ON CALl magazine
QUARTER THREE 2019
Woodrow WIlson was president DOW AVERAGE Average income PALM BEACH COUNTY
CO$T OF LIVING New Home (Median Price) . . . . $5,626 New Car (Avg. Cost) . . . . . . . . . . $ 826 Gas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25¢/gal Milk (Qt) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12¢ Bread (Loaf) . . . . . . . . . . . . . . . . . . . . . . . . . .9¢ Eggs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38¢/doz. Steak (lb) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34¢ Stamp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3¢
MEdical Service FEe Schedule For
NEW IN 1919
THE pogo stick • gasoline tax • dial telephones Greyhound racing with mechanical rabbits Bentley & Citroën cars were first introduced American Meteorological Society was founded in Boston. The American Legion was formed on March 15, 1919 pulp magazines (True Story) Non-stop crossing of the Atlantic (Newfoundland to Ireland by Alcock & Brown) Commercial airline service (Deutsche Luftreederie) WPB calls . . . . . . . . . . . . . . . . . . . . $2 Obstetrical calls . . . . . . . . $30 Out of town calls . . . . . . . $3 Urine Exam . . . . . . . . . . . . . . . . . . .$2 Night calls 11pm -6am . . . . . $4 Anesthesia . . . . . . . . . . . . . . $5-$25
Happy 100th Birthday!
President’s Message It’s Centennial Time! One hundred years ago the Palm Beach County Medical Society swung into action by creating and promoting an environment in which physicians and their staffs could provide the best possible medical care for their patients. That devotion to perfection remains today, and the Society is seen as one of the most active and productive medical organizations in America. With creativity and service as themes, the Society acted brilliantly about 20 years ago by establishing an independent Palm Beach County Medical Society “Services” Board, whose purpose is to reach out to the entire community with supportive programs. For example, Project Access offers free consultations for lower-income or uninsured individuals seeking advice and directs patients to a large volunteer staff of physicians.
Other activities supported by the Services Board include: 1) A Care Coordination Training Program leading to certification as community health workers 2) A Physician Leadership Academy, which emphasizes the importance of engendering advocacy and transformation in future roles 3) A Physician Wellness Program recognizing the serious stress on the profession, which can lead to early retirement, depression, substance abuse and even suicide 4) A Medical Reserve Corps, which promotes healthy practices throughout the community with volunteers who assist in local hospitals and health departments and train with emergency response personnel 5) A Healthcare Emergency Response Coalition, which fosters emergency planning and ensures overall readiness through coordination of community-wide training In addition, the Services Board raises funds to produce an annual Future of Medicine Summit, which attracts nationally-known speakers to discuss issues affecting everyone’s health environment, and a Heroes in Medicine annual event recognizing exceptional talent among all health-related professionals in many categories of service.
Michael T.B. Dennis, M.D. President, Palm Beach County Medical Society Services Board
One hundred years is a significant milestone, so please join us at the 100th Year Birthday Party from 6-9 pm, September 20th, 2019 at the Atlantis Country Club. The event will be coupled with the second annual “Docs Got Talent Show,” featuring an amazing array of talent from our local physicians. Add to your calendar the spectacular 2019 Centennial Gala and Festival of Trees and Lights scheduled for the evening of November 16, 2019 at the Kravis Center, Cohen Pavilion in West Palm Beach. This festive occasion is very popular and will include recognition of outgoing Society President Marc Hirsch, MD and the installation of new President Larry Bush, MD. I’m thrilled to announce a new idea for the next 100 years to meet the challenges which are inherent in the system – the Centennial Ambassador Circle, comprised of 100 physician champions. Members will be asked to contact and open lines of communication with at least five potential new donors, who will then be contacted by the Services staff. The past 100 years have seen remarkable advances in guaranteeing the very best medical care for all residents of the region, and in the words of that popular song, “We’ve only just begun.” To your good health, Michael T.B. Dennis, M.D. President Palm Beach County Medical Society Services If you are interested in joining this new team of champions, please contact Katherine Zuber 561-433-3940 for further information. OnCall • Q3 2019
New Members Kanwal Bawa, DO Emergency Medicine
Laura Megan Balda, MD Family Medicine
Erica R. Podolsky, MD General Surgery
Jean Dominique Morancy, MD John Yu, MD
Medical Students Jacqueline Baikovitz Gabrielle Benesh Jessica Delamater Desmond Green Alexandra Herweck Rajika Jindani Spencer Lacy Angela McGaugh Bernadette Miramontes Hardik Patel Hana Perone
