July/August 2012 Physicians Bulletin

July/August 2012 • USA $1.95

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THIS issue

JULY/AUGUST 2012

features

departments

1 9

1 0

Regarding a Physician’s Conscience “Freedom of Conscience” Act

2 0

Joining the Fight Against Hunger MOMS Foundation sponsors Food Bank Free Produce Stand

2 5

COVER: Their Special Places Dr. Wakefield & Dr. Massey Backyard Oasis

2 8

Comparing Medicine

Editors Desk Stands Worth Taking

1 2

NMA Message The Wait is Over (For Now)

1 4

Legal Update IRS Payroll Tax Audits

1 5

Young Physician Report Finding Her Voice

1 6

Clinical Update 10 Suggestions for Communication

In the UK and the U.S.

3 0

MOMS Events Past Presidents Luncheon & Upcoming Events

6 Physicians Bulletin July/August 2012

3 2

Member News & In Memoriam

3 4

Campus Update

3 7

New Member Update

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JULY/AUGUST 2012 VOLUME 33, NUMBER 4 A Publication of the

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Metro Omaha Medical Society 7906 Davenport St. • Omaha, NE 68114 (402)393-1415 • www.omahamedical.com OFFICERS President | Marvin J. Bittner, M.D. President-Elect | Debra L. Esser, M.D. Secretary-Treasurer | David D. Ingvoldstad, M.D. Past President | Pierre J. Lavedan, M.D. Executive Director | Diane Parsons

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Physicians Bulletin is published bi-monthly by Omaha Magazine, LTD, P.O. Box 461208, Omaha NE 68046-1208. © 2012. No whole or part of contents herein may be reproduced without prior permission of Omaha Magazine or the Metro Omaha Medical Society, excepting individually copyrighted articles and photographs. Unsolicited manuscripts are accepted, however, no responsibility will be assumed for such solicitations. Omaha Magazine and the Metro Omaha Medical Society in no way endorse any opinions or statements in this publication except those accurately reflecting official MOMS actions.

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SPECIALISTS IN ORTHOPAEDIC MEDICINE July/August 2012 Physicians Bulletin 9

EDITORS desk

Marvin Bittner, M.D. President Metro Omaha Medical Society

Stands Worth Taking

A

FEW YEARS AGO, I was utterly fascinated

by a political campaign. It wasn’t something that the candidate said. It was something that was left unsaid.

Scott Kleeb was running for U.S. Senate from Nebraska. His campaign described his background. That included his experience growing up abroad. That included his ranch work in western Nebraska. That included his Ph.D. in history from Yale. That included his faculty appointment at Hastings College. Yet something was left unsaid.

It was remarkable that his campaign material was so detailed that it even mentioned the subject matter of his Ph.D. dissertation (The Atlantic West: Cowboys, capitalists and the making of an American myth). Nowhere to be found, however, in any of the official campaign material was the simple fact of where he had gone to college to get his undergraduate degree.

Why would a candidate in a statewide election in Nebraska omit the name of his college? Surely he had an undergraduate degree from some place.

After all, he had gotten into a Ph.D. program at Yale. But where did he get his bachelor’s degree?

And why was it left out of the campaign publicity?

I was fascinated by these questions. I checked the Internet. I found out the answer to the question of where he went to college. That immediately answered the question of why the name of the college was omitted from his campaign publicity.

Perhaps I have given enough clues that some of you have already deduced the name of his undergraduate institution: the University of Colorado at Boulder. Given the loyalty of Nebraskans to University of Nebraska-Lincoln

10 Physicians Bulletin July/August 2012

football, it’s easy to see why he wouldn’t make it easy for voters to find out about association with Boulder.

Several weeks ago I myself ventured to Boulder. We’re no longer in the same football conference with Colorado. Despite the attenuation of that aspect of Colorado-Nebraska rivalry, I learned about another aspect of Boulder that would not sit well with most Nebraskans, particularly physicians. Boulder is a hotbed of the anti-vaccine movement. The region has many devotees of approaches to health that deviate from mainstream scientific medicine. I learned of a woman with a particular commitment to some of those approaches. She was pregnant.

She did undergo standard, scientific testing for Group B streptococcal colonization. The test was positive. However, she did not accept standard treatment for this condition to protect the fetus.

She relied instead on “natural” interventions.

She gave birth to a boy. Forty-five minutes after birth, the child stopped breathing.

Cheering at football games is a way that Nebraskans can support our side in a football rivalry. What can we do about a more serious rivalry with Colorado, a rivalry between mainstream scientific medicine and those who reject it? For one thing, I think we simply need to get out the message of mainstream scientific medicine in every way possible. Those of us who join together in MOMS and NMA, even if we do no more than send a check when a dues notice arrives, are adding our voices to the important call for more acceptance of mainstream scientific medicine and fewer neonates who wind up in the ICU.

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NMA message

By Dale Mahlman, Executive Vice President, Nebraska Medical Association

The Wait is Over (For Now)!

O

N JUNE 28, I, along with millions of

others, awaited the Supreme Court decision on the Affordable Care Act (ACA). With a watchful eye on CNN and the SCOTUSblog. com, I wondered how the past few years would be remembered.

It was one of those moments that you would potentially remember the rest of your life, like where you were when Apollo 11 landed on the moon in July of 1969. Just shortly after 9 a.m. on June 28, 2012, CNN reported that the individual mandate, the cornerstone of the decision, had been overturned and the balance of the ACA decision was still being released by the court. At the same time, I turned to SCOTUSblog and there was only chatter about the other decisions being released that morning until a quick comment appeared that the decision to uphold the individual mandate had just been read by the court? No sooner than I read it on SCOTUSblog.com, CNN reported the actual decision of the court was that the individual mandate was constitutional. If ever there was a need for “I’m Sorry” legislation for journalists, that was the time.

Immediately, all the networks were abuzz over the decision and the ruling of Chief Justice John G. Roberts Jr., that this was a tax, not a mandate.

Given we are now less than four months from a presidential election that has been defined by this issue, the court’s decision on ACA is sure to gain even greater intensity as a campaign issue.

In response, the NMA Board of Directors had a statement prepared stating that our general

12 Physicians Bulletin July/August 2012

position remained being committed to ensuring health care for all. Our efforts in 2007 and 2008 culminated in recommendations that focused on preventive care, wellness and personal responsibility of the patient, along with health insurance access that is universal and portable with appropriate cost controls. Our board believes as strongly today as in 2008 that our recommendations included in our own bill, LB 656, the Health Care Affordability and Accessibility Act, are valid and needed today.

