Lancaster Physician Summer 2014 by Hoffmann Publishing Group

Summer 2014

Ofﬁcial Publication of The Lancaster City & County Medical Society

A Day In The Life of a Hospitalist

The Versatility, Responsibilities, Challenges, & Contributions of Hospital Medicine Specialists

LANCASTER AGENCIES AID REFUGEES In Building New Lives & Getting the Health Care They Need

Beneficial Effects of Wine Consumption–

FACT Hype? OR

Contents

2014 BOARD OF DIRECTORS

SUMMER 2014

OFFICERS James M. Kelly, MD President

Lincoln Family Medicine

David J. Simons, DO President Elect

Community Anesthesia Associates

Robert K. Aichele, MD Vice President

Aichele & Frey Family Practice Associates

Paul N. Casale, MD Past President

The Heart Group of Lancaster General Health

C. David Noll, DO Secretary Ephrata Community Hospital

A Day In The Life of a Hospitalist The Versatility, Responsibilities, Challenges, & Contributions of Hospital Medicine Specialists. (p.8)

Stephen T. Olin, MD Treasurer

Lancaster General Hospital

DIRECTORS Charles A. Castle, MD Stacey Denlinger, DO

Lancaster Agencies Aid Refugees

Laura H. Fisher, MD Alyssa K. Jones, M.D. John A. King, MD Venkatchalam Mangeshkumar, MD Karen A. Rizzo, MD, FACS Jennifer Zatorski, M.D.

Beneficial Effects of Wine Consumption–

In Building New Lives & Getting the Health Care They Need (p.24)

Fact or Hype? (p.20) Editor-in-chief: Kelly Lyons Executive Director, LCCMS

Editors: Laura Fisher, MD Lancaster Family Allergy James Kelly, MD Lincoln Family Medicine

Lancaster Physician is a publication of the Lancaster City & County Medical Society (LCCMS). The Lancaster City & County Medical Society’ s mission statement: To promote and protect the practice of medicine for the physicians of Lancaster County so they may provide the highest quality of patient-centered care in an increasingly complex environment. Cover Photo: Jeremy Hess Photography

Best Practices

In Every Issue

6 Sleep Disorders

4 President’s Message

8 A Day In The Life of a Hospitalist

12 Healthy Communities

11 Helping Patients With C. Diff

28 Legislative Updates

24 Patient Advocacy 34 Restaurant Review 37 News & Announcements 42 LMS Foundation Updates

Lancaster Physician is published by Hoffmann Publishing Group, Inc. Reading PA HoffmannPublishing.com 610.685.0914

For Advertising Info Contact: Kay Shuey, Kay@hoffpubs.com, 717.454.9179

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President’s Message

A Message from Jim Kelly, M.D., Newly Elected President of the Lancaster City & County Medical Society Board of Directors.

I James Kelly, M.D. President

first joined the Lancaster County Medical Society in 2004, during my second year of residency at Lancaster General Hospital. I was asked by one of our faculty members, Steve Olin, M.D., to be a resident representative for the board. At the time, I had little knowledge regarding organized medicine. I attended monthly board meetings and mostly listened, slowly learning the basics and gaining an understanding of the key political issues facing medicine today. In my tenth year on the board, I feel ready and excited to take on the role of president of our local society.

The biggest question I hope to answer over my twoyear term is “What is the role of our county medical society?” As medicine shifts to a higher percentage of employed physicians, the medical society role is changing. While private physicians continue to take advantage of PAMED’s educational and administrative resources, employed physicians contractually receive these services from their hospitals.*Proving our relevance and worth to every physician is my goal, and each physician will certainly have a varied idea of what the society can and should do. Therefore, I want to share my vision of what our county society should provide members over the next few years: 1. Looking across the state, Lancaster County has one of the largest and most active local medical societies. However, at our annual statewide PAMED meeting, we historically have had little political activity from our delegation. We often have difficulty filling our 8 voting seats. I would like this to change. Based on our size, we potentially have a large voice at the state level. I intend to identify concerns that we, as a county, can present to PAMED to facilitate change. We have several local physicians such as Tony Castle, M.D.; Paul Casale, M.D.; and Karen Rizzo, MD, who are politically active in Harrisburg. I would like to identify physicians interested in being our next generation of leaders at the local and state level.

*Editor’s note: The Pennsylvania Medical Society is currently developing new products and resources for employed physicians.

2. In the county, I would like to see more grassroots political activity from physicians. If we meet and support our local legislators, this can make a difference at the state level. The most rewarding moments of my board tenure have involved opportunities where I educated and hopefully influenced decision making from local politicians. I would like to pair interested physicians with legislators geographically based on the specific medical issues at hand. An ophthalmologist should be educating local politicians regarding scope of practice concerns and the differences between ophthalmology and optometry, and an infectious disease specialist should lead discussions regarding Lyme disease education and

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management. These are all hot political topics, and our local legislators are hearing from their constituents. Physicians need to be involved in the conversation. 3. When asked, physicians list camaraderie as a big factor in their decision to join the local medical society. In this age of employment, many specialties have a clear division between hospitalist and outpatient physicians. In this setting, the local medical society functions to provide one of the few opportunities to meet and socialize with other physicians. Directly related to my membership, I have met and feel comfortable contacting specialty physicians when questions arise. Through society functions, I personally have had interactions with physicians employed by Lancaster General, Wellspan, and Physicians Alliance. Putting a face to a name not only ensures a call back, but it also enhances a feeling of camaraderie and trust in a growing medical landscape. 4. When a physician joins the Pennsylvania Medical Society, county membership is tied to the annual fee. I regularly speak to physicians who are unaware we have a county society, let alone realize the programs we sponsor. Doctors on Call, PALCO, a medical student scholarship program, and the Community Transformation Grant (aimed at educating and standardizing hypertension management across the county) are several programs falling under our umbrella. Educating members regarding our capabilities may facilitate involvement and open up the door for new ideas. With three major health systems in the area, the medical society provides a neutral ground for worthwhile countywide initiatives to thrive. 5. We have an aging physician base in Lancaster County, and our difficulties locally in recruitment and retaining new physicians is well publicized. Through social functions and involvement, I have seen county societies provide a medical neighborhood to assist with retention of young physicians. I would like to sponsor events involving residents and young physicians, to help facilitate new and continuing employment as well as camaraderie with other local physicians.

My goal ultimately is to listen and provide for membership needs at the state and local level. I do understand our role continues to evolve, and I am confident I can lead the county society in the right direction over the next two years. Any members with questions, concerns, or suggestions are welcome to contact me at Lincoln Family Medicine (717-738-0660) or through email (jxkelly@lghealth.org).

Visit lancastermedicalsociety.org

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best

pr ctices Sleep Disorders A Day in the Life of a Hospitalist Helping Patients with C. Diff

Sleep Disorders JONATHAN KLAPPER-LEHMAN Respiratory Care Services Director, Lancaster Regional Medical Center

hat is sleep? According to Wikipedia, “Sleep is a naturally recurring state characterized by altered consciousness, relatively inhibited sensory activity, and inhibition of nearly all voluntary muscles.” It is distinguished from wakefulness by a decreased ability to react to stimuli, and it is more easily reversible than being in hibernation or a coma.

Sleep is a very important part of our lives. As we sleep, our body is able to renew itself—it repairs damaged muscle, restores our immune system and allows our brains to process all of the events of the day. Long-term memories are created during sleep.

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Yet according to the American Foundation for Sleep, more than 70 million Americans suffer from some type of sleep disorder, including sleep apnea, narcolepsy, delayed sleep phase syndrome, sleep walking, sleep talking, nightmares, abnormal sleep/wake rhythms, and excessive daytime sleepiness. Sixty-nine percent of children experience one or more of these sleep problems a few nights a week. Poor sleep habits cost Americans $100 billion in lost work, decreased productivity, and missed school days last year. In fact, sleep has become such an issue that the American Board of Internal Medicine developed the subspeciality of sleep medicine in 2008. There are five stages of sleep, and we go through six cycles of sleep during an average eight hour night. Each cycle varies between sixty and ninety minutes.

Sleep Disorders

STAGE 1: Light sleep (day dreaming) • The body relaxes, but the mind is still active. • It is easy to wake up. STAGE 2: Deeper level of sleep • Brain waves slow down. • Brief bursts of rapid brain wave activity called sleep spindles occur. STAGE 3: Deeper sleep • Tall, slow brain wave activity occurs. STAGE 4: Deepest sleep • Brain wave activity slows down. • Difficult to wake up. • Often confused when awakened. • This is when you see bed wetting in children, sleep walking, and night terrors. STAGE 5: Rapid Eye Movement (REM) • Occurs about 90 minutes after you fall asleep. • Where most dreams occur. • Brain waves resemble Stage 1. Brain and eyes are active, yet the rest of the body is relaxed. • Harder to wake up. • Heart rate and breathing increase.