2019 Q3 â€˘ OnCall
Victoria Rea-Wilson Adwight Risbud Alexandria Sarkar Khushali Shah Gautam Shrivastaus Jared Silberlust Jenny Soitter Logan Stone Scott Stratman Alfredo Valdivia Sheldon Warren
TABLE OF CONTENTS
BOARD OF DIRECTORS President, Marc J. Hirsh, MD President-Elect Larry Bush, MD
Vice President Roger Duncan, MD
Secretary Claudia Mason, MD
Treasurer Dawn Davanzo, MD
Shawn Baca, MD Andrew Berkman, MD David Coradin, MD Kleper de Almeida, MD Michael Dennis, MD Henry Haire, MD James Heron, MD Alison Kohn
Ekaterina Kostioukhina, MD Brandon Luskin, MD Stephen Babic, MD Leslie Perla, MD Alan Pillersdorf, MD Martha Rodriguez, MD Jack Zeltzer, MD
BOARD OF TRUSTEES
Jose F. Arrascue, MD Shawn Baca, MD Larry Bush, MD Roger Duncan, MD James Goldenberg, MD Marc J. Hirsh, MD
Brandon Luskin, MD Claudia Mason, MD Alan Pillersdorf, MD Brent Schillinger, MD Jack Zeltzer, MD
BOARD OF DIRECTORS
Michael Dennis, MD President Don Chester Treasurer
Ivy Faske, MD Vice President Matt Gracey Secretary
Jean Acevedo William Adkins, MD Elaine Alvarez Jose F. Arrascue, MD Brenda Atkins Steven Borzak, MD Madelyn Christopher Ljubica “Jibby” Ciric Patti Corbett Bobbi Horwich Barbara James Andrew Larson, MD
Gary Lesser, Esq. Roshan Massoumi Stuart Miro, MD Alan B. Pillersdorf, MD Brent M. Schillinger, MD Mollie Shulan, MD Kelly Skidmore Ben Starling III Patricia Thomas Maureen Whelihan, MD Paul Wieseneck Jack Zeltzer, MD
PBCMS STAFF DIRECTORY Tenna Wiles CEO Deanna Lessard Member Services & Physician Wellness Director
Mindi Tingler Director of Communications Katherine Zuber Membership Development & Events Director
Lauren Stoops Director of Development
Karen Harwood Director of Community Programs
John James Public Health & Disaster Services Director
Mindy Gonzalez Director of Finance & Administration
Subscriptions to OnCall are available for an annual rate of $50. For more information contact PBCMS at (561) 433-3940. The opinions expressed in OnCall are those of the individual authors and do not necessarily reflect official policies of Palm Beach County Medical Society or its committees. OnCall is owned and published four (4) times per year by Palm Beach County Medical Society, Inc., 3540 Forest Hill Blvd., #101, West Palm Beach, FL 33406. (561) 433-3940. ©Copyright 2019 Palm Beach County Medical Society, Inc. OnCall Journal is designed and edited by Mad 4 Marketing. Visit us on the web at mad4marketing.com 954.485.5448
DEPARTMENTS 3 4 6
Michael T.B. Dennis, M.D. President, Palm Beach County Medical Society Services Board
Welcome New Members Med Memo
First Members of Our 1919 Society
Florida’s New Telehealth Law
The History of Medicine in Palm Beach County: 1970-1995
Physician Leadership Academy
Terminating Patient Relationships
Trust Plan Renewal
Community Health Workers
Dr. J. John Goodman and Judy Goodman
David J. Davidson, Esq., The Florida Healthcare Law Firm
Martine Pierre-Paul Vice-President, Financial Sales Manager Boca Raton Florida
Jeremy Cohen Senior Group Benefit Agent
OnCall • Q3 2019
MED MEMO Call for Nominations The PBCMS Excellence in Medicine Award, the highest honor awarded by the Society, recognizes Palm Beach County Medical Society members whose lives encompass the true spirit of being a physician. The award will be presented to a physician who exemplifies the highest values of altruism, compassion, leadership and dedication to patient care. The Honoree will be inducted into the PBCMS Hall of Fame. The award will be presented at the PBCMS Centennial Gala on November 16, 2019.
For online nominations go to www.pbcms.org or call 561-433-3940.
Speakers Bureau Are you interested in helping to educate the community? PBCMS offers speaking opportunities that are reserved for PBCMS Members only.
For more information, contact Deanna Lessard at 561-433-3940 ext. 105, or by email at email@example.com.
Physicians We Need Your HELP! PBCMS is looking for volunteer physician mentors to match up with premed students. The program is designed to fill a need for “clinical shadowing” experiences for students. Those exposures to clinical medicine have become increasingly important in the evaluation of medical school applications. Details of the shadowing experiences will be worked out between the student and physician and may occur in an office, clinic or other facility.
If you are interested in learning more or adding your name to the list of current mentors please contact Deanna Lessard at firstname.lastname@example.org or call 561-433-3940 ext. 105.
Q3 2019 • OnCall
THE DATE Celebrating Women in Medicine Dinner September 12, 2019 Benvenuto’s Restaurant Cheers to 100 Year PBCMS Birthday Party & Doc’s Got Talent September 20, 2019 Atlantis Country Club Physician Well Being Symposium October 19, 2019 Atlantis Country Club PBCMS Centennial Gala & Festival of Trees & Lights November 16, 2019 Kravis Center
PBCMS Centennial Gala The Centennial Gala Host Committee has been announced. The Centennial Gala will be held Saturday, November 16, 2019 at the Kravis Center. Join us as we honor our president Marc Hirsh, MD and welcome incoming president Larry Bush, MD.