If the old quote from coaching legend John Wooden is in fact valid, “It is what we learn after we know it all that really counts,” then regardless of the outcome of this election cycle, the time is now to address the health-care crisis and begin to move to a more “affordable and accessible” system. What we discovered in 2008 regarding the uninsured population in Nebraska has only gotten worse. What we discovered watching the debate in Washington D.C. was painful, passing a 2,000+ page piece of legislation full of “the secretary shall” didn’t exactly garner bi-partisan support. Hopefully, we have all learned from our earlier missteps, fixing the problem will not be without pain but remember, “anything worth doing is worth doing well.”

We believed a few years ago we had an idea in Nebraska that would begin to address the issue with LB 656. Perhaps our leadership in Washington D.C. should understand physicians want to be part of the solution, with their focus being their patients and not their political party.

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July/August 2012 Physicians Bulletin 13

LEGAL update

By Matt Ottemann Partner in the Tax Practice Group McGrath North Mullin & Kratz, PC LLO

M

OST BUSINESS OWNERS AND managers

are well aware of their federal payroll tax obligations. Many an owner or manager has been up until the wee hours of the morning completing payroll tax paperwork. But many owners and managers are not aware of their personal liability for payroll taxes or how the IRS can build a case for an owner’s or manager’s personal liability. A recent IRS memorandum provides guidance to IRS agents on documenting payroll tax cases against owners and managers.

A business must withhold income taxes from employee pay. The business must account for this tax money and send it promptly to the IRS. Failure to do so not only makes the business responsible for the shortfall, it may also make an owner or manager personally responsible as well.

The IRS views payroll taxes, withheld by a business, as trust fund money. Therefore, business owners and other “responsible persons” have personal liability for these taxes. “Responsible persons,” under the federal tax law, may include owners, company officers, or managers. The IRS can assess a Trust Fund Recovery Assessment— which is essentially a 100 percent penalty—and against every responsible person. In situations where payroll taxes are not properly paid, the IRS often makes an assessment against every manager, officer, or owner and waits for them to turn on each other. One officer or co-owner may get stuck with the penalty while others will owe nothing.

A recent IRS memorandum, issued by the National Director of Collection Policy to the IRS’ regional agents, states that IRS agents should determine, on a case-by-case basis, the amount of documentation required to assert a penalty. Key factors for this determination are

IRS Payroll Tax Audits: What Every Business Owner or Manager Needs to Know an individual’s “responsibility” and “willfulness.” In determining “willfulness,” the IRS and federal courts generally focus on an individual’s knowledge regarding the failure to pay taxes and whether the individual showed reckless disregard for tax payments.

Unfortunately, an individual need not actually perform the withholding and payment duties to be deemed “responsible.” If an individual has signature authority (even if unexercised) while other payments (not to the IRS) are made, that can be enough for the IRS to assert personal liability.

Recently, the IRS has imposed personal liability on owners in the following situations: • A couple formed two companies, held the top management offices for both companies, and managed the companies’ day-to-day business. Both spouses possessed the authority to sign tax returns on behalf of both companies and signed payroll checks for both companies. They also signed for bank notes and security agreements and served as personal guarantors. However, they hired a bookkeeper to be responsible for paying payroll taxes. Their bookkeeper later died and was found to have embezzled from the companies. The IRS found willful nonpayment for the couple when the couple sold the companies and chose to pay employees and third-party creditors, rather than the IRS. • A company owner was held liable for back payroll taxes, and the 100 percent tax penalty, despite his claims that he had been duped by his bookkeeper into believing that the taxes were paid. The IRS ultimately dismissed the bookkeeper and pursued the owner. A federal court

14 Physicians Bulletin July/August 2012

found that “willfulness” existed when the owner turned over funds to the bank and other creditors rather than the IRS, after it was proven that the owner knew of the tax obligation.

The following are the types of documentation which the IRS will use to determine whether an owner or manager should have individual liability: • Form 4180 Interviews: The IRS will conduct interviews with each potentially responsible person using its Form 4180.

The IRS will inquire about an individual’s duties with the business, the actions that individual took to ensure that taxes were paid, and the duties of the other owners or managers.

• Articles of Incorporation.

• Bank signature authority cards.

• Copies of cancelled checks which demonstrate payment to other creditors – not the IRS. Of course, if the IRS can’t easily obtain these records from the business itself, it will get these records using a subpoena.

IRS agents are directed to exercise their judgment regarding the amount of documentation needed to support a tax penalty. Agents may ask for more documentation. However, the above items are often enough to impose and support the tax penalty.

Many physicians own their own practices or have ownership interests in other businesses.

Have you verified that federal payroll taxes are being properly paid? If you have reason to believe that payroll taxes are not being paid in a business which you own or manage, you should seek professional guidance.

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The Omaha-Metro Business to Business Magazine

S A FIRST-YEAR STUDENT in medical

school, I joined the AMA because I thought I “should.” Policy was interesting, but I simply did not know much about it. During my second year, an opportunity arose to travel to Washington, D.C. for AMA Medical Student Lobby Day. How often do medical students, or any students for that matter, get to have a voice among our congressional leaders?AMA Medical Student Lobby Day provides students such an opportunity every year. I had friends in Washington, and it sounded like a great opportunity to learn a little more about medical policy.

So, on Feb. 7 more than 300 white coats descended on Capitol Hill – short white coats. I was one of them, and I was terrified. How could I talk about policy? I was a lowly medical student. I had not earned the right to have an opinion about medical policy. I admit, I contemplated skipping my senator meetings all together. Luckily, there was much more to lobby day than lobbying. Lobby Day provides students with a unique glimpse into the political process. Most medical students do not understand the extent to which the politics of medicine affects their daily lives and will impact their future careers. Real issues like tort reform, physician reimbursements, student debt and the future of residency programs are being discussed, debated and decided on “The Hill” daily. The people doing most of the discussing? - not the doctors, not their patients, but politicians.