Our need for sleep does not decrease as we progress through adulthood. However, our ability to sleep often does. With our ever increasingly busy lifestyles, our “sleep hygiene” (an important skill that we have lost during the last fifty years or so) often suffers greatly. Yet we still practice sleep hygiene for the benefit of our young children—and then marvel at how quickly they fall asleep when we cannot. By simply applying the pre-sleep routine we do with our children, we can help to improve how quickly we fall asleep and the quality of our sleep as well.

When people need additional help, the Sleep Laboratory at Lancaster Regional Medical Center and the physicians at Lancaster Pulmonary and Sleep Associates provide comprehensive diagnostic testing to identify sleep disorders and treat them. Among the most common are: •

Sleep Apnea

•

Hypersomnia (excessive daytime sleepiness)

•

Insomnia (inability to get a good night’s sleep)

• Parasomnias (sleep walking, sleep terrors, How much sleep do we need? Though restless leg syndrome, etc.) research cannot pinpoint the exact amount • Set a regular bed time which will allow a full • Nocturnal epilepsy and circadian rhythm of sleep needed by people at different ages, eight hours of sleep. disorder (jet lag, shift work related sleep the following identifies daily amounts the disorder, etc.) • Set up a series of actions prior to sleep and American Foundation for Sleep recommends: repeat them every time. For example: Sleep difficulties can be frustrating, but 1. Stop the routine activities of the day. they can be overcome. If you or someone AGE SLEEP NEEDED 2. Get something to eat or drink. in your care is struggling with them, you 3. Change clothes. Newborns 16–19 hours can learn more and get help at Lancaster4. Do your nightly toiletries. PulmonaryandSleepAssociates.com or by 3–6 months 13–15 hours calling 717.735.0336. 5. Read a relaxing book or listen to music. 6–12 months

12–14 hours

1–3 years

10–12 hours

3–6 years

10–12 hours

6–18 years

8–10 hours

Over 18 years

6–9 hours

• Remove all distractions from the bedroom such as televisions and cell phones. • Set your alarm for morning, and then turn the clock away from you. • If you still can’t sleep, leave the bedroom and go read something relaxing. Return to the bedroom when you are tired again. LANCASTER

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L A N C A S T E R M E D I C A L S O C I E T Y.O R G

Best Practices

A Day in the Life of a Hospitalist

The Versatility, Responsibilities, Challenges, & Contributions of Hospital Medicine Specialists day’s assignments are determined, the team breaks and begins their rounds. Depending on the hospital census, they could be seeing anywhere from 15 to 25 patients with a targeted average of 18 patient encounters.

JOHN KING, M.D., HOSPITALIST General Internal Medicine of Lancaster

t is 7 a.m. and there are four doctors meeting over yogurt, tater tots, and muffins in the physicians’ dining room of Lancaster Regional Medical Center. They are receiving sign-outs of events in the hospital, as well as new admissions and consults from the night before. Across town at Lancaster General Hospital, and at hospitals across the country, hospitalists are also getting sign-out from the covering nighttime physician team. News of Code Blue calls, doctor responses to patients’ needs, and eventful overnight admissions are shared with the daytime team. After this is completed, the daytime team determines which patients each provider will be rounding on that day. Emphasis is placed on rounding on patients seen the previous day for the purpose of continuity and building on relationships established on the previous days’ rounds. There is also a general geographic component to the assignments to make it easier for nurses to track the rounding providers. After the

These physicians practice what is currently known as “Hospital Medicine.” Their appropriate title is “Hospitalist.” The hospitalist definition as determined by the Society of Hospital Medicine Board is as follows: “A physician who specializes in the practice of Hospital Medicine. Following medical school, Hospitalists typically undergo residency training in General Internal Medicine, General Pediatrics or Family Practice. They may also receive training in other medical disciplines. Some Hospitalists undergo additional post-residency training, specifically focused on Hospital Medicine, or require other indicators or expertise in the field such as the Society of Hospital Medicine Fellowship in Hospital Medicine, or the American Board of Internal Medicine’s recognition of focused practice in Hospital Medicine.” The hospitalist specialty has evolved over the last 15–20 years due to a variety of factors. Among them are the efficiency gained by having a physician (or team of physicians) stationed at the hospital instead of multiple practitioners seeing their individual patients and returning to their offices to see their outpatient panel. For primary care physicians, interruption of phone calls from nurses and the difficulty in managing complex hospital patients while

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seeing their outpatients is quite daunting. Additionally, primary care physicians have been tasked to remain open longer in the evening and to be available on weekends as well. In addition to primary care, the practices are essentially acting as Urgent Care centers, too. Hospital medicine has become quite specialized. With an increase in technology and emphasis on decreasing length of stay in the hospital, the presence of physicians stationed in the hospital has become more important. The intensity of service where a patient can be seen multiple times during the day and have their problems immediately addressed if they are “crashing” help to improve patient care and maximize utilization of resources. Additionally, the underlying residency training of internal medicine programs with an emphasis on inpatient rotations serves as a strong foundation for managing patients in the hospital. Most family physicians have emphasized their role in preventative care and outpatient management of diseases and generally have formed referral

Summer 2014

A Day in the Life of a Hospitalist

Typically, hospitalist programs target 15-18 encounters/day for optimal efficiency on both the part of the hospital paying the physicians as well as appropriate utilization of hospital resources. Hospitalists are often tasked with additional responsibilities such as being present at “rapid responses” where nurses have identified the need for urgent medical attention on inpatients. Also, participation in Code Blue/ACLS protocol care in the setting of hospitalized patients is also often required. The work of hospitalists is evaluated on an entirely different set of metrics than those in the outpatient setting. While outpatient medicine has seen the rise of the Patient Centered Medical Home (PCMH) and numerous incentives for certain quality indicators in their care, the hospital care parameters are unique to inpatient care.

relationships with hospitalists. This pattern of practice, however, is not universal. There are a significant number of hospitalists who are family medicine trained, and there are physicians who care for their own patients in the hospital working around the obstacles of their office schedules. In Lancaster, the physicians at Stephen G. Diamantoni, M.D. & Associates Family Practice round on their inpatients and even continue to deliver babies. It is now approximately 1 p.m. Hopefully, the team of physicians is able to eat lunch together and discuss who is left to be seen as well as share information passed on to them by the nursing staff. They spread the work of new admissions and consults. During the course of the day, these physicians have spoken with the patient, family members, nurses, and case managers as well as subspecialist physicians with whom they have consulted. The treatment plan of most hospital patients is quite complex and the acuity level for most people who meet admission criteria is quite severe. Some subspecialist consultation is

often required, and developing a coherent treatment plan with multiple physicians is one of the key components of optimal hospital medicine. Along with addressing the patient’s physical illness, issues such as family dynamics, the patient’s functional status as determined by physical and occupational therapists, and the requirement for home services such as CPAP or BiPAP machines must all be sorted out. Homecare, or discharge to a nursing facility is a very common scenario requiring additional coordination. Medicare and most insurance companies have addressed transition of care as a key area of focus for improvement. Hospitals are penalized if patients return to the hospital, and primary care providers are incentivized with additional payments for seeing patients within a short time after hospital discharge. Anecdotal as well as statistical analysis has borne out that these measures have reduced the rate of readmissions, or “bouncebacks” to the hospital.

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They are largely driven by Medicare’s Value Based Purchasing program which emphasizes quality indicators of patient satisfaction with both the physician and the hospital, reduction in payments for early readmission, and reduction in pay for care for preventable hospital acquired infections. Length of stay and timeliness of completed discharge summaries are also followed closely.

continued on page 10

L A N C A S T E R M E D I C A L S O C I E T Y.O R G

Best Practices

A Day in the Life of a Hospitalist

approach of phoning in “patchwork orders.” At the end of the day, late discharges are completed, discharge summaries dictated, and accumulated paperwork is finalized. It is frequently a time of reflection on the good, bad, and the ugly of the day which has preceded. Frustrations often voiced by hospitalists include adapting to the implementation of EMR - although a begrudging acceptance and acknowledgement of electronic medical records’ ability to improve patient care and documentation is sometimes voiced. Hospitalists also face the difficulties of managing noncompliant patients who come and go from the hospital when they please, rather than as directed, and those who present to the hospital because they don’t adhere to outpatient treatment plans.

Additionally, compliance with practice guidelines such as prescription of aspirin and beta blockers for acute MI patients and stroke patients is also incorporated into the evaluations. Most hospitals use a dashboard report type of format to evaluate their hospitalists. Patient satisfaction is measured by the Press-Ganey firm with measurements from HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems).