Mr. Barry and Mrs. Louise Snyder
Mr. David Ulrich and Ms. Melisa Niver
In Memoriam Dr. Robert Levine
Dr. Robert Levine, a Life Honorary member of the Palm Beach County Medical Society and active member of the Retired Physician Section passed away in April. He will certainly be missed by his wife Deborah, colleagues, friends, neighbors and the PBCMS Staff.
Barbara H. Jacobowitz
Barbara H. Jacobowitz, 61, of Royal Palm Beach, Florida passed away Sunday, July 7, 2019. Barbara was a 2018 Heroes in Medicine awardee and friend to the Palm Beach County Medical Society. She is survived by her loving husband, Dr. Irwin Jacobowitz; daughter, Melissa Jacobowitz; son Joshua Jacobowitz; sister Pamela (Paul) Bierman, friends and community.
Jerome Goldstein, MD
It is with a heavy heart that we share the sad news of the passing of our dear friend and longtime PBCMS member Jerome Goldstein, MD. Dr. Goldstein is survived by his loving wife Rochelle.
Chair Mr. Barry and Mrs. Louise Snyder Chair Mr. David Ulrich & Ms. Melisa Niver Dr. James & Mrs. Dianne Goldenberg Dr. James Howell & Mrs. Marie Gottfried Dr. Martha Rodriguez & Mr. Jesus Perez-Mendez Dr. Jack & Mrs. Marci Zeltzer Dr. Henry Haire Ms. Patricia Thomas Dr. Gordon Johnson and Mrs. Linda Ruth Dr. Ekaterina Kostioukhina Dr. Stephen & Mrs. Joan Babic Dr. Aleisha Canik Dr. Andrew & Mrs. Jennifer Berkman Dr. Roger Duncan & Mrs. Lisa Quarrie-Duncan Dr. Faustino Gonzalez & Dr. Idalmis TeranGonzalez, MD
PBCMS Services will be presenting each of the 67 incoming FAU Medical Students with a stethoscope at their White Coat Ceremony. Thank you to the following donors who have already made their contribution: Acevedo Consulting Jose Arrascue, MD Stephen Babic, MD Jeff Berman, MD Larry Bush, MD Paul Christakis, MD Gregory Cotes
Edgar Covarrubias, MD
Michael Dennis, MD Howard Doyle, MD Roger Duncan, MD Ivy Faske, MD Renee Gasgarth, MD James Goldenberg, MD Howard Goldman, MD Faustino Gonzalez, MD Matt Gracey Henry Haire, MD James Heron, MD Marc J. Hirsh, MD JEM Research Michael E. Kafrissen MD Stuart Katz, MD Kandace Kichler, MD Jerold Kramer, DO
Dr. & Mrs. H. Donald Lambe Barbara Lea Levi & Associates Brandon Luskin, MD Antonio Mendez, MD Stuart Miro, MD Alan Pillersdorf, MD Greg Quattlebaum Steven Reznick, MD Martha Rodriguez, MD Louis Rogow, MD Mark A. Rubenstein, MD Brent Schillinger, MD Andrew Shapiro, MD Drs. David & Mollie Shulan Yrma Signo, MD William Slomka, MD Jerome Spunberg, MD Jim Sugarman Robert Tome, MD Maria Vazquez-Pertejo, MD Paul Wieseneck Tenna Wiles Michael Zeide, MD Jack Zeltzer, MD
OnCall • Q3 2019
FMA Annual Meeting Each year, FMA members convene to present, deliberate resolutions and adopt policies that impact the practice of medicine and the health of our communities. With 22 Delegates, Palm Beach County Medical Society has a proud tradition of strong leaders advocating for the practice of medicine. Our impact is stronger through our partnership with Dade and Broward County in the South Florida Caucus. This year’s meeting was held Aug 9-11, 2019 at the Hilton Bonnet Creek in Orlando, Florida. Alan Pillersdorf, MD, Ankush Bansal, MD, Mark Rubenstein, MD and Tenna Wiles, CEO to serve on FMA Board of Governors.
THANK YOU Jose Arrascue, MD Stephen Babic, MD Shawn Baca, MD Andrew Berkman, MD David Coradin, MD Anthony Dardano, MD Dawn Davanzo, MD Roger Duncan, MD Henry Haire, MD Marc J. Hirsh, MD James Howell, MD
Leonard Kaufman, MD Tulisa LaRocca, MD Claudia Mason, MD Emanuel Newmark, MD Michael Patipa, MD Henry Pevsner, MD Martha Rodriguez, MD Mark Rubenstein, MD Brent Schillinger, MD Jack Zeltzer, MD
to our PBCMS Delegates
Congratulations to Ronald Giffler, MD President FMA
Ronald F. Giffler, MD is the President and CEO of FirstPath. He received his medical degree and residency training in Anatomic and Clinical Pathology from the Medical College of Virginia. This was followed by a fellowship in oncologic surgical pathology at the University of Texas M.D. Anderson Cancer Hospital in Houston, TX. Dr. Giffler is certified by the American Board of Pathology in Anatomic and Clinical Pathology. Dr. Giffler also holds a law degree from the University of Miami and a Masters Degree in Business Administration from Nova Southeastern University. Dr. Giffler is actively involved in numerous professional organizations, including The Florida Medical Association, The Florida Medical Association Foundation, The Professionals Resource Network (PRN), The Broward County Medical Association, and the College of American Pathologists. Dr. Giffler served for many years as a Colonel in the United States Army Reserve until his retirement in 2015. He is a graduate of the Army’s Command and General Staff College.