We listened to current and former politicians discuss these issues. We were awakened to jolting realities about the budget and the current economic state of this country. And among all of the facts, figures and partisan opinions, I learned one very important thing at lobby day – politicians know nothing about the practice and pursuit of

medicine. Physicians know what is best for their practices. Physicians know what is best for their profession. Physicians know what is best for their patients. There are many physicians who choose to speak up and to lobby their lawmakers. But while sitting in the ballroom of the Marriott in Washington, D.C., just blocks away from the Capitol building, I wondered if we might speak a little louder.

Physicians are the best advocates for both their patients and their profession. The people with the most knowledge, the most experience, and the most know-how on the subject of health and patient care cannot afford to be silent. The decisions that are now being made in Washington are too big and too important. Passion and voice can be powerful tools when used correctly – and the time to use them is now. Lobby Day showed me that not only does Washington need to here from us, Washington also wants to hear from us.

Even a voice as seemingly small and insignificant as a short white coat will be heard – if that voice will only find the courage to speak up. I will be forever grateful that Lobby Day and the AMA have helped me find my voice.

July/August 2012 Physicians Bulletin 15

CLINICAL update

10 Suggestions for Communication

By Dr. Alan M. Lembitz, Cheif Medical Officer COPIC Insurance Company

C

OMMUNICATION AFFECTS ALL AREAS of

medicine. When The Joint Commission assessed sentinel events, 66 percent included elements of communication mishaps. Communication failures that lead to errors are often complex—resulting from hierarchical difficulties, critical information being unavailable, conflicting roles, ambiguity in responsibilities and power struggles. Some practical suggestions include:

1. Be aware of nonverbals. Research suggests that humans use nonverbal behavior to derive the meaning of an interaction 60 to 90 percent of the time. This is especially true in emotionally charged situations.

Humans often determine whether they trust the other in an amazingly short time.

2. Be open with support personnel. Team members have different vantage points and often have more time to listen to patients. To create an open environment, be approachable and let the support team be “the eyes and ears” of patient care.

3. Communicate empathy. Patients often complain about not being heard or understood. Work to understand the feelings of the patient and convey that understanding.

Try to discern what is the “chief concern” and “chief complaint” of the patient.

4. Be clear when communicating radiology and pathology reports between clinicians.

The clinician should give a detailed description of the reason for the exam.

The interpreting physician report should be inclusive and describe all significant findings. Any findings that may be seriously adverse to the patient’s health require direct communication from the interpreter to the responsible clinician (don’t simply trust that the report will be read and acted on).

5. Pay attention to handoffs. Handoffs occur frequently. They can be inherently risky because of the potential for miscommunication. Handoffs include a transfer of

16 Physicians Bulletin July/August 2012

information and a clear delineation of the responsibility for next action. Tools such as checklists or standardized communication can improve the transfer of care.

6. Take a time-out. Conduct briefings with the entire surgical team, using active communication and checklists to assist with the procedure. Use timeouts as a way of building good team communication, including learning names, asking team members to speak up and establishing a culture of safety.

7. Assess your methods of contact. Does a call to your office trigger a lengthy phone tree with a long wait time? Do you provide alternatives such as cell phone numbers to other clinicians and hospital EDs? Recognize the difference between synchronous and asynchronous communication and all the different modalities to accomplish it.

8. Manage your discharge process. There are many risks associated with patient discharge. Involve the patient and his or her family (when appropriate) in the follow-up plan, medication list and postdiagnostic and procedural instructions.

9. Accurately communicate prescriptions.

Medication errors are common in medical liability lawsuits. Remember the five “Rs”—right patient, right drug, right dose, right route and right time. Be aware that “e-prescribing” can generate a perfectly clear and legible transmission of a completely inappropriate medication and/or dose.

10. Informed consent is critical. Informed consent is always a process, and a consent or a permit form as well as other records are documentation of that process. Portions of the process can be delegated; however, the final step of affirming the patient’s understanding and desire to proceed is the responsibility of the physician or provider

July/August 2012 Physicians Bulletin 17

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feature

Mahlman

Dr. Spry

Sen. Pirsch

Regarding a Physician’s Conscience

S

TATE SEN. PETE PIRSCH said he would consider re-introducing

“Freedom of Conscience” legislation in the 2013 if key stakeholders can resolve issues that had previously held up the bill.

The original legislation, introduced in 2011, was narrow in scope and aimed to protect health-care professionals who find themselves in situations involving such issues as abortion and embryonic stem cells, the Omaha legislator said. Key stakeholders attempted to craft legislation that was more universal in 2012, but ran out of time, he said.

The bill did not advance out of the Judiciary Committee during the 2012 legislative session. An amendment that would have expanded the scope of the bill was never filed, Pirsch said.

At a news conference in March featuring a group of medical professionals, as reported by the Nebraska Radio Network, Chief Medical Officer Barry Hoover with the Physician Network of Lincoln discussed the need for Freedom of Conscience legislation. He said health-care professionals should not be forced to go against their beliefs. “A physician should not be coerced to practice in such a way that violates his or her moral, ethical or religious beliefs. Such coercion violates the rights of the physician, impairs the patient-physician relationship and diminishes the availability and quality of health care in our society.”

The NMA took a neutral stance on the Freedom of Conscience Act, which is typical for the organization’s approach to legislation relating to such issues as family planning and abortion, said Dale Mahlman, executive vice president. He added that the NMA would review any Freedom of Conscience legislation introduced in 2013.

Les Spry, a kidney specialist in Lincoln who is active with

the NMA and the American Medical Association, said he had misgivings about the original legislative bill.

First, he explained his philosophy toward Freedom of Conscience legislation, which he called a “fine idea.” Physicians must bring some of their own beliefs into their practice. Physicians may never agree on matters of conscience. Finally, a physician’s ethics change over time.

“My ethics and conscience are different than they were 35 years ago when I started practicing medicine.” To the person who proclaims “you can’t question my ethics,” Dr. Spry has an answer: “My God, I think I can.”

A physician’s actions – and ethics – must answer to a higher being. Dr. Spry suggested the state Board of Medicine and Surgery.

“It should have the final review.”

Back to Dr. Spry’s concerns about Freedom of Conscience legislation: —The ethics and conscience of the patient must be included.

Is the physician’s conscience or ethics more important than the patient’s?

—A physician and patient must first try to reconcile their differences. If the differences are irreconcilable, the physician has an obligation to offer the patient an alternative for care. “You have to offer a referral,” Dr. Spry said. “You can’t walk away from the patient.”