Many hospitalists are drawn to this type of work based on the type of schedule, which is often a seven days on/seven days off format. This calls for an intense work week with clearly defined time off. This format is meant to enhance continuity of care in the hospital and provide physician presence throughout the course Concluding the day also involves reviewing great “saves” and of the day. Typically the days are 10-12 hours of in-house pres“mishaps” of the day, for the purposes of both passing on data and ence. This allows for patients to be discharged in the evening if all therapeutic release. As for job satisfaction, hospitalists commonly appropriate consultations and test results indicate that the patient share that comes when appropriate care in a timely manner with is safe for discharge home. the right resources results in optimal hospital care and a successful, At the end of the day, the sign-out ritual is repeated. The events of efficient, and cheerful hospital stay for the patient. After sign-outs the day are relayed to the doctor who comes on at night, commonly of pending labs, studies, and potential problems for the nocturnist, termed a “Nocturnist.” This subspecialty of medicine is evolving the hospitalist turns over the reins…and the pager. 7 a.m. will be further into specialized care of emergencies and addressing patient here soon. problems that arise at night in full, rather than the “old school”

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Summer 2014

Best Practices

New Treatment May Be Unusual But Is Helping Patients With C. Diff FRIEDA SCHMIDT Manager, Public Relations, Lancaster General Health

(LANCASTER, PA, May 2014)

n unusual treatment is offering hope for patients with a recurring infection caused by an overgrowth of “bad” bacteria (Clostridium difficile or C. diff) in the gastrointestinal tract when standard therapies have failed. The concept of fecal transplant was introduced more than 55 years ago. Although still considered investigational by the Food and Drug Administration (FDA), it has been approved for use with informed patient consent.

“Naturally the idea of a fecal transplant may be repulsive, at first, to some, but it’s nothing compared to the severe cramps, abdominal pain and diarrhea that plagues people with C. diff every day,” said Paul Allegretti, DO, a gastroenterologist on the medical staff at Lancaster General Hospital and in practice with Lancaster Gastroenterology, Inc. Dr. Allegretti performed the first fecal transplant at the Lancaster Gastroenterology Procedure Center in the fall of 2013. “The procedure has also been approved by the Pennsylvania Department of Health to be performed by gastroenterologists at Lancaster General Hospital,” said Dale Rosenberg, MD, the Chief of the Division of Gastroenterology at LGH and a member of Regional Gastroenterology Associates of Lancaster. According to Dr. Allegretti, a fecal transplant involves taking stool from a healthy, carefully screened donor and transplanting it into a patient experiencing unresolved C. diff. The healthy bacteria from the transplanted stool then begin to grow and prevent the spread of the “bad” bacteria. “The goal is to re-introduce the natural balance of ‘good’ bacteria that normally exists in a healthy person’s gastrointestinal tract,” Dr. Allegretti added. “It’s like a mega strength probiotic of good digestive bacteria.” Studies and patient reports indicate the procedure is extremely effective. One of the latest studies, published in the New England Journal of Medicine, compared C. diff patients undergoing fecal transplants to those receiving the traditional treatment of aggressive antibiotic regimens. The results showed 94 percent of transplant patients were cured compared to only 27 percent using antibiotics.

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The concept of fecal transplantation dates back to fourth century China when people ingested feces to treat food poisoning and diarrhea. It has also been used in veterinary medicine for many years. However, interest in the procedure for humans has garnered more attention over the past decade as cases of C. diff have escalated. Every year, according to the Centers for Disease Control and Prevention, about a half million people in the United States contract C. diff and an estimated 14,000 to 30,000 die from it. Dr. Rosenberg noted that it most commonly occurs after a person receives antibiotic therapy for an infection. He recommends testing for C. diff when diarrhea occurs under these circumstances. C. diff is considered a “superbug” (one that can be drug resistant). It is especially virulent in those with weak or ineffective immune systems. Even when antibiotics work, a number of people get the infection again the moment they stop the medicine. “To help prevent the infection from spreading, isolation gowns, gloves, and thorough hand washing are imperative,” noted Dr. Rosenberg. “Intensive cleaning of infected hospital rooms and patient bathrooms is crucial as well.” “Until now, there hasn’t been a good treatment for severe and recurrent cases of C. diff,” said Dr. Allegretti. “Not everyone with C. diff needs to go this route, but as awareness grows, I believe more people will want to know if fecal transplant may be the right option for them.”

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Healthy Communities

ian Lancaster Physic ongoing series...

CARING FOR THE LONG TEstRerM County In Lanca

Masonic Village’s Grand Lodge Hall and Formal Gardens

Masonic Village at Elizabethtown LINDSAY DE BIEN

Lancaster County has the largest number of senior living communities of any county in America. Right or wrong, people have perceptions of each community. That’s why we’re talking with the administrations of different Lancaster County facilities to set the record straight about retirement living in general and to share what individual facilities offer to those seeking long-term care. This ongoing series in Lancaster Physician magazine features long-term care options in Lancaster County. Through it, we aim to provide insight to physicians and the patient community so people can be better equipped to navigate this major change in their families’ lives.

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ils Kile was enjoying an active lifestyle. He was volunteering, working on an in-house television station, and enjoying taking photos of events and scenery while living at the Masonic Village at Elizabethtown. He was not expecting the twelve-day hospitalization that brought his life to a temporary halt. Fortunately, because of Masonic Village’s continuum of care, Kile could return to Masonic Village after his hospital stay and receive the short-term rehabilitation services he needed right there. “We did the right thing by coming to Masonic Village,” he says on behalf of his wife, Patty (who has also received shortterm rehabilitation) and himself. “We came here to live. I was motivated [to get better] by what I was missing. Life inspired me. I enjoy life too much. I had a good attitude and that has a lot to do with it.”

Summer 2014

Caring for the Long Term

During his rehabilitation, Kile experienced the benefits of living in a retirement community that offers comprehensive and transitional services. He was able to receive all the care he needed without leaving Masonic Village. The Masonic Village provides a full spectrum of long-term options including retirement living, personal care, nursing care, and memory support services. They also offer home care, hospice, and short-term rehabilitation services, which are available to Masonic Village residents and the local community. In addition, Masonic Village also offers an adult daily living center, in which participants have access to rehabilitation care and other on-campus services. All services are open for everyone with or without a Masonic affiliation.

Quality of Care Rehospitalization is one of the largest problems in the medical system, with many individuals being readmitted back into hospitals within a month of being discharged. This problem is especially common among older adults. High quality rehabilitation services, such as the care provided in Masonic Village’s Transitional Care Unit, can help to reduce readmission rates, which ultimately benefits patients and the health care industry as a whole. “Because we do a great job of caring for our patients, the Masonic Village is consistently well below national benchmarks for hospital admissions and readmissions,” says John Mast, M.D., Associate Medical Director. The Transitional Care Unit has consolidated healing services into one entity of highly trained health care professionals who are devoted to accelerated recovery. Certified nurses and licensed practical nurses are on consistent assignments within the unit, making it easy to notice slight changes in particular patients. The high staff-to-patient ratio and low turnover rates within the Masonic Village leads to enhanced and personalized services. continued on page 15

Accommodations and Services Masonic Village’s new Transitional Care Unit offers skilled care in rehabilitation, including physical, speech, and occupational therapy. These services aid in the recovery process of those who have experienced injuries and illnesses such as orthopedic conditions, total joint replacement, amputation, strokes, cardiac events, respiratory conditions, and complications from diabetes and infections. The new unit includes 20 private and 7 semi-private suites. “Recent renovations make the environment warm and inviting to help people feel at home while they concentrate on their recovery,” shares Beth Bossert, R.N., N.H.A., Administrator of Health Care Services. When patients are not receiving rehabilitation therapy, they can enjoy amenities within the unit, such as a flat-screen TV, telephone, refrigerator, wireless internet access, electric lift chairs and beds, and country kitchen dining or in-room meals. Country kitchen dining allows individuals to dine in an open, social atmosphere, where meals can be made-to-order. The Transitional Care Unit is equipped with state-of-the-art rehabilitation equipment, an emergency call system, therapy techniques, and advanced technology. The convenience of on-campus access to laboratory and X-ray services also helps individuals avoid rehospitalizations.

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Summer 2014

Caring for the Long Term

At Masonic Village, doctors are available onsite every day of the year. When sudden changes of conditions appear, doctors can see a patient promptly, within the same day. Doctors and nurses attend monthly meetings which focus on continuing to provide quality care for patients. Staff members, including social workers, continue their mission by assisting patients beyond their return home, making the transition as smooth as possible. This assistance entails home and community skills training, mobility, self-care training, a home exercise program, nutrition management, and medical transportation. As Wils Kile can attest, Masonic Village at Elizabethtown’s 1,400 acres of retirement living amenities and continuing care services promote an active, enjoyable lifestyle, no matter what life brings.

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L A N C A S T E R M E D I C A L S O C I E T Y.O R G

Healthy Communities

Summer for e ik L n so a e S o N ’s There

e iv t c A g in t t e G in Lancaster County Getting Out &

AMY B. KLATT, Freelance Writer

Summer is here and there are plenty of reasons to get outside & get active in Lancaster County.

tepping outdoors connects you with the outside world in a way that a stationary bike or elliptical machine at the gym cannot. Whether it’s walking alongside a trickling stream, running on a sandy white beach, watching the sunset over a mountain ridge, or even hearing the wind blow through the trees in the morning, being outdoors can make you feel energized and alive.