Q3 2019 • OnCall
Ronald Giffler, MD
1919 Society Members by Leon Fooksman
Meet Dr. and Mrs. Goodman: One of the First Members of Our 1919 Society Dr. J. John Goodman and Judy Goodman both believe in the importance of the medical profession getting involved in improving Palm Beach County, especially in helping medically underserved people. And so, not surprisingly, the Goodmans were among the first contributors to Palm Beach County Medical Society’s 1919 Society in 2010. They donated $10,000, and other physicians in Dr. Goodman’s dermatology practice matched them -- raising an additional $20,000 for the Society’s endowment. The couple, married for 40 years, has been living in Palm Beach County for decades and serving on the boards of numerous medical organizations, always to improve medicine and help patients. Dr. Goodman is a dermatologist. He earned his B.S. from Yale University, his M.D. degree from the University of Vermont, and was a clinical fellow in Dermatology at Massachusetts General Hospital; with post-graduate studies in dermatology at the Skin and Cancer Unit of New York University, Bellevue Medical and Harvard Medical School. He was a Resident in Dermatology at Mount Sinai Hospital in New York, and also was a medical officer in the U.S. Army in the Korean War, serving as Chief, Dermatology Section for the U. S. Army Hospital in Ft. Bragg, North Carolina; and the U.S. Army Hospital in Fort Meade, Maryland. He was licensed in Florida in 1958 and set up his dermatology practice in West Palm Beach where he continued to practice for more than 60 years, with appointments to active attending staff at both Good Samaritan and St. Mary’s Hospitals until recently, when he joined the emeritus staff. Dr. Goodman, in addition, became one of the nation’s most respected clinical research investigators for a variety of pharmaceutical companies and worked on clinical trials for such well-known drugs as Humira and Denavir. He later owned Med-Check, Inc., an international CRO, which he later sold to Hazleton/Corning.
degrees with a concentration in health law from Nova Southeastern University. She is a member of both the Florida Bar and the D.C. Bar and remains currently in private practice Dr. J. John Goodman and in West Palm Beach Judy Goodman where she conducts research and consults in health law and policy for hospitals, research institutions, and governmental clients. She is a member of the Associate Graduate Faculty at Florida Atlantic University where she teaches health law and policy in the Health Administration department of the Business School. Palm Beach County Medical Society has been a part of their lives for many years. Dr. Goodman has been a member since his earliest practice days. Mrs. Goodman joined the Board of Palm Beach Medical Society Services in 2010, serving until 2016 and stepped down after completing two full three-year terms. Mrs. Goodman was featured in On Call in 2010 about the Common Interest of Doctors and Lawyers. She was awarded the “Outstanding Leadership Award” by the Society in 2012. Mrs. Goodman explained that the reason the couple donated to the 1919 Society was to “inspire other doctors to go beyond just volunteering time and service, by showing how philanthropic medical doctors can truly be.” Dr. and Mrs. Goodman believe that the Future of Medicine Summit is an important annual educational project and they are proud of the Society’s efforts to help medically underserved people. As for the future, they foresee that many of the coming technological changes in telehealth and personal medicine will benefit many.
Mrs. Goodman is a health care lawyer. She earned her B.A. degree from Stephens College in Columbia, Missouri, and earned both her M.B.A and J.D. OnCall • Q3 2019
Florida’s New Telehealth Law David J. Davidson, Esq. The Florida Healthcare Law Firm The opportunities to use technology to provide healthcare services seem to be growing as fast as technology itself. This trend is especially true when care is delivered by a “remote” provider. In fact, an AMA study released in May 2019 indicated that telehealth was the fastest growing “place of care” in the country, outpacing urgent care centers, retail clinics and ambulatory surgery centers. Unfortunately, the laws governing telehealth have not always kept up with the pace of that growth, and questions remain about how it could be provided in Florida. However, the Florida Legislature took a step toward delivering answers by passing House Bill 23, which Governor Ron DeSantis signed into law on June 25, 2019. The Act, which is primarily codified in Florida Statutes §456.47, took effect on July 1, 2019 and answers many outstanding questions, including:
What Constitutes Telehealth in Florida and Who can Practice It? The new law sets out a straightforward and broad definition of telehealth. Basically, telehealth in Florida is the use of telecommunication technology by a telehealth provider to deliver healthcare services. These services can include assessment, diagnosis, consultation, treatment, monitoring, transfer of medical data, education, public health services and health administration. Voice-only telephone calls, emails and faxes are specifically excluded from the definition. Obviously, those activities are still permissible, but they fall outside the definition. The statute’s designation of providers who can practice telehealth is also very broad. Any licensed or certified healthcare provider can practice telehealth, so long as the services rendered are within the scope of the provider’s license or certification. Out-of-state providers who do not have Florida licenses may also register with the state in order to provide telehealth services to patients in Florida.