Should stakeholders propose a revised version of the bill, Pirsch said, he would evaluate the legislation in the fall. “It presents an opportunity of having brought together these stakeholders … and get them talking.”

July/August 2012 Physicians Bulletin 19

COVER feature

Joining the Fight Against Hunger

E

VALUATING THE IMPACT THAT the free produce stand in Carter Lake, Iowa, has had on the area’s hungry requires several approaches.

First, are the numbers. The Food Bank of the Heartland produce stand, which operates from early June through early August, gives away 1,000 pounds of produce at the stand each week – during just one hour of operation.

“We’re providing a service to an area of the community where fresh produce is not an everyday item,” said Brian Barks of the Food Bank of the Heartland.

People often are waiting in line before the produce stand is opened each week, he said. “Demand varies. It can start off slower at the beginning. It’s word of mouth that makes it blow up.”

The stand offers produce – such as cabbage, onions, potatoes and carrots, and lots of corn in the later weeks – to those who stop by. The Carter Lake stand is open from 5 p.m. to 6 p.m. on Wednesdays. The Food Bank of the Heartland also operates a produce stand outside the Washington public library, near 40th and Ames streets in Omaha.

More powerful may be the stories that Food Bank of the Heartland produce stand staffers have to tell. One elderly woman commented that produce was a luxury item she just could not afford.

20 Physicians Bulletin July/August 2012

COVER feature

Food Bank for the Heartland operates its programs that serve vulnerable populations throughout the extended Omaha community.

Those programs include Kids Cafe, Food for Seniors, BackPack, Mobile Pantry and, most recently, Fresh Produce. As the number of hungry children, families and seniors increases, the Food Bank expands these programs to meet the growing need.

And expanding programs such as its Fresh Produce program, Barks explained, requires community support. “Without the MOMS Foundation’s support,” he said, “there is no produce stand in Carter Lake.”

The Metro Omaha Medical Society and its foundation are dedicated to improving the health of the community while promoting healthy eating, said Diane Parsons, executive director. “Any effort to provide healthy alternatives in our community to people who may not be able to afford fresh fruits and vegetables is extremely important, especially with the childhood obesity epidemic.”

Barks explained that a direct correlation exists between hunger and obesity. He explained: “I have $10 to feed my family for the rest of the week. I see the produce aisles. I see apples, potatoes, what not. They’re expensive. So I go to where the starch-laden items are and I buy a big bag of cereal. It’s a no-brainer for me. I go where I can get the most for my money. I buy the bag of cereal and skip the fruits and vegetables. The most expensive items get marked off their shopping list.

“The real emphasis of food banks is to get more protein and produce into the community.”

Parsons said the food bank’s approach just makes sense. “When a community is doing well as a whole, its individuals are better off and, ultimately, we’re all responsible for the well-being of our community. We feel compelled to do our part.”

James Newland, M.D., serves as the president of the MOMS Foundation. He said the foundation has a history of worthy causes through its match fund.

Each year, the MOMS Foundation selects a worthy local nonprofit organization to benefit from this special program. Past recipients include Hospice House – the Josie Harper Residence, Lasting Hope Recovery Center and Hope Medical Outreach Coalition.

Here’s how the Match Program works: Members of the MOMS Foundation Board of Directors investigate local charities that are candidates for selection and choose one. MOMS members are encouraged to support the designated charity, and the Foundation matches those donations up to $5,000.

“As members of MOMS, we are all a part of our community. Altruism is a part of the nature of being a physician,” Dr. Newland said. “We are simply supporting our community, especially those who have special needs. In a sense, it is our duty as physicians to be supportive of our fellow citizens.

The MOMS Foundation Mission Statement says the following: “The Metro Omaha Medical Society Foundation identifies and provides support to community priorities where physician involvement can make a difference in improving the health of the Metro Omaha Community.”

Dr. Newland said the Carter Lake produce stand will bear the MOMS logo.

“It is sort of ‘our’ produce stand,” he said. “The food is there for anyone who needs it, and no identification is needed. In this way, MOMS is given some good recognition as a positive force for the people of the community.

Barks passes on another story of the produce stand’s impact. At times, some of the less routine staples – such as zucchini – have been offered at the stand. “People want to know what it is. How do you eat it? How do you prepare it?

“We tell them – and they later tell us they liked it.”

July/August 2012 Physicians Bulletin 21

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Too many patients, not enough time?

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Consider hiring a Physician Assistant PA’s practice medicine as a licensed professional with physician supervision.

They exercise autonomy in medical decision-making and can: • take complete medical histories • perform physical examinations • order and interpret diagnostic studies • make diagnoses • order treatments • write prescriptions • assist with surgery • perform procedures such as stress electrocardiograms, sigmoldoscopic exams, lumbar punctures, suturing lacerations, and bone aspirations • apply casts and splints to fractures • provide emergency treatments for life-threatening situations

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The Metro Omaha Medical Society Strategic Partners offer products and services are of interest to physicians. We encourage you to talk with our Strategic Partners when making valuable business decisions for yourself or your practice.

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24 Physicians Bulletin July/August 2012

feature

Their Special

O

Places NE LIKES TO SEE if he can grow tropical plants in a climate that is anything but. Another

found out he doesn’t need a traditional kitchen to bake pizzas and breads.

For the two physicians, their backyards are the perfect places for them to pursue their passions.

Their backyards also provide them with a respite after a day at work.

“My backyard is where I can go to escape,” said Brent Wakefield, M.D. So true for John Massey, M.D. The two MOMS members shared what makes their backyards special.

Dr. Wakefield’s backyard features an organic vegetable garden, rose garden and koi pond. He also has tropical plants growing in pots on his deck.

Dr. Wakefield, a urologist, said he became fascinated with plants when he was a child. A trip to Hawaii in 2006 rekindled that curiosity.

He brought home a souvenir: a coconut seed. Six years later, the tree stands 8 feet tall, but must remain in a pot. The pot means mobility and allows Dr. Wakefield to bring the tree inside during the winter months.

“It’s a tropical plant and doesn’t tolerate cold temperatures,” he said. “My goal is just to keep it alive.”

That’s also the goal for his coffee tree, plumeria (a flowering tree whose blooms are used in Hawaiian leis) tree, lemon tree and a Philodendron, which he has kept alive for 15 years.

Dr. Wakefield said he would like to build a greenhouse in his backyard, but doesn’t have the space.