Remember that outdoor activities aren’t limited to running and hiking. Gardening, yardwork, swimming, jumping rope, or even running through the sprinkler with your kids also counts as outdoor fitness. These are all great ways to burn calories and have fun. Thanks to beautiful Lancaster County and all of the exceptional opportunities for outdoor fun that surround us, it has never been easier to get close to nature while getting active. Whether you enjoy biking, hiking, walking, kayaking, or just getting some fresh air—it’s all here. To help get you ready for a season of fresh air fitness, here are a few favorite outdoor spots in Lancaster County worth exploring.

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Summer 2014

Chickies Rock Taking a scenic hike to the top offers impressive views of York County and the farmlands of northwestern Lancaster County. Chickies Rock is an outcropping of quartzite rock towering 200 feet above the river. http://www.explorepatrails.com/ singletrail.aspx?id=22

Tucquan Glen Nature Preserve This outdoor sanctuary features an abandoned dirt road and worn trail that roam through the heart of the ravine for almost a mile. Walk or bike the trail down to the railroad and return via the road for an estimated 2.4 miles of exercise. In summertime, over 20 species of ferns and 40 species of trees are found throughout the preserve. http://www.lancasterconservancy.org/preserve/tucquan-glen

Conestoga River Water Trail Kayaking enthusiasts love the Conestoga River Water Trail, a popular and scenic river that runs for sixty miles and drains into the Susquehanna. No kayak? Visit Chiques Rock Outfitters for a rental and possible tour. http://www.chiquesrockoutfitters.com

Kelly’s Run Pinnacle Trail System Kelly’s Run is a national recreation trail, accessible from the Holtwood Recreation Area and from Pinnacle Overlook. This trail system provides six miles of loop trails with scenic hiking in the Kelly’s Run Natural Area. Kelly’s Run Trail is four miles long and considered challenging. http://www.pplweb.com/citizenship/environment/preserves/holtwood/hiking-trails.aspx

Conestoga Greenway Trail Hike or bike the Conestoga Greenway Trail, which runs next to the Conestoga River at Sunnyside. At 1.3 miles in length, the greenway passes through lush woodlands bordering the river for most of its length. http://www.traillink.com/trail/conestoga-greenway-trail.aspx

Refreshing Mountain Zip Line Canopy Zip lining is fun for all ages—experience a series of cables and platforms that take you on a tour through forests and near wildlife right in Lancaster County. Expect this to be refreshing, exhilarating, and challenging. http://refreshingmountain.com/ziplines.cfm

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IMPROVING LIVES ACROSS

LANCASTER COUNTY For more than nine decades, United Way of Lancaster County has been making change happen in Lancaster County through the caring generosity of people like you. And it’s working. Last year—in partnership with other nonprofit community organizations— we touched more than 165,000 children, women, and men in these three focus areas: • Education: Helping children and youth come to school ready to learn and stay there to achieve their full potential • Financial Stability: Helping families stay in their homes and become financially independent • Health: Helping give our neighbors pathways to good physical and mental health To learn more about how you can help make a lasting difference in this community, we invite you to contact our local Leadership Giving Team at (717) 824-8131 or visit www.LiveUnitedLancaster.org.

United Way of Lancaster County  630 Janet Avenue  Lancaster, PA 17601 LeadershipGiving@uwlanc.org  www.LiveUnitedLancaster.org  (717) 824-8131

Summer 2014

Getting Out & Getting Active

Mt. Gretna Lake & Beach Mt. Gretna Lake & Beach is a swim and recreation facility open to the public for a daily fee. Mt. Gretna Lake & Beach includes eight acres of beach, recreation lawn, and picnic grove areas adjacent to mountain stream. In addition to swimming, you can bring your own permitted kayak or rent one there. http://www.mtgretnalake.com

Sickmansmill Tubing If you’re looking for a memorable trip for the entire family, tube along the scenic Pequea Creek. While tubing, visitors have seen great blue herons, deer, mink, geese, ducks, dragonflies, butterflies, tadpoles, minnows, and Lancaster County cows cooling off in the creek. http://sickmansmill.com/wsb4558076101/index.html

Historic Lancaster Walking Tour Take a stroll through the beautiful streets and byways of old Lancaster City for a historic walking tour. In addition to the walk, you will learn about the history of Lancaster. http://www.historiclancasterwalkingtour.com

Roland Park Check out the hiking, walking, biking, and jogging trails on over 70 acres of rolling hills and woodland in Akron, PA. The park includes volleyball and basketball courts, an 18-hole disc golf course, and picnic facilities. http://www.akron-pa.com/parks.html

Longs Park This 80-acre city park is home to a whole host of activities including a free summerlong music series, a nationally acclaimed fine art and craft festival, and the world’s largest chicken barbecue. Additionally Long’s Park includes outdoor amenities including picnic pavilions, a petting farm, children’s playgrounds, a three-acre, spring fed lake, tennis courts, and a fitness trail. http://longspark.org/about-the-park/

For more recommendations on how and where to enjoy the outdoors, download the Lancaster on the Move guide via the link below. It offers information about more than 225 free or low cost parks, nature preserves, state game lands, walking and hiking trails, lakes, outdoor clubs, and senior recreation opportunities throughout Lancaster County. http://www.lancastergeneralhealth.org/LGH/ECommerceSite/media/LGH-Media-Library/LGH%20Images/Our%20Services/ Healthy%20Weight%20Management/LOM_Parks-2011.pdf *Source: Lancaster Visitors Bureau.

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Beneficial Effects of Wine Consumption–

FACT Hype? OR

STEPHEN T. OLIN, M.D. LG Health Physicians Downtown Family Medicine

homas Jefferson was known to have said, “Good wine is a necessity of life for me.” In addition, “Wine from long habit has become an indispensable for my health,” and “Wine… the true old man’s milk and restorative cordial.”

broader range of health benefits. The “French Paradox” is an example, where the seemingly paradoxical relationship between the high fat/high dairy diets of French people and the low occurrence of cardiovascular disease among them is ascribed to their consumption of wine.

Wine as a medicinal agent The most studied chemical in dates back to at least 2000 B.C. “Moderation red wine is resveratrol which is a Hippocrates, the father of mod- in all things” phenolic compound produced ern medicine, considered wine in the grape skins and leaves of grape vines. a part of a healthy diet and advocated its The concentration of resveratrol varies use as a disinfectant for wounds and a cure depending upon grape variety, climate, and for various ailments ranging from diarrhea wine making techniques. However, there are and lethargy to pain during child birth. The other components in wine that have been Roman physician Galen also used wine the focus of medical research, including as a disinfectant for all types of wounds, including those sustained by the gladiators. catechin and quercetin. In the past twenty years, wine consumption has been suggested as having a much

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Alcohol, including wine, has been shown to increase mineral density in both men and

Summer 2014

Beneficial Effects of Wine Consumption—Fact or Hype?

women. However, heavy alcohol consumption has a damaging effect and may lead to an increase in the frequency of fractures. Moderate consumption of alcohol has been linked with a variety of cancers including breast, colon, esophageal, and stomach. However, the antioxidant properties of resveratrol found in grapes have shown some protective quality that inhibits cancerous changes in cells. There are no long-term or conclusive studies, although several suggest a lower risk for lung, ovarian, and prostate cancer. Although excessive alcohol consumption leads to high blood pressure, increases cholesterol levels, and causes heart dysfunction, moderate wine consumption may lower the mortality risk of heart disease. The most compelling study to date, published in the British Medical Journal in 2011, found that light to moderate alcohol consumption was associated with a reduced risk of multiple

cardiovascular outcomes, including lower stroke incidents and mortality, lower coronary heart disease incidents and mortality, and all-cause mortality. Moderate drinking was defined as up to one drink (5 oz.) per day for women and two drinks per day for men. Although alcohol consumption has been associated with impaired mental function (short term and long term heavy drinking leads to behavioral changes and memory impairment), moderate alcohol consumption has been shown to lower the risk of developing Alzheimer’s disease and dementia. There are a few studies that suggest moderate alcohol consumption may lower the risk of developing Type II diabetes. Risk of infection from helicobacter pylori, a bacterium strongly associated with peptic ulcer disease, has been shown to be lessened in moderate wine and beer drinkers.