Q3 2019 • OnCall
What is the Standard of Care for Telehealth Services?
The standard of care for telehealth services is the same standard that applies to David J. Davidson, Esq., the provider when The Florida Healthcare Law Firm rendering faceto-face care. For example, if the standard of care for a physician is to order a CT scan of the head for a patient reporting the sudden onset of a severe headache during an inperson exam, then a physician conducting that exam via telehealth will be held to that same standard. One interesting exception to the telehealth standard of care exists. If a telehealth provider evaluates a patient sufficiently to offer a diagnosis and treatment plan, that provider is not required to research the patient’s medical history or conduct a physical examination in advance. Although that approach may make some sense, what about a physician who uses telehealth to correctly diagnose and treat a sprained toe, but fails to discover in the medical history that the patient is diabetic? If a malpractice case was filed in that situation, my guess is that it would be left to a jury to determine whether a diagnosis of a foot injury without finding out if a patient is diabetic constitutes “sufficient diagnosis and treatment.” I do not believe this exception will be used to circumvent the standard of care.
Is There Anything that Cannot be Done via Telehealth? Despite the broad authority granted to telehealth providers in the new statute, certain care and treatment cannot be rendered via telehealth. These services are: treatment for a psychiatric disorder, inpatient treatment at a hospital, hospice services and treatment of a nursing home resident. Otherwise, so long as the provider stays within the scope of his or her license or certification, telehealth remains a practice option.
What About Medical Records? As is the case with the standard of care, medical records for telehealth must be maintained in the same manner as medical records for all other care and treatment. Everything that is generated as part of the telehealth encounter must be kept in the medical record, and the record must be complete and accurate. Telehealth records are afforded the same level of confidentiality as any other medical record, and must be maintained in the same manner.
Conclusion Telehealth is rapidly growing throughout the country. Patients and providers are seeing the convenience of such a resource and the ways it can enhance patient care. With House Bill 23, the Florida Legislature has established a clear and workable framework for telehealth in the state. Here’s hoping this opportunity truly does enhance the health of our communities.
For more information about Florida’s new Telehealth Law, contact David J. Davidson, Esq. The Florida Healthcare Law Firm
CENTENNIAL GALA Palm Beach County Medical Society & Services
Co-Chair Sally Chester, RN
Co-Chairs Dr. William & Mrs. Imelda Slomka
Let Your Creativity Soar RESERVE A TREE
Decorate & accessorize a tree that will serve as the centerpiece of our Gala reception and as an item for the silent auction.
REGISTER BEFORE 11/1/19 • $45
Get The Equipment Your Practice Needs To Succeed Up to 100% financing
Tailored purchase options
Possible tax deductions*
No pre-payment penalties
No hidden fees
Flexible re-payment plans
Please contact Martine Pierre-Paul at (561) 351-0219 or email@example.com • Consult your tax advisor for additional information on eligibility Normal Bank approval applies. Member FDIC.
For more information & questions contact Deanna Lessard
561-433-3940 ext. 105 • firstname.lastname@example.org
OnCall • Q3 2019
Jupiter Medical Center
The History of Medicine in Palm Beach County Revisiting Key Moments From 1970–1995 In 2019, Palm Beach County Medical Society is celebrating our centennial year. As part of our special year, we are looking back at the milestones in the history of medicine in Palm Beach County and our organization’s role in it -- as told in the book, A Tradition of Caring, A History of Medicine in Palm Beach County, by Leon Fooksman (Legacy Publishing Company, 2013). Here’s our story during the years 1970-1995. Medicine in the 1970s had its share of changes. Healthcare costs continued escalating due to high Medicare expenditures, rapid inflation in the economy, rise of hospital expenses, and from the greater expenses associated with technology and medications. In 1974, President Richard Nixon became the latest president to attempt to create a national health insurance system. He called for using existing privatesector healthcare systems and relying on government subsidies and tax credits to get all Americans under an umbrella of health coverage. Like previous attempts, it was rejected, this time by liberals and labor unions. But Nixon was successful in other areas. His “War on
Q3 2019 • OnCall
Cancer” centralized research at the National Institute of Health, and him signing the 1971 National Cancer Act paved the way for scientific progress in preventing, detecting, and treating cancer. Locally, established medical facilities throughout the county were barely able to keep pace with demand from a growing population and increased healthcare regulations. Facilities such as St. Mary’s Hospital in West Palm Beach had to expand to meet the demand. The hospital opened the Schwartz Dialysis Center in 1977, as well as Neonatal Intensive Care Units II, and III to serve critically ill infants. A private maternity room was opened as well. Brand new facilities also were filling up soon after they opened their doors. By 1979, shortly after Palm BeachMartin County Medical Center — later called Jupiter Medical Center — opened, hospital officials had to put a cap on admissions until more nurses were hired. When the hospital first opened, it operated from what was formerly the outpatient clinic and convalescence pavilion for Salhaven Retirement Village. The medical facilities had been donated to Palm Beach-Martin County Medical Center, at the time a not-for-profit corporation formed by Doctors George Ford, Edwin Brown, and William Donovan. “Dr. Ford worked very hard to get the land donated, and we were able to donate the land to Palm BeachMartin County Medical Center,” said Robert Diaz, a founding physician, in a video commemorating the hospital’s 25-year anniversary. They donated 30 acres