Instead, he focuses on his koi pond – which he build during a half-dozen weekends of work extended over two years “to see if I could do it” – and his organic vegetable garden. The latter produces beets, carrots, beans, tomatoes, peppers and other vegetables, which he eats or gives to friends.

Dr. Massey said he enjoys the time he spends in the backyard of his southeast Lincoln home – and its brick pizza oven. Ten years ago, when the Masseys were looking to build their home, his wife, Julie, had designs for the house.

Dr. Massey’s interests lay outdoors –where he wanted to build his an outdoor oven similar to the ones found in Macaroni Grill restaurants. >> Story continued on page 26.

Wakefield File Hometown: Wheelersburg, Ohio Bachelor’s Degree: Ohio State University in biochemistry Medical Degree: Medical College of Ohio in Toledo Residency: University of Nebraska Medical Center in urology Speciality: Urology Group: Adult and Pediatric Urology and Urogynecology Hobbies: Gardening, cooking and coin collecting Why I Join MOMS: “To be a part of the greater Omaha medical community and to network with my peers.”

July/August 2012 Physicians Bulletin 25

feature

Massey File Hometown: Lincoln Bachelor’s Degree: University of Nebraska Lincoln in chemistry Medical Degree: University of Nebraska Medical Center Residency: UNMC in anesthesiology Specialty: Interventional pain medicine Group: Spine and Pain Centers of Nebraska Family: Wife, Julie; daughters, Katie and Libby; son, Ben Hobbies: “Making pizzas in my backyard.”

Why I joined MOMS: “My partners have been in practice for 15 years. However, during the past year, we’ve moved into the Omaha market.

We believe in medicine and getting involved.”

Above, Dr. Wakefield’s herb garden.

Right, Dr. Massey’s outdoor oven.

<< “Cooking is my hobby,” explained Dr. Massey, who specializes in interventional pain medicine. “I wanted an oven to bake pizzas. It was more practical to put it outside.”

So he did. The oven – similar to the old-fashioned Italian ones – came from a California company. The brick panels are five inches thick. The cooking counter is made of concrete. The design was Dr. Massey’s.

The Massey family uses the oven several times a week. Dr. Massey has used his oven to bake turkeys, chickens and ducks.

For a recent family Thanksgiving celebration, he baked 50 trout.

“But I really like to make pizza and bread,” he said. Neopolitan pizza to be exact. The type that is light weight because of its thin crust. His wood-burning oven reaches temperatures of 1,000 degrees Fahrenheit – which means Dr. Massey can bake a pizza in four minutes. Each year, he uses about one cord of oak in his oven each year. “In other words, a lot.” At 1,000 degrees, he explained, one oak log burns in about 20 minutes. His pizza recipe has evolved over time, but key ingredients include basil, and fresh mozzarella cheese and tomatoes.

The pizza oven and a backyard swimming pool are center pieces for Massey family parties. His children often have backyard parties, during which their guests made their own pizzas.

Dr. Massey said he typically makes the dough and prepares the ingredients the day before.

Dr. Massey recalled the time members of the church youth group sold pizzas as a fundraiser – and delivered 115 pizzas right after Sunday services.

“It was a little over the top,” he said, “but it was a ton of fun.”

26 Physicians Bulletin July/August 2012

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Margaret Block, M.D. M. Salman Haroon, M.D. Ralph J. Hauke, M.D. Timothy K. Huyck, M.D. Robert M. Langdon, Jr., M.D. Kirsten M. Leu, M.D. John M. Longo, M.D.

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nebraskacancer.com July/August 2012 Physicians Bulletin 27

feature Photo by Birrell Signature Photography

Marwan Salfity, M.D.

Salfity File Hometown: Amman, Jordan Undergraduate degree: University of Cambridge, United Kingdom, in pharmacology Medical degree: University of Cambridge Residency: Nassau County Medical Center in New York; two years at Mayo Clinic in internal medicine Fellowship: Baylor College of Medicine, Houston, in cardiovascular surgery Specialty: Cardiology Group: Nebraska Cardiac Care Family: wife, Sonia; daughter, Shereen; sons, Shareef and Matthew Why I joined MOMS: “Because I like being a part of the community of physicians in Omaha. I want to be connected to them and to learn from them.”

Urmila Mukerjee, M.D.

Comparing Medicine in the UK and the U.S.

M

ARWAN SALFITY, M.D., APPRECIATES the greater

flexibility physicians practicing in the United States are afforded over their counterparts in the United Kingdom. “You can practice in an inpatient setting, outpatient setting – or both.”

Urmila Mukherjee, M.D., appreciates the support junior residents in the United States receive from their senior colleagues. “My training in the UK has given me a solid foundation. Medicine is all about teamwork and this is done very well here in the U.S.” Dr. Mukherjee – who is currently in second year of her internal medicine residency at UNMC but began her medical training in the United Kingdom – said she found herself caring for 40 patients on her first day of residency training in the UK. “I have to admit I was a little overwhelmed, she recalled. “But that was the system – and you hit the road running, I managed to get through the first day and actually ending up having a good experience” Drs. Salfity and Mukherjee described the differences they discovered in the way medicine is practiced in the United Kingdom to how they care for patients in the United States. The two have practiced medicine in both.

The National Health Service, or NHS, is the UK’s public health system, and provides free medical health care for millions of people every year. Most people who are entitled to receive free NHS treatment are British citizens, permanent residents, asylum seekers, those who are part of the European Union, and those visiting the

28 Physicians Bulletin July/August 2012

country who need acute care. Access to NHS treatment comes mainly through a General Practitioner initially, who will then refer to the patient to a specialist as needed for further evaluation.

Dr. Salfity estimated that about 95 percent of health care in the UK is controlled by the government through National Health Services. In the United States, less than 50 percent is controlled by the government through Medicare and Medicaid.

Dr. Salfity explained that physicians in the UK must work their way up through the system, first serving as house officers, registrars, senior registrars and, finally, consultants. “Eventually, you can serve as a consultant – but you may have to go to a small town where a position is available.”

Dr. Salfity came to the United Kingdom as a teenager to attend boarding school. At first, he had difficulty adapting – improving on his English and learning to be without his parents. “Eventually, you adapt. When I first went there, my English was not as good as it is now. It took some time. I realized I could never get rid of my accent. So I gave up trying.”

Dr. Salfity remained in the United Kingdom to earn his bachelor’s degree and medical degree. He came to the United States for his medical residency, and stayed.