The antioxidant and the anticoagulant properties of wine may also have a positive benefit in slowing the effects of macular degeneration. And although consuming wine together with food may offer a positive benefit for weight management, a standard 5oz serving of red wine contains 106 calories and white wine 100 calories. Finally, for both men and women regarding psychological functioning, personality, and other health related behaviors, a Danish study found wine drinkers to operate at optimal levels. The reported studies on the potential benefits of alcohol consumption (wine in particular) have only been observational, however, as opposed to randomized robust research studies over many years comparing well-matched groups of non-drinkers with continued on page 22

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people who consume a moderate amount of wine (e.g. 5 oz./day in women and 10 oz./day in men). It is unlikely this type of extensive study will ever be performed. Also, we should remember Ralph Waldo Emerson’s advice, “Moderation in all things,” which has been well-supported as a practical approach in the many reported studies on the health benefits of wine. Abstaining from the daily amount (5 and 10 oz.) referenced in all studies to date throughout the week and instead consuming 35 oz. (women) and 70 oz. (men) on a Friday or Saturday night will likely lead to more harm than good! Given the absence of solid data, if you drink alcohol, do so “in moderation.” If you currently don’t drink alcohol, there’s no resounding reason to start.

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Patient Advocacy

Lancaster Agencies Aid Refugees

In Building New Lives & Getting the Health Care They Need â&#x20AC;&#x153;What we need to do is really consider the trauma of what these people have been through.â&#x20AC;?

SUSAN SHELLY

mericans engage in frequent conversation and debate concerning immigration and immigrants in the United States. Rarely, however, does much dialogue occur about refugees who are identified for resettlement by the United Nations and sent here, many having experienced unimaginable hardship and terror. The Office of the United Nations High Commissioner for Refugees reports there are about 15.5 million refugees around the world in need of protection and help, most of them driven from their homes because of persecution and armed conflict. Each year, the U.S. government authorizes entry for 80,000 refugees who have been identified as having experienced persecution or fear of persecution. Of them, about 500 refugees resettle in Lancaster and the surrounding area each year, creating opportunities and challenges for the new residents and the people who work to help them resettle. Many refugees are men and women of Nepali origin who once were citizens of Bhutan, a remote country in South Asia flanked by China and India. They fled their homes in Bhutan during the early 1990s because of human-rights violations by the Bhutanese government.

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Summer 2014

Lancaster Agencies Aid Refugees

Many ended up in refugee camps in Nepal, where they languished for 20 years as the governments of Nepal and Bhutan held talks to try to figure out what to do with them. When an agreement to vacate the camps was reached in 2007, resettlement began and moved quickly, resulting in an influx of Bhutanese of Nepali origin.

Sheila Mastropietro, who has been working with refugees for 27 years and currently serves as Director of the Lancaster Immigration and Refugee Office of Church World Service. “What we need to do is really consider the trauma of what these people have been through.”

Other refugees in the Lancaster area have come from Myanmar, Rwanda, Somalia, Cuba, Ethiopia, Sudan, the Democratic Republic of Congo and Iraq. They all arrive here unsure and anxious about what their new lives will present. While some have spent many years in crowded camps with miserable living conditions, others have been displaced by war or genocide. Some have lost family members to cruel violence.

The Lancaster Immigration and Refugee Office of Church World Service helps to resettle about 300 refugees a year, while Lutheran Children and Family Services’ Refugee Resettlement Program serves about 200 clients annually.

“Some of the people we serve have seen their family members killed and tortured and their limbs cut off and women raped,” said

The challenges of helping the refugees (who have legal status in the United States and are eligible for benefits, including

medical care) are many. Cultural differences can create barriers and trust issues as family members must follow guidelines continued on page 26

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In Lancaster County, there are a number of excellent choices for General Otolaryngology care, including ENT Head and Neck Surgery of Lancaster. But we also offer what we believe is some unique expertise. Our physician, Francis Ruggiero, M.D., is a fellowship-trained Head and Neck Surgeon. His training provides him with uncommon skills for addressing such difficult problems as cancers of the mouth and throat, advanced skin cancers, thyroid and parathyroid disease, and reconstructive problems of the face, neck, mouth and throat. Our speech pathologist, Laurie Sabol CCC-SLP, one of the most seasoned in Lancaster County, has over 30 years of experience treating patients with voice and swallowing problems. Working closely with Dr. Ruggiero, she offers patients not only her cultivated skill and compassion, but the best technology, in the form of the only videostroboscopy system in the area. For some ENT problems, there are many good options; for some of the most challenging problems patients face, think ENT Head and Neck Surgery of Lancaster.

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Patient Advocacy

for enrolling children in school, looking for work, being placed in housing, and other tasks. The agencies that help to resettle refugees work with local landlords and employers to arrange for housing, and they help their clients find work. They are expected to have their clients settled in jobs or school within three months of their arrivals.

Health issues are also problematic for the refugee population. While all potential refugees receive health screenings to rule out the possibility of any contagious diseases (they are not admitted in the U.S. for resettlement if disease exists), many refugees suffer from significant health issues when they arrive in Lancaster.

Stephanie Gromek, Refugee Health Care Manager for the World Church Services program, and Ellen Willenbecher, Refugee Medical Coordinator for Lutheran Children and Family Services, team up with SouthEast Lancaster Health Services and Lancaster General Health to make sure refugees receive the health care they very much need.

“When folks come here, they for the most part haven’t had adequate medical or behavioral health care for a long time, if ever,” Willenbecher said. “And, they are desperately in need of that care.” Medical issues vary from population to population, but often include hypertension,

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Summer 2014

Lancaster Agencies Aid Refugees

Gromek explained. “We’ve identified key issues that we need to address.” Those issues include proper refrigeration of food and the importance of keeping screens in the window.

diabetes, gastro-related problems, unresolved orthopedic injuries, and others. Many refugees who lived in one of the main Nepali camps suffer from cardiac issues resulting from an outbreak of rheumatic fever there.

While the physical health concerns are many, psychological health must also be addressed. An initial health check, including a mental health assessment, occurs within seven days upon arrival in Lancaster, but mental health issues are not always easy to recognize. Typically, newly arrived refugees are overwhelmed and sometimes distraught, making it difficult for them to describe their mental states or for medical personnel to differentiate between normal and abnormal behavior.

According to Gromek, post-traumatic stress disorder and substance abuse are not uncommon in the refugee population. Some refugees also experience health problems related to diet, such as malnutrition and anemia. Very few have had much, if any, dental work, and all require immunizations. Some refugees begin to develop diet-related health problems once they arrive in Lancaster.

“A lot of the red flags aren’t recognized because the refugees aren’t even recognizing them,” shared Gromek.

“It’s really overwhelming for them to go to the grocery store,” Gromek said. “All of a sudden there’s a huge amount of food available, but people might not understand what’s good for them and what isn’t, or how to prepare or keep foods from going bad.”

The stress of resettling and adjusting to a strange land is often coupled with strong memories of horror from the lives the refugees have left behind. “All populations have adjustment issues, Poor food choices can quickly result in health problems in certain and the trauma of life before coming here gets layered onto those populations. “Getting people educated quickly is really important,” issues,” Willenbecher said. “It’s not an easy situation to deal with.”

“A cancer diagnosis is a life-changing event that requires hope, strength and support. Providing comfort and compassionate care is my passion and purpose. As your doctor, I will be your tireless partner and advocate.”

An effective strategy for dealing with those stresses is simply to get to know the refugees and their stories and to establish trust with them. Gromek runs “learning circles,” in which clients get together to share a meal, along with stories of their experiences and their cultures. The circles are held once or twice a week, typically lasting for about two hours. The goal is to bring people together and begin to build community.

Please Join Us in Welcoming Dr. Rodriguez to Our Fine Community.

“We want to make sure we establish safe space and build trust,” Gromek said. “That makes it easier for everyone.”

Lancaster Cancer Center, Ltd. (“LCC”) is proud to announce that Joanna Rodriguez, M.D., has joined our medical group. Dr. Rodriguez earned her Doctor of Medicine degree in 2008 from St. George’s University School of Medicine, her Internal Medicine certification in 2011 from Thomas Jefferson University Hospital in Philadelphia, as well as her Fellowship in Hematology and Medical Oncology in 2014. Dr. Rodriguez earned numerous awards during her academic career, is Board certified in Internal Medicine, and board eligible in both Hematology and Medical Oncology. She has extensive research experience and holds membership in the American Society of Hematology, the American Society of Clinical Oncology, and the American College of Physicians. After an extensive search, we are excited that Dr. Rodriguez has joined LCC and know that she will continue to deliver the care expected of LCC physicians: dedicated to patients, family and the community.

While life for new refugees is by no means easy, the Lancaster-based agencies that help them experience good success rates with resettlement. Most clients who are eligible for work find jobs, and they are encouraged to take English as a Second Language classes in order to advance in their jobs. Children attend local schools and are encouraged to participate in activities. All clients attend a program in which they learn about American culture.

H. Peter DeGreen, M.D. Lena Dumasia, M.D. H.P. DeGreen III, D.O.

According to Mastropietro, Lancaster’s refugees are generally courageous, brave, and determined to do what needs to be done to begin new lives. “The people who end up coming here are the strong ones,” shared Mastropietro. “They’ve done what they needed to do, and they’re not going to hang back. They’re going to make a success of their lives.”