to Palm Beach-Martin County Medical Center and sold the remaining 600 acres east of the railroad tracks to Alcoa Properties Inc., which built Jonathan’s Landing. Meanwhile, Jupiter Hospital continued growing over the years and established more programs with expanded services, including the Ella Milbank Foshay Cancer Treatment Center in 1986 and a sleepdisorders center in 1990. Like so many other early medical institutions, the hospital had a tight-knit staff. Dr. Mark Gocke, the son of T.M. Gocke, who worked with his father at Jupiter Medical Center, said in the video that he liked knowing everyone by his or her first name: “I like the small size…[I like] the intimacy of the staff and knowing everybody pretty well—the medical staff, the nursing staff, and even George, who cleans the floors. These are all people we say hello to in the mornings. There is a family-type atmosphere.” One of the lesser-known hospitals that opened to care for Palm Beach County’s booming population was the Doctors Hospital in Lake Worth. Doctors Hospital opened on January 22, 1973 at 10th Avenue North. Privately owned by a group of 20 doctors, it was one of the largest in the region, with 200 beds. The group sold Doctors Hospital to the Hospital Corporation of America, a Nashville-based private operator of healthcare facilities around the world, in 1980. Doctors Hospital was number 23 on a list of the top 25 mostly profitable hospitals in South Florida, according to South Florida Business Journal in 1990.
After another sale, the hospital closed down in 1995, and all of its emergency and acute-care services were moved to JFK Medical Center. It was more profitable for Columbia/HCA Healthcare Corp., the owner of the hospital, to combine the two profitable hospitals. “We are taking two profitable hospitals and combining their services, which should make us even stronger,” said Wayne Campbell, the former chief executive officer at Palm Beach Regional, in The Sun-Sentinel in 1995. Today, the former hospital site is a residential development.
Physicians Fight Back By the mid-1980s, local physicians were in crisis mode. In 1984, a Palm Beach County jury awarded $10.5 million to the plaintiff in a landmark malpractice case involving a brain-damaged child. A year later, the Florida Legislature passed the Comprehensive Malpractice Reform Act, which required doctors to obtain costly professional liability insurance. Dr. R. Robert Eastridge, a urologist who was president of the Palm Beach County Medical Society from 1985 to 1986, recalled that many doctors feared they would be driven out of business because trial lawyers took on malpractice as their dominant issue, and doctors began getting sued for exorbitant sums of money. For neurologically damaged babies, many awards were in excess of $1 million. As a result, malpractice insurance went up considerably, as much as $89,600 a year for obstetricians.
OnCall • Q3 2019
Lawyers like Robert Montgomery, who represented the plaintiff in the 1984 brain-damage child case, explained in a 1986 Palm Beach Post article that part of the reason for the high malpractice insurance premiums had to do with insurance companies’ unwillingness to settle cases out of court: “Those who bring the awards are ‘a cross-section of America’…There’s nothing available in our state that will take care of a child who’s permanently injured and needs round-the-clock care but court-ordered awards.” Dr. Eastridge said the Medical Society doctors fought back by educating the public and legislators: “In the Medical Society, we were trying to educate the community about these large payments and the fact that we were losing medical care and coverage in the community. We were often on television debating plaintiff attorneys.” In 1986, about 200 local physicians boarded a Medical Society chartered plane to Tallahassee, Florida and joined as many as 27,000 doctors from across the state in marching during the legislative session in support of doing away with mandatory malpractice insurance and capping jury awards in malpractice suits.
Lawsuits continued taking a toll on doctors, as well as the medical care that patients were receiving, in the 1990s and even into the 2000s. Dr. Jack Zeltzer, a surgeon and president of the Palm Beach County Medical Society in 2012, said malpractice lawsuits have been the root of unnecessary medical testing and many other problems in the healthcare system. “I personally think malpractice and defensive medicine, which is a consequence of the malpractice issue, is a huge, huge burden and unnecessary cost on the delivery of healthcare and probably remains as one of the major pillars that needs reset in order to get a decent system going. Until that’s done, probably nothing is going to happen… There’s so much money being spent on unnecessary testing, and something like 30 percent of it is related to defensive medicine. As long as there’s been someone saying ‘I’m going to sue you,’ there’s a doctor saying, ‘I better get every test in the book.’”
AIDS, A Mystery Disease Hits Local Area The first recognized cases of AIDS, or acquired immune deficiency syndrome, occurred in the United States in the early 1980s. A number of gay men in New York and California suddenly began to develop
The problem escalated until finally many doctors in Palm Beach County had had enough, and did the only thing left to do: leave their practice or stop accepting new patients. Emergency rooms at local hospitals were being crippled by the resignations of neurosurgeons and orthopedic surgeons over the malpractice issue, recalled Dr. Eastridge: “Without having physicians available to treat patients, these patients had to be taken elsewhere to facilities in Orlando, Tampa or further north…This went on for three to four years. Gradually, over a period of time, there were changes in the Legislature to decrease the malpractice awards, primarily malpractice awards for pain and suffering.”