He said he has noticed several differences between health care in the United States and the United Kingdom: —Medical centers in the United Kingdom are special-

feature ized. In a community with five hospitals, for example, just one would likely perform bypass surgeries. “In this town (Omaha), at least five hospitals do bypass surgery. The goal in the UK is to make hospitals more specialized and, in doing so, more financially and functionally efficient.

—Physicians in the UK typically either work in a hospital or as general practitioners – but not both. “This is the way our country (the United States) is going now.” Dr. Salfity sees benefits and disadvantages. Physicians are not as rushed traveling from their clinics to treat their hospitalized patients.

However, patients don’t see their primary care physicians when they are hospitalized. “There is some disconnect.”

Dr. Mukherjee’s first hospital stay in the UK came as a teenager when she had her wisdom teeth removed. Normally, the procedure would have been on an outpatient basis, she explained, but there were complications.

She was subsequently admitted: “I was treated very well. The care was excellent.”

Fifteen years later, Dr. Mukherjee found herself hospitalized at the Nebraska Medical Center with complications with her pregnancy. “That was interesting. The physician is now the patient.” She experienced eight weeks of bed rest leading up to the birth of her twin daughters. “I have nothing but praise for the nursing and OB staff at the Nebraska Medical Mukherjee File Center” Dr. Mukherjee said she noticed Hometown: some distinct differences between Sutton, in the County of her hospital experiences. Patients Surrey, United Kingdom being treated in U.S. hospitals are Undergraduate degree: more likely to have private rooms.

King’s College, London in In the UK, they stay in wards, biochemistry and microbiology; sharing space with 10 to 15 other master’s degree in pharmacology patients. “In my room, there were at King’s College, London only six patients – three on one side of the room and three on the other.”

Medical School: She also realized that informaUniversity of Southampton, tion is more free-flowing in the Southampton, Hampshire, United States from physician to United Kingdom patient. “As a patient, you have Residency: more rights. You’re allowed to Completing residency in voice your concerns more.” internal medicine at UNMC Another difference between the two is her experience working Hobbies: in the acute setting. In the UK, avid swimmer and avid dancer physicians take medical histories (classical Indian). She has and conduct thorough examinaperformed on stage, on television tions before ordering tests. “We’re and before the queen of Belguim. limited in what testing you can do.

Family: Resources are limited. You have to husband, Sandeep be sure the test you are ordering Mukherjee, M.D., (on faculty will change management” at UNMC); twin daughters, In the United States, much of Mira and Saara, age 4. the preliminary work has been completed before she initially Why I joined MOMS: sees the patient, especially in the “I must confess that I didn’t ER. “The initial assessment of the know much about it. I was patient is different here. There is not curious. Other people were as much clinical decision-making joining and I wanted to see that I have to do – it’s been done what it was all about.” for me.”

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fashioncleaners.com | 402-342-3491 July/August 2012 Physicians Bulletin 29

MOMS events PAST PRESIDENTS LUNCHEON

The Metro Omaha Medical Society hosted its annual Past Presidents luncheon May 9 at Happy Hollow Club. Current president Marvin Bittner, M.D., updated the group on the society’s activities and his vision for the organization.

1.

Among those who attended were, from left, Drs. Edward Malashock, Lee Retelsdorf, Jeoffrey Deeths, Perry Williams, Rowen Zetterman, Stanley Truhlsen and William Bruns

2. From left, Drs. Pierre Lavedan (immediate past president), Britt Thedinger, John C. Mitchell III, and Marvin Bittner (president).

3.

1

2

From left, Drs. Rowen Zetterman, Frederick Paustian and Peter Whitted

3

Coming Events AUG. 7: WOMEN IN MEDICINE PASTA AMORE (ROCKBROOK) – 5:30 P.M. – 7 P.M.

SEPT. 26: RETIRED PHYSICIANS MEETING MOMS BOARD ROOM – 10 A.M.

Panel discussion with representatives from HOPE Medical Outreach, Charles Drew Health Center and OneWorld Community Health Center discussing how physicians can assist patients in gaining access to their services.

Paul Paulman, M.D., will discuss medical education at UNMC and abroad.

SPEED DATING FOR YOUR SPECIALTY AUG. 23: CREIGHTON CAMPUS - 5:30 P.M. – 7 P.M. AUG. 23: UNMC CAMPUS - 5:30 P.M. – 7 P.M.

Event features Michael Durant, the inspiration for the “Blackhawk Down” movie.

Physician volunteers needed to speak one-on-one with medical students about their specialty.

30 Physicians Bulletin July/August 2012

SEPT. 28: NMA 2012 ANNUAL SESSION AND HOUSE OF DELEGATES STRATEGIC AIR AND SPACE MUSEUM IN ASHLAND.

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Helping Your Patients Feel Better Again

A Voice In Medicine’s Future Members of the Metropolitan Omaha Medical Society and Nebraska Medical Association have a powerful voice in shaping the future of medicine. Your membership ensures you are up to date with legislative activities that impact local, state and national health care.

IF YOU ARE A MEMBER – we encourage you to get involved. Each fall, face-to-face legislative meetings are held with the state senators that represent the metro Omaha area. All members are welcomed and encouraged to participate in these meetings. Watch the eBulletin and email notices for more information as these are scheduled. Visit www.OmahaMedical.com for dates.

Boys Town Medical Campus Pacific Street Clinic NOT CURRENTLY A MEMBER? You owe it to

yourself to make your voice heard by joining your peers as a member of MOMS/NMA. Call (402) 393-1415 for more information on membership or complete the membership application located in the back of this Bulletin issue and return it to the Metro Omaha Medical Society. It’s that simple. It’s that important.

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July/August 2012 Physicians Bulletin 31

MEMBER news

Dr. Marvin Bittner

Dr. Bittner directs travel clinic

T

HE CREIGHTON TRAVEL CLINIC, under

the direction of Marvin Bittner, M.D., is open at the Dundee Clinic, 5002 Underwood Ave., on Mondays from 5 p.m. to 7 p.m. Serving patients of all ages, the Creighton Travel Clinic is a one‐stop shop for all travel immunizations and prescriptions for malaria, travelers’ diarrhea, motion sickness, altitude sickness and more.

Dr. Bittner is assisted at the clinic by Gary Gorby, M.D., and Laurel Preheim, M.D.