1858 Charter Lane, Suite 202, Lancaster PA 17605 lancastercancercenter.com • 717.291.1313

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Legislative Updates

TORT REFORM— Progress, But the Work Goes On SCOT CHADWICK Vice President of Governmental Affairs, PAMED

ne of the things I’ve learned from talking to physicians is that they often aren’t aware of all of the good work the Pennsylvania Medical Society (PAMED) does on their behalf. A perfect example is tort reform.

The fact is that PAMED has made a lot of progress on tort reform, and our list of accomplishments is pretty long. And the proof, as they say, is in the pudding. For example, did you know that annual medical liability lawsuit filings are down 45 percent from what they were a little more than a decade ago? That’s right, medical liability lawsuits against physicians and hospitals have been cut nearly in half thanks to our hard work.

Most Pennsylvania physicians report that they continue to engage in defensive medicine as a result of the state’s hostile medical liability environment, which is another way of saying that there are still too many non-meritorious lawsuits filed against health care providers. That being the case, it’s perfectly understandable that physicians who aren’t familiar with our efforts assume that PAMED isn’t doing much to address the problem.

Before I get into some of the specific achievements that delivered those results, let me state emphatically that we aren’t resting on any laurels. On the contrary, we strongly believe that we still have a long way to go in our efforts to create a fair and balanced medical liability environment in Pennsylvania.

JOIN NOW! Membership in the Pennsylvania Medical Society is a statement of your commitment to the medical profession and to the patient-physician relationship. Here’s how to join today:

Talk to a member services assistant by calling 855-PAMED4U Complete an application online at www.pamedsoc.org/YourAdvocate

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Summer 2014

Tort Reform

PAMED has a robust, ongoing tort reform agenda that includes caps on pain and suffering awards, limits on plaintiffs’ attorney fees, increased liability protection for physicians who provide emergency care, strengthening the Certificate of Merit court rule, and closing the loophole in the expert witness requirements. We’ll know we’ve succeeded when young physicians start saying they want to practice in Pennsylvania due to our medical liability climate, rather than saying they’re leaving because of it. Still, coming back to the point I made at the start of this post, we probably need to do a better job of making physicians aware of PAMED’s achievements that led to the big drop in lawsuit filings, so here goes.

• PUNITIVE DAMAGES Punitive damages are allowed only if a health care provider engaged in willful or wanton conduct or in reckless disregard to rights of others, and punitive damages are capped at 200 percent of compensatory damages except in case of intentional misconduct.

• PERIODIC PAYMENT Mandates periodic payment of future medical damages with automatic cut-off at death.

• REDUCTION TO PRESENT WORTH Mandates reduction to present worth of future work loss damages.

• STATUTE OF REPOSE Seven-year absolute time limit on filing of claims except in the case of an injured minor or foreign object left in the body. Preserves the existing two-year absolute limit on filing of wrongful death or survival claims except in case of fraud or wrongful concealment of cause of death.

• EXPERT WITNESS QUALIFICATIONS Establishes expert witness qualifications, including active practice or teaching and either same or similar specialty or board certification in same or similar specialty when defendant physician is board certified.

• REMITTITUR • AFFIDAVIT OF NON-INVOLVEMENT Defendants can obtain quick dismissal by filing an affidavit stating that they were not involved with the plaintiff’s care individually or through agents and employees and had no obligation to provide care to plaintiff individually or through agents or employees.

• COLLATERAL SOURCE RULE Limits double recoveries for past “losses” covered by collateral sources such as private health and disability insurance.

Requires the court to consider the adverse impact of a verdict on availability or access to health care in the community when ruling on a motion to reduce verdict.

• VENUE Medical liability actions may be filed only in the county where the cause of action arose, or if multiple defendants, only in a county where action against one of the individual defendants could be brought.

• JOINT AND SEVERAL LIABILITY Modifies joint and several liability rule so that defendants less than 60 percent liable will only be responsible for their proportionate share of award.

• APOLOGY Physician apologies and other benevolent gestures (except admissions of fault or negligence) to a patient after a poor outcome are inadmissible to prove liability in a medical liability action.

• CERTIFICATE OF MERIT Requires attorneys who file a professional liability action to file a certificate of merit stating that he/she has in hand a supporting report from a qualified expert within 60 days of filing claim.

I have to confess that to non-lawyers (confession: I’m a lawyer) a lot of this may sound like legal mumbo-jumbo. However, collectively these victories are the reason lawsuit filings are down 45 percent. So, if you hear a physician say PAMED needs to do something about tort reform, please do three things: 1. Show that physician this list of accomplishments 2. Point out that lawsuit filings are down 45 percent as a result, but most importantly… 3. Tell him or her that PAMED is hard at work on the next wave of reforms. As always, you can reach me with questions or comments at 717.558.7814 or schadwick@pamedsoc.org.

This article originally appeared on the Pennsylvania Medical Society website at http://www.pamedsoc.org/MainMenuCategories/Laws-Politics/Weekly-Capitol-Update-Blog/Weekly-Capitol-Update/10902.html LANCASTER

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Summer 2014

Legislative Updates

Lawsuit Abuse Reforms from Last Decade Working Now, but There’s Room for Improvement The following is a statement from Bruce A. MacLeod, MD, president of the Pennsylvania Medical Society and a practicing emergency medicine physician from Pittsburgh. Dr. MacLeod’s statement is made in response to recently released data on medical malpractice cases in Pennsylvania.

espite a slight uptick in the number of 2013 medical malpractice filings, lawsuit abuse reforms that were adopted in 2002 appear to be having a positive impact to weed out meritless lawsuits. According to the Administrative Office of Pennsylvania Courts, the latest filings show a 43.4 percent decline from the “base years” of 2000 to 2002. Specifically, the AOPC credits the elimination of venue shopping and requiring a certificate of merit.

The AOPC points out that 77 percent of jury verdicts in 2013 went to the defense. In other words, personal injury lawyers often take cases to trial that do not involve negligence or malpractice.

The Pennsylvania Medical Society led the fight for these changes, and our prediction that they would cause a significant reduction in unnecessary lawsuits has been proven accurate. However, while Pennsylvania physicians can be justifiably pleased with the results of the Society’s hard-won reforms, more remains to be done.

Another reform that should be seriously considered is contained in Pennsylvania House Bill 804. If passed, this bill would require clear and convincing evidence of gross negligence to find liability in emergency care. Physicians practicing medicine in a fast-paced emergency department should be held to a different standard of medical

The success in weeding out most meritless lawsuits shouldn’t be considered satisfactory progress. There’s more work to be done, particularly to strengthen the certificate of merit Supreme Court rule.

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negligence than those practicing in a doctor’s office. Lifesaving decisions must be made without the benefit of a prior relationship to the patient and often without any knowledge of the patient’s medical history. Holding providers who are providing emergency care to the same liability standard as providers who have those advantages is fundamentally unjust and invites unwarranted lawsuits. House Bill 804 represents a reasonable reform that should be made. Our elected leaders in Harrisburg could help the medical tort environment in Pennsylvania by passing this bill.

L A N C A S T E R M E D I C A L S O C I E T Y.O R G

Legislative Updates The Pennsylvania Medical Society Liability Insurance Company (PMSLIC) has provided generous funding to the Lancaster City & County Medical Society for many years; not every county in the state receives this financial commitment. LCCMS is honored to garner PMSLIC’s support for our programs, year after year, which is based on the strength of our membership—both in numbers and activity of our organization. As such, we are pleased to share this announcement:

PMSLIC Insurance Transitioning Policyholders to NORCAL Mutual Beginning August 1

ugust 1, 2014 marks the beginning of an exciting new phase in our company’s history. For more than 35 years, PMSLIC Insurance Company, a wholly owned subsidiary of NORCAL Mutual Insurance Company, has served the medical community with the promise of providing the highest quality products and services. Continuing in this spirit, NORCAL Mutual is integrating its subsidiaries and undergoing a strategic expansion to become one national mutual insurance company to provide our policyholders greater services and resources. Beginning August 1, PMSLIC policyholders will transition to NORCAL Mutual at their next renewal. Our policyholders will continue to receive the same exceptional level of personal service and attention that has been a hallmark, and will also continue to work with the same service teams they have come to know. We will be notifying each of our policyholders of any potential changes to their coverage as they approach their renewal period and will endeavor to make this conversion as seamless as possible for our policyholders.

Comprehensive cardiothoracic care… Specializing in procedures involving the heart, lungs, arteries and veins including: Coronary artery bypass grafting Cardiac valve replacement and repair Surgery for lung cancer and vascular surgery for the prevention of strokes and amputations

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PHYSICIAN

Summer 2014

Legislative Updates

What Exactly Are You A Doctor Of? SCOT CHADWICK Vice President of Governmental Affairs, PAMED

recent survey done for the American Medical Association by Global Strategy Group revealed some interesting facts about patient confusion when it comes to health care practitioners.