Q3 2019 • OnCall
Wellington Hospital Medical Center
rare opportunistic infections and cancers that were stubbornly resistant to any treatments. Soon, the disease hit a small community in Palm Beach County: Belle Glade, a town of less than 20,000 residents known for its fertile farm country and rich soil where the high school football players go on to someplace bigger. Although New York City had the largest number of AIDS victims, the rate per million in New York was 369. Whereas in Belle Glade, the rate per million was 1,500 or higher, Dr. Jeffrey Sacks, epidemiologist for the State of Florida, explained in a 1985 article in the New York Times. The AIDS rate in Belle Glade “is the highest rate of occurrence that I am familiar with,” he said, at the time. Belle Glade had one case for every 541 people, making the town’s rate of infection 51 times the national average. Eventually, state investigators, working with CDC officials, found that most of the victims fell into the categories of homosexual men and intravenous drug users, who were considered at high risk to contract AIDS. This was the reason the cases were clustered in a deteriorated, one-square-mile section of the city’s southwest section known for prostitutes and drugs. AIDS continued to spread at an exponential rate across the nation, and Florida was no exception. As many as 1.5 million Americans were estimated to be infected with the virus by the end of the 1990s. In the years to come, hospitals and medical professionals would have to rethink and reorganize the medical services they were providing in order to get the epidemic under control. Leon Fooksman A Tradition of Caring, A History of Medicine in Palm Beach County, by Leon Fooksman (Legacy Publishing Company, 2013).
OnCall • Q3 2019
Cyberattackers When cyberattackers pose as decision makers in your practice, will you be ready? Imposter fraud, in which a criminal poses as an executive, vendor or other trusted entity in order to steal company funds, is a fast-growing threat. Last year, one form of imposter fraud, business email compromise (BEC), affected nearly three-quarters of businesses surveyed by the Association for Financial Professionals. In total, firms have been hit with more than $5 billion in costs from BEC schemes, according to FBI figures. Companies of all sizes and in virtually all industries are potential targets for these sorts of attacks. Imposter fraud is very different from a fraudster stealing online banking credentials and using the data to make fraudulent payments. Imposter fraud means your practice’s authorized users make the payments, so they look like normal transactions to your bank. As a result, fraud is not quickly identified and recovering funds is harder.
You can help protect your practice by taking steps to improve your security:
Protect your computers and network:
Malware is often a key component of BEC scams. Use anti-malware software from a reputable provider that automatically updates to block new threats. Be sure to follow other security best practices as well, such as having a firewall in place to filter traffic to and from your network.
Review your insurance policy:
Knowing what your insurance will cover should your business fall victim to fraud is a great way to prepare for an incident.
Alert your bank immediately:
Be sure to notify your bank instantly should you spot instances of potential fraud risk.
Learn more about how we can help. Martine Pierre-Paul, Martine.email@example.com, Vice-President, Financial Sales Manager, Boca Raton Fl. Account openings and credit are subject to Bank approval. Member FDIC.
Verify all requests:
Train employees to follow up on any unusual request for payments or changes in payment information through a channel other than the one used to make the original request.
Warn against oversharing:
Encourage employees to exercise caution when sharing work-related or even personal information on social media and other websites.
Use account controls:
Access management features offered by banks allow you to define how transactions proceed and give you additional layers of protection.
Q3 2019 • OnCall
Martine Pierre-Paul, Vice-President Financial Sales Manager, Boca Raton Fl.
(Back row) Jose David Suarez MD, Edison Castro DO, Jair Munoz Mendoza MD (Front row) Claudia Marcelo DO, Shelley Singh DO, Catherine Garcia MD, Tulisa LaRocca MD, Lauren Shapiro MD, Aimee Gonzalez MD, Margarita Almeida-El Ramey DO, Carlos Ramirez-Mejia MD, Heather Kessler-Reyes MD, Sidney Coupet DO, David Drew MD
Physician Leadership Academy South Florida Medical Organizations Collaborate to Bring Leadership Training to Physicians As if their intense medical schooling wasn’t enough, six physicians from each of Palm Beach, Broward and Miami-Dade Counties spent seven-months learning how to be better leaders through The Physician Leadership Academy (PLA) of South Florida. The collaborative program between the Palm Beach County Medical Society (PBCMS), Broward County Medical Association (BCMA) and the Dade County Medical Association (DCMA) helps to build skills not taught on medical school campuses. Among the objectives of the program are improving physician engagement in their local medical societies, finding ways to educate physician residents about the business of medicine and exploring approaches to improving physician wellbeing, self-care, efficiency and resiliency. Each year, physicians may apply for the limited spots in their local medical society. The group then meets monthly seven times. The Academy is administered by the Palm Beach County Medical Society Services, supported by a grant from The Physicians Foundation, and continuing medical education credits are provided by the Florida Medical Association. The 2019 PLA class graduated on June 1 with a half-day program facilitated by Bob Addleton, EdD, a national consultant to physician leadership programs.