Dr. William Hunter

Dr. Hunter named Golen Apple recipient

W

ILLIAM, HUNTER, M.D., DIRECTOR

of Creighton University’s pathology undergraduate medical education, was named a winner of the School of Medicine’s 2012 Golden Apple award presented by the 2014 School of Medicine class. The award recognizes School of Medicine faculty for excellence in teaching and dedication to patient care.

Dr. Geoff Talmon

Dr. Talmon recoginized for teaching excellence

G

EOFF TALMON, M.D., WAS among 13

faculty members at the University of Nebraska Medical Center who recently were honored with awards that recognized excellence in teaching and community service.

Dr. Talmon, assistant professor of pathology and microbiology, received the Hirschmann Prize for Teaching Excellence for Basic Science Education as well as a Golden Apple Teaching Award. Dr. Talmon also received the College of Medicine Class of 1962 Basic Science Outstanding Teacher Award.

IN memoriam William Melcher, M.D. Dec. 16, 1930 – April 13, 2012

32 Physicians Bulletin July/August 2012

Eelco Gerlings, M.D. March 27, 1936 – May 30, 2012

Henry Kammandel, M.D. September 30, 1915 - July 1, 2012

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â&#x20AC;&#x153;I was in a prairie dog town in the Niobrara Valley Preserve, shooting landscapes and plant life.

Seeing the remains of a prairie dog, we realized there must be a predator nearby. The Plainsman, our guide, warned us of prairie rattlers. Then we saw it. A three-foot reddish-brown rattler struck the Plainsman twice, sinking its venom into his thick rubber boot heel. After he carefully shook him loose, I moved in close with my 50mm lens and took the shot.â&#x20AC;?

Scott Drickey, Photographer

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CAMPUS update

Creighton University announces affiliation with Alegent Health

C

REIGHTON UNIVERSITY AND ALEGENT

Health recently announced agreements to form a long-term strategic affiliation, which includes the expected acquisition of Creighton University Medical Center (CUMC) from Creighton and its clinical partner Tenet Healthcare. The addition of CUMC into the Alegent Health family will make Alegent the primary teaching sites for Creighton’s health sciences schools, enhancing both the academic experience for students and healthcare in the greater Omaha community.

Alegent Health will expand its academic footprint that currently includes 14 academic

Stemming the mental health crisis in rural America

I

T’S ESTIMATED THAT MORE than one-half of

all U.S. mental health care takes place at the primary care level and that percentage jumps considerably in rural areas where there often are no mental health practitioners for hundreds of miles.

New online training modules have been designed by the Behavioral Health Education Center of Nebraska(BHECN) to help primary care providers better treat patients with mental health issues.

“Our primary care practitioners are on the front lines in the battle for mental health and in many ways they are overwhelmed,” said Howard Liu, M.D., a child and adolescent psychiatrist at UNMC and and interprofessional education director for BHECN. “With these training modules,

affiliations between Alegent and Creighton including OB/GYN residency, nursing and pharmacy.

Alegent is also the primary teaching site in the region for psychiatry.

“We are excited to enhance our longtime relationship with Alegent Health through this new and strategically important affiliation,” said the Rev. Timothy R. Lannon, president of Creighton University. “The combined health-care entities will further the missions of both faith-based organizations by improving local healthcare and transforming medical education for the benefit of physicians, students and the communities whose patients we serve.”

Lannon said he believes that by affiliating with Alegent Health, Creighton students will have richer clinical experiences whether they are training in medicine, nursing, dentistry, pharmacy or other health professional fields.

Richard A. Hachten II, Alegent president and CEO agreed. “We understand the importance of ensuring that tomorrow’s healthcare providers receive the best possible clinical training. We are excited to provide a broader array of educational opportunities for Creighton students.

Just as important is what we’re providing the community – the strongest health-care system in the region.”

The agreements are expected to be finalized later this summer, after which Alegent will manage the operations of Creighton University Medical Center and Creighton Medical Associates.

Both Alegent and Creighton have been engaging physicians, operational and administrative personnel in active work groups to create the design, governance and operational aspects of the long-term strategic affiliation.

we hope to help arm primary care practitioners with the tools to help them treat patients with mental health issues.”

BHECN – a UNMC program that aims to improve behavioral health training and education throughout the state – has created the training modules to help family physicians, pediatricians, physician assistants, nurse practitioners, pharmacists, and other primary care providers treat depression in adolescents, adults and geriatric patients.

blood from blood tests for research instead of having it discarded after tests are complete.

Personal information will be removed to protect the confidentiality of the donor. A peer-review committee will monitor the materials’ use.

DNA and serum withdrawn from the biobank will enable scientists to bridge research between animal models and clinical trials.

“It can serve as preliminary evidence for funding requests for new areas of clinical research and clinical trials,” Dr. Larsen said.

It also can tell the scientists themselves if they are on the right track. UNMC already has multiple, condition-specific biobanks with samples from people who have consented to help with a certain area of study.

But, the need for a larger resource is vital, Dr. Larsen said, noting the dilemma faced by UNMC’s pancreatic cancer team. “For five years, they’ve tried to recruit individuals who may be at risk for pancreatic cancer to test new biomarkers of risk and they still haven’t received the number of samples they need,” she said.

Biobank to offer patients way to contribute to advancing medical knowledge

U

NMC HAS ESTABLISHED a biobank — a

large collection of biologic samples that will help scientists more quickly move research breakthroughs into benefits for patients.

The biobank, expected to open by December, will be a tremendous resource for UNMC’s scientists, said Jennifer Larsen, M.D., vice chancellor for research.

Patients treated at UNMC clinics and The Nebraska Medical Center, UNMC’s hospital partner, will have the opportunity to donate

34 Physicians Bulletin July/August 2012

T

Creighton School of Medicine accredited HE CREIGHTON UNIVERSITY SCHOOL of

Medicine was recently awarded accreditation for eight years – the maximum period allowed – by the Liaison Committee on Medical Education. The renewal of accreditation followed an exhaustive self-study by the School of Medicine as well as an onsite visit by an LCME review team.

The area’s best choice for high quality and cost-effective digestive health care.

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Medical Society Foundation identifies and provides support to community priorities where physician involvement can make a difference in improving the health of the Metro Omaha Community.