For example, 94 percent of respondents said only a physician should be permitted to perform amputations of the foot. No surprise there, but 74 percent of respondents also said they thought a podiatrist was a physician.

Here’s another example. An overwhelming 93 percent of respondents felt that only a physician should be allowed to perform surgical procedures on the eye that require the use of a scalpel. At

the same time, 42 percent of respondents thought an optometrist was a physician. More than a third even thought a “doctor of nursing practice” was—you guessed it—a physician. Now, I’m not picking on podiatrists, optometrists, or advanced practice nurses; all are highly qualified health care providers who do a great job treating patients within their scope of practice. Rather, my point is that patients need help in understanding that “Dr. Smith” might be a physician, but he or she might also be a doctor of nursing, or optometry, or even naturopathic medicine —all non-physicians. Most of this type of patient confusion is unintentional, and no one is suggesting that a non-physician who holds a doctorate degree shouldn’t be allowed to use the term “doctor.” However, advertisements or signs in a practitioner’s office that refer to “Dr. Smith” without explaining the doctorate is in nursing, or optometry, or chiropractic medicine, or naturopathy, clearly result in patient misunderstandings as to the training and qualifications of the good doctor. The solution, of course, is to require practitioners to clearly identify the type of doctorate, license, or certification they hold in their advertisements, brochures, office signs, and other communications. House Bill 2061, introduced by Rep. Bryan Cutler (R-Lancaster County), does exactly that, and goes on to prohibit deceptive or misleading information from appearing in those publications and communications. And, lest you think the bill is aimed only at non-physician practitioners, Rep. Cutler’s legislation also requires physicians who advertise they are “board certified” to include the full name of the approved certifying board and the name of the specialty or subspecialty. I don’t know about you, but I’d take comfort in knowing that the “board certified” physician I chose to do my procedure is actually board certified in the specialty that deals with my procedure. The Pennsylvania Medical Society strongly supports House Bill 2061, and it was at our request that Rep. Cutler introduced it. I’m pleased to report that on June 26 the House Health Committee unanimously approved the measure, successfully completing the first step of a process that will hopefully lead to enactment before the end of the legislative session in November. We promise to keep you posted. As always, you can reach me with questions or comments at (717) 558-7814, or via email at schadwick@pamedsoc.org. See more at: http://www.pamedsoc.org/MainMenuCategories/Laws-Politics/ Weekly-Capitol-Update-Blog/Weekly-Capitol-Update/11244.html?utm_source=MagnetMail&utm_medium=email&utm_term=Castle&utm_campaign=DD%20 %2D%206%2F30#sthash.M5dXQuPf.dpuf

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L A N C A S T E R M E D I C A L S O C I E T Y.O R G

Restaurant Review

e g d i r The F

KELLY LYONS LCCMS Executive Director

ending a non-foodie to do a restaurant review has one benefit: intrigue. You might wonder if my raving or devastating critique is accurate—“Let’s go see for ourselves.”

Fortunately, my assignment was pretty laidback: The Fridge. And laidback is the first thing you notice about The Fridge. The building itself is unassuming; I’ve driven past the place many times, never realizing it was a restaurant.

The evening my dinner partner and I visited was sunny, hot, and windy. Nevertheless, small groups of people were gathered in front of the building, seated at the two or three tables provided, or simply sitting on the steps or leaning against the wall. Everyone was enjoying conversation, laughing, and drinking what The Fridge is all about—craft beer. It was very welcoming. Once inside, the first thing I noticed was the refrigerated wall of beer. Frankly, I’m not sure I noticed anything else for a moment. Awed, I proceeded directly to the “fridge.” A few other people were standing there, dropped-jaw, so I didn’t feel out of place.

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Summer 2014

The Fridge As someone who has not traveled much, the selection was overwhelming. Although I’ve been in places with thirty-page beer menus, seeing the cold, intriguing array of beer selections before my eyes was a different experience. Like wine bottles, the labels were fascinating. I felt there was no way a person could work his or her way through the offerings—although I desperately wanted to try. But to begin to attempt it, food would absolutely be necessary.

THE FRIDGE

My companion wisely walked directly to the counter to order what The Fridge is also known for—specialty flatbread pizza. All are hand-made with fresh-from-the-farm ingredients, locally sourced. (The Fridge is located directly behind John Jeffries.) About four or five pizza choices were available, as well as soup and other selections. (You can see their menu for yourself at beerfridgelancaster.com.) The pizzas are rectangular, so no traditional NYC triangle slices. The slices are rather modest in size, so if you’re hungry, you’ll probably need more than one to satiate your appetite. The offerings are directly in front of you as you order, so you can see what you’re choosing. My companion chose one slice of the portabella and cremini mushrooms, kale, and gruyere pizza. I considered the slice to be an appetizer. I chose two slices of the tomato, basil, and mozzarella, as I didn’t want to overwhelm my taste buds. The artisanal pizza was overall very good: fresh-tasting, with a crisp outer crust. I found the center of the crust to be somewhat soggy rather than doughy. A balance between the two would have been more pleasing.

534 N. Mulberry St., Lancaster, PA 17603 717.490.6825 • beerfridgelancaster.com

On to the beer! We chose our beers based on a favorite brewery of my dinner companion. She had the Du Claw Sweet Baby Jesus, and I opted for the Du Claw Cocoa Fuego. The SBJ is a chocolate peanut butter porter, jet black with a full body and creamy mouth feel. Only lightly sweet, it’s well-balanced and savory. Absolutely delicious.

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The Cocoa Fuego is a stout that’s also slightly sweet and full-bodied. Hints of roasted malts, chocolate, and espresso are easily detected. I was in for a treat and something I’ve never experienced before in a beer—a prickly mouth feel. Why? Chipotle peppers! What an amazing taste and feel. Sweet and spicy. Beer with a bite. I was very pleased.

Lee A. Klombers, M.D.

We then decided to split one more. Since the Du Claw had been so good to us, we went for their Euforia. This English Brown Ale tasted of caramel, almond, and toffee. It’s dark brown, medium-bodied, and creamy. Another Du Claw success.

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Of the three selections, my favorite was the Cocoa Fuego. The prickly bite was, well, fun. I think after that experience the Euforia paled in comparison, although still a great, flavorful beer.

David S. Williams, M.D.

Overall, The Fridge was great. The restaurant provides a perfect combination of food, beer and ambience—a relaxed evening if you can get past being thunderstruck by the beer selection. Oh, and they sell wine and spirits too.

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Summer 2014

News & Announcements

The maternal fetal medicine practice provides a variety of services to women with complicated pregnancies, including: perinatology consultations, pre-conception counseling, ultrasound, non-stress tests, genetic counseling, and prenatal diagnostic screening tests. Porter said WellSpan has additional expansion plans in the works—both at the hospital and elsewhere in Lancaster County.

WellMatched: WellSpan Health in Lancaster County AMY WALSH, Public Relations Coordinator at WellSpan Ephrata Community Hospital

ommunity hospitals and physicians can sometimes feel like extended family. They’re alongside you during some of the most important moments in your life—from pregnancy and child birth to injuries and illness.

For many residents in northern and eastern Lancaster County, that extended family has been Ephrata Community Hospital and its affiliated physicians. The hospital has been serving the community for the past 65 years, and is now part of an even bigger family—WellSpan Health.

“Together we are stronger and can provide new services and more coordinated care” With its recent affiliation with Ephrata Community Hospital, WellSpan Health has become the largest health system in the region. Comprised of a multispecialty medical group of more than 730 providers, a home care organization, four hospitals, more than 11,000 employees and 93 patient care locations, WellSpan Health offers a comprehensive array of health care options to the communities it serves.

Earlier this spring, Ephrata Community Hospital and WellSpan announced the alignment of their brand identities as a means to reflect the strengths of the two non-profit health care organizations. “With this new brand alignment, we’ve brought past, present and future together—just as we’ve brought the strengths of our two organizations together,” said John M. Porter Jr., a senior vice president with WellSpan Health and president of WellSpan Ephrata Community Hospital. The hospital will transition to its new identity, WellSpan Ephrata Community Hospital, over the next several months. The new system identity will also roll out in various ways across the organization’s outpatient centers, physician practices, home health program, and other services in Lancaster County. “It is important that our identity reflect the strength of a regional health care leader that is committed to improving health in our local communities,” Porter said. Porter noted that WellSpan has already begun to expand services in northern Lancaster County, opening the WellSpan Maternal Fetal Medicine practice in Brownstown, West Earl Township in February.

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Also, WellSpan patients in Lancaster County are now able to access the MyWellSpan secure online patient portal. The new online service allows patients to manage their personal health care information at any hour of the day, all through their computer or mobile device, Porter said. MyWellSpan offers Lancaster County patients the ability to access their active medical conditions, lab results, medications, immunizations, and allergies. Patients can also communicate with their physician’s office using the portal. Porter said additional content and functionality are expected to be added to the site within the next several months. It seems the Ephrata Community Hospital family is experiencing a lot of changes lately, but Porter said both WellSpan and Ephrata are seeing benefits from this new relationship. “Our affiliation with WellSpan Health has always been about working as one integrated health-care system and leveraging the strengths of both organizations to provide exceptional community-focused patient care right here in Lancaster County,” Porter said. “Together we are stronger and can provide new services and more coordinated care,” he added. “It’s only been nine months since our affiliation became official, and we’re already seeing that happen.” For more information about WellSpan in Lancaster County, visit

www.wellspan.org/lancaster.

L A N C A S T E R M E D I C A L S O C I E T Y.O R G

To publish photos new LCCMS mem of ber physicians, plea se submit digital copies to klyon

News & Announcements

Welcome...

s@lancastermed icalsociety.org

New Members

Reinstated Members

Srikanta Banerjee, Resident American University of Antigua College of Medicine

Marie Monica Roa Calderon, MD LGHP–Internal Medicine

Daniel Chess, MD Anesthesia Associates of Lancaster

Leon Kraybill, MD, CMD LGHP–Geriatrics

Bret Daniels, MD LGHP–Twin Rose Family Medicine

Charles Krespan, MD Doctors, May-Grant Associates

Michael Del Terzo, MD Lancaster Urology

Timothy Labosh, MD LGHP–East Petersburg Family Medicine

Eric Finkelstein, MD Lancaster Spine Institute

Felicia DeJesus, MD

Steven Ginder, MD Pinnacle Health Dept. of Emergency Medicine

Joshua Peterson, DO SouthEast Lancaster Health Services

Celeste Heckman, MD LGHP– Strasburg Family Medicine

Bret Jacobs, DO Penn State Hershey Medical Group–Middletown

Sandeep Bansal, MD The Heart Group of Lancaster General Health

Tara Casher, Practice Administrator Lancaster Gastroenterology Mitchell Crawford, Resident

Christopher Shih, MD Regional Gastroenterology of Lancaster

Rajiv Kaira, DO Cocalico Family Sports Medicine

Louis Neureuter, MD

Christopher Putney, MD LGHP– Strasburg Family Medicine

Paul Sieber, MD, FACS Lancaster Urology

Stephen Wehibe, MD LGHP– Abbeyville Family Medicine

Brian Young, MD LGHP– Twin Rose Family Medicine

Nancy Jeffries, DO New & reinstated members (02.01.14 – 06.20.14)

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Summer 2014

News & Announcements

Frontline Groups The Lancaster City & County Medical Society thanks these groups for 100% membership in the Medical Society for 2014.

Allergy & Asthma Center

Family Medicine of Ephrata

Lincoln Family Medicine

Baron Family Practice

Georgetown Family Health

Manheim Family Medicine

Brain Orthopedic Spine Specialists

Glah Medical Group

Maternal-Fetal Medicine Specialists

The Heart Group of Lancaster General Health

Neurology & Stroke Associates PC

Cardiothoracic & Vascular Surgeons of Lancaster

Heritage Surgical Associates

OBGYN of Lancaster

Care Connections Clinic

Hyperbaric & Wound Care

Child & Adolescent Psychiatric Associates

Hypertension & Kidney Specialists

Community Anesthesia Associates

Justin L. Cappiello, MD PC

Campus Eye Center Cardiac Consultants PC

Highlands Family Practice

Jeffrey H. Chaby, DO & Associates

Community Services Group Conestoga Family Practice – Terre Hill

Keyser & O’Connor Surgical Associates, Ltd

Conestoga Pulmonary & Sleep Medicine

Lancaster Arthritis & Rheumatology Care

Dermasurgery Center PC Dermatology Associates of Lancaster, Ltd Eastbrook Family Health Center Electrodiagnostic Medicine Group Ltd

ENT Head & Neck Surgery of Lancaster Ephrata Behavioral Health Services Eye Associates of Lancaster, Ltd Eye Health Physicians of Lancaster Eye Physicians of Lancaster PC Family Eye Group

New Holland Family Medicine

Orthopedic Associates of Lancaster, Ltd Orthopaedic Specialists of Central Pa

Otolaryngology Physicians of Lancaster Pain Medicine & Rehab Specialists Patient First – Lancaster

Pennsylvania Counseling Services – Lancaster

Lancaster Cancer Center, Ltd

Pennsylvania Specialty Pathology

Lancaster Cardiology Group LLC

Red Rose Cardiology

Lancaster County Center for Plastic Surgery

Rothsville Family Practice Roy D. Brod, MD

Lancaster Ear, Nose and Throat Lancaster Family Allergy Lancaster General Health Physicians Lancaster HMA Physician Management

Southeast Lancaster Health Services, Inc – Arch St. & Hershey Ave.

Stephen G. Diamantoni, MD & Associates – Leola Surgical Specialists of Lancaster

Lancaster Physicians for Women

Welsh Mountain Health Center

Lancaster Plastic Surgery

Westphal Orthopedics

Lancaster Radiology Associates, Ltd Lancaster Skin Center PC

Upcoming Events PAMED Annual Business Meeting & House of Delegates October 17–19, 2014 • Hershey, PA Lancaster City & County Medical Society Holiday Social Fundraising Event for Lancaster Medical Society Foundation Scholarship December 13, 2014 • Lancaster Country Club

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News & Announcements

RGAL Recognized for Commitment to Patient Safety and Quality in Endoscopy

ongratulations to Regional Gastroenterology Associates of Lancaster (RGAL) for recently receiving the National Quality and Safety Recognition from the American Society for Gastrointestinal Endoscopy (ASGE). Just 35 other endoscopy centers in Pennsylvania were awarded this recognition, and RGAL was the only center within Lancaster County to be selected. ASGE recognizes endoscopy centers that meet ASGE’s high standards and follow its guidelines in the areas of physician privileging, quality assurance, endoscopy reprocessing, CDC infection control, and staff competency. RGAL was also acknowledged for its leadership in patient safety by the Patient Safety Authority in March. One of just ten practices in the state of Pennsylvania selected, RGAL was the only non-hospital recognized for this achievement.

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L A N C A S T E R M E D I C A L S O C I E T Y.O R G

LMS Foundation Updates

RGAL Recognized for Patient Safety and Quality of Care

SCHOLARSHIPS AVAILABLE

For Lancaster County Medical Students

RGAL is honored to be the only GI practice in Central Pennsylvania to receive two prestigious National and State recognitions for patient safety and quality of care.

he Lancaster City & County Medical Society (LCCMS) believes in supporting our local students as they pursue a degree in allopathic or osteopathic medicine.

We encourage Lancaster County residents who are attending medical school to apply for the scholarship award. They can find the application form on the LCCMS website at www.lancastermedicalsociety.org, or they can get a copy by contacting Kelly Lyons at 717-393-9588 or klyons@lancastermedicalsociety.org.

• National Quality and Safety Recognition from the American Society of Gastrointestinal Endoscopy (ASGE) for commitment to quality and safety of the RGAL endoscopy centers. • Pennsylvania Patient Safety Authority Recognition as a leader in quality initiatives focused on patient safety.

Students considered for the award must exemplify good character, motivation, academic excellence, and demonstrate financial need. Since its creation in 1991, the Foundation has awarded over $200,000 in scholarship funding. Established in 1844, the Lancaster City and County Medical Society has a strong past, but it’s also sharply focused on the current and future needs of physicians and their patients. We serve to promote and protect the practice of medicine for the physicians of Lancaster County so they may provide the highest quality of patient-centered care in an increasingly complex environment.

Scan the link to print your application & get started NOW!

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To learn more about the commitment to quality and patient safety by RGAL physicians and staff, visit www. RGAL.com.

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717.629.1180 Call or text

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WellMatched. As part of WellSpan Health, Ephrata Community Hospital and its outstanding system of physicians and services are stronger than ever.

Ephrata Community Hospital and its physicians and services have long been an important part of this community…recognized for their expert skills, convenient physician offices and health centers, and compassionate care. Now, as part of WellSpan Health, that rich tradition continues. Together, we’re proud to be the region’s largest, most comprehensive health system. And together, we’re working to make your health care even stronger. It all starts with bringing more specialists and technology to the community, for an even higher level of care. We’re developing a new kind of doctor-patient relationship—one that introduces a whole team of professionals focused on helping you feel your best. And through MyWellSpan, it’s easier than ever to manage your health online—anytime, anywhere.

WellSpan in Lancaster County: • WellSpan Ephrata Community Hospital • More than 100 respected physicians • Quality, coordinated home care • 32 convenient locations • Home medical equipment

A healthier community starts today. Learn more about our physicians, services and programs in Lancaster County at WellSpan.org/Lancaster or call (855) 237-4222.

WellSpan Medical Group • WellSpan Ephrata Community Hospital • WellSpan Gettysburg Hospital WellSpan York Hospital • WellSpan Surgery & Rehabilitation Hospital • WellSpan VNA Home Care © 2014 WellSpan Health

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