“Throughout the program, physician participants learned how to navigate varying personalities in the workplace, manage business challenges and develop important leadership qualities,” he explained. “This program helps physicians acquire the tools they need to run a business, hold a leadership position in a hospital, even handle a media interview.” James Goldenberg, MD, chairman of the PLA, added, “Physicians of all ages and positions participate in this program and come out the other end able to better tell their stories, advocate on behalf of their patients, identify the challenges facing the medical profession, and inspire and lead the people around them.” Graduate Aimee Gonzalez, MD, reflected about her PLA experience, “We are beginning to shape the future of healthcare,” she said. “We as physician leaders cannot forget we are advocates for physicians and patients,” added another participant, Jose David Suarez, MD.
For more information about the Physician Leadership Academy, contact Program Director Karen Harwood at 561-433-3940, ext. 119 or firstname.lastname@example.org. OnCall • Q3 2019
Terminating Patient Relationships By Julie Brightwell, JD, RN, Director, Healthcare Systems Patient Safety, Department of Patient Safety and Risk Management, and Richard Cahill, JD, Vice President and Associate General Counsel, The Doctors Company Just as it is an acceptable and reasonable practice to screen incoming patients, it is acceptable and reasonable to know when to end patient relationships that are no longer therapeutic. It is critical, however, to end the patient relationship in a manner that will not lead to claims of discrimination or abandonment. It is appropriate and acceptable to terminate a relationship under the following circumstances:
• Treatment nonadherence • Follow-up nonadherence • Office policy nonadherence • Verbal abuse, violent behavior, or threats of physical harm • Nonpayment
A few situations, however, may require additional steps or a delay or even prohibit patient dismissal. Examples of these circumstances include: • If the patient is in an acute phase of treatment, delay ending the relationship until the acute phase has passed. • If the practitioner is the only source of care within a reasonable driving distance, or when the practitioner is the only source of specialized care, he or she is obliged to continue care until the patient can be safely transferred to another practitioner. • If the patient is in a prepaid health plan, the patient cannot be discharged until the practitioner complies with the terms of the payer-provider agreement. • A patient may not be dismissed or discriminated against based on limited English proficiency, or because he or she falls within a protected category under federal or state legislation. • If a patient is pregnant, the physician can safely end the relationship during the first trimester if the pregnancy is uncomplicated and there is adequate time for the patient to find another practitioner. During the second trimester, a relationship should be ended
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only when it is an uncomplicated pregnancy and the patient is transferred to another obstetrical practitioner prior to the cessation of services. During the third trimester, a relationship should end only under extreme circumstances. • The presence of a patient’s disability cannot be the reason(s) for terminating the relationship unless the patient requires care for the particular disability that is outside the expertise of the practitioner. When terminating the relationship is appropriate and none of the restrictions mentioned above are present, termination of the relationship should be completed formally. Put the patient on written notice that he or she must find another healthcare practitioner. The written notice should be mailed to the patient by both regular mail and certified mail with a return receipt requested. Keep copies of all the materials in the patient’s medical record.
More details on what to include in a written notice can be found in the expanded version of this article: www.thedoctors.com/articles/terminatingpatient-relationships/. The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.
The 2019 Renewal is here! The BCBS INSURANCE TRUST FUND received an excellent, 8% RENEWAL. New HMO options have also been added to enhance the offering, with prices below current levels! Palm Beach County Medical Society (PBCMS) offers an exclusive, association-type health insurance opportunity to physician practices in Palm Beach County. The plans provide affordable health insurance to member EMPLOYER-physicians, their fulltime employees and their families. It offers comprehensive plans and a range of benefit levels. The Trust Plans are a Co-Op/Association type plan, where the members merge assets together to create a larger group. For over 30 years, federal laws and regulations allow for employers and “groups of employers in the same profession” to form a “NOT FOR PROFIT” Trust for employee benefits. This is best known as a “Co-Op,” according to the Florida Bar Association. The MCMS, Inc. Insurance Trust Fund was created in 1981 as such a Co-Op, but only for Physicians (and their employees) in Private Practice. Under the Co-Op’s agreement with Florida Blue, physicians have no risk for excessive claims, and they share in underwriting surplus profits. At a
Q3 2019 • OnCall
Jeremy Cohen Senior Group Benefit Agent
time when many doctors are concerned about rising operational costs — including employee health coverage — Co-Op participants are reaping the benefits of a group insurance plan that rewards the physicians and their families, as well as practice employees and their covered dependents. Medical practices in 10 Florida counties have shared in a profit of more than $2.3 million since joining with members of other local medical societies to form a single, large group insurance plan with Florida Blue. Through this thriving health insurance Co-Op, participating physicians are sharing major profits, saving money and offsetting future rate increases. The Trust Plans have both traditional plans and High Deductible Health Plans (HDHP), which use Health Savings Accounts (HSA). Most plans are BCBS Blue Options Network plans (Their allencompassing national/international network). Two new HMO plans have become available, to enhance the overall offering.
The 2019 Renewal is Here! The BCBS INSURANCE TRUST FUND received an excellent, 8% RENEWAL. New HMO options have also been added to enhance the