State Senator Andrew “Andy” Dinniman was also given a special award to commemorate his service to the community as a teacher, university professor, county commissioner, school board member and fourteen (14) years as a State Senator. The Clam Bake was supported by contributions from several sponsors including Astra Zeneca; Abbott; Mass Mutual of Greater Philadelphia and the Paoli Hospital Medical Staff.

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