MOMS Foundation 7906 Davenport St. Omaha, NE 68114 402-393-1415

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July/August 2012 Physicians Bulletin 35

Application for Membership This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the Nebraska Medical Association (NMA). I hereby consent and authorize MOMS to use my application information that has been provided to the MOMS credentialing program, referred to as the Nebraska Credentials Verification Organization (NCVO), in order to complete the MOMS membership process.

Personal Information Last Name: _____________________________ First Name: _______________________ Middle Initial: ______ Birthdate: _________________________________________________ Gender: Male or Female Clinic/Group: __________________________________________________________________________________ Office Address: ________________________________________________________________ Zip: __________ Office Phone: ____________________ Office Fax: ___________________ Email: _________________________ Office Manager: _______________________________________ Office Mgr. Email: ________________________ Home Address: ____________________________________________________ Zip: ________________________ Home Phone: __________________________________________ Name of Spouse: ________________________ Preferred Mailing Address: Annual Dues Invoice: Event Notices & Bulletin Magazine:

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Home Other: __________________________________

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Home Other: __________________________________

Educational and Professional Information Medical School Graduated From: __________________________________________________________________ Medical School Graduation Date: ____________________ Official Medical Degree: (MD, DO, MBBS, etc.) _______ Residency Location: _____________________________________________ Inclusive Dates: _________________ Fellowship Location: _____________________________________________ Inclusive Dates: _________________ Primary Specialty: ______________________________________________________________________________

Membership Eligibility Questions YES

NO

(If you answer “Yes” to any of these questions, please attach a letter giving full details for each.)

Have you ever been convicted of a fraud or felony?

Have you ever been the subject of any disciplinary action by any medical society, hospital medical staff or a State Board of Medical Examiners?

Has any action, in any jurisdiction, ever been taken regarding your license to practice medicine?

(Including revocation, suspension, limitation, probation or any other imposed sanctions or conditions.)

Have judgments been made or settlements required in professional liability cases against you?

I certify that the information provided in this application is accurate and complete to the best of my knowledge.

_____________________________________

Signature

___________ Date

B

Fax Application to: 402-393-3216

36 Physicians Bulletin July/August 2012

Mail Application to: Metro Omaha Medical Society 7906 Davenport Street Omaha, NE 68114

Apply Online: www.omahamedical.com

NEW MEMBER update NEW MEMBERS Heather Gomes, M.D. Otolaryngology

Colleen Hanna-Slagle, M.D.

Kelly Caverzagie, M.D.

Heidi Edsill, M.D.

Lynn O’Hanlon, M.D.

Medical School: UNMC

Medical School: CUMC

Medical School: UNMC

Specialty: Internal Medicine

Specialty: Obstetrics and Gynecology

Specialty: Neonatology

Location: UNMC General Internal Medicine

Location: Creighton Women’s Health Center West

Location: Methodist Women’s Hospital

D

R. CAVERZAGIE ENJOYED LIVING and working in and

around Detroit during the time that Nebraska joined the Big 10 Conference. He and his wife had many “discussions” with friends and neighbors about the merits of our football teams. Their red flag was displayed a little more prominently after this change.

D

R. EDSILL MOVED BACK to

Omaha after completing residency in Minneapolis. She recently completed her first 5k run and now proudly calls herself a “runner.” Her goal is to compete in a half-marathon someday.

When not running, she loves to cook new foods with her husband, try new restaurants and attend live music events – everything from classical and jazz to new independent artists.

D

R. O’HANLON SPENDS MUCH of her free time at the

stable watching her daughter ride her horse. She is also incubating peacock eggs.

Pediatrics

Muhammed Haroon, M.D. Oncology

Timothy Huyck, M.D. Hematology/Oncology

Neelima Kandula, M.D. Anatomical and Clinical Pathology

William Leight, M.D. Otolaryngology

Matthew McMahon, M.D. Gastroenterology

Kayla Pope, M.D. Child & Adolescent Psychiatry

Rajkumar Yarlagadda, M.D. Radiology

Interested in becoming a MOMS Member?

Call 402-393-1415, apply online at www.OmahaMedical.com or complete the application on page 36.

July/August 2012 Physicians Bulletin 37

Your home...your builder.

Exceptional.

Selecting a builder is as much an expression of taste as it is a statement of confidence. No one understands this better than Curt Hofer & Associates. As one of the area’s most respected custom homebuilders, we provide a one-of-a-kind experience in creating your once-in-a-lifetime home.

Your wants, your needs, your style, your preferences – everything we do at Curt Hofer & Associates is advanced with the thought of you in mind. That means spending time with you, from the very beginning and at every step along the way.

From individual rooms, to how these rooms come together to create a home, to the landscape and exteriors that immediately bid you welcome, the team Curt Hofer & Associates knows how to bring the best ideas to life – yours. The result?

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38 Physicians Bulletin July/August 2012

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WHERE CAN YOUR PATIENTS GO FOR HEART CARE THAT DOESN’T SKIP A BEAT?

Here. After uniting two successful open heart surgery programs in less than two years, we’ve emerged as one of the top hospitals in the nation for cardiac surgery outcomes.

At Alegent Health Hear t & Vascular Institute, we’ve developed standardized processes that allow us to provide consistent care and ex traordinary outcomes. This has earned us the highest rating awarded by the Society of Thoracic Surgeons, three out of three stars. Based on measures of quality that range from pre-op care to survival rate, this rating is given to only 14 percent of the nation’s hospitals. To us, though, it’s about more than providing a higher level of care. It’s about getting patients back to their lives and the things that matter most. Check out how we’re making hear t care healthier at Alegent.com/Hear t.

1-800-ALEGENT Alegent.com/Heart

Alegent Health is a faith-based health ministr y sponsored by Catholic Health Initiatives and Immanuel.

Metropolitan Omaha Medical Society 7906 Davenport Street Omaha, NE 68114

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One number accesses our pediatric surgical specialists, any problem, anytime.

Physicians’ Priority Line

1.888.592.7955

When a newborn is critically ill, a single call gives you instant access to our neonatal intensive care specialists and a full range of pediatric and surgical subspecialists, all supported by state-of-the-art technology and equipment. It can also link you to our neonatal transport service team, who will arrange for transport to Children’s Hospital & Medical Center based on the child’s needs. Twenty-four hours a day, seven days a week, one call links you to physician-to-physician consults, referrals and admissions. There’s no problem too large, no child too small. www.ChildrensOmaha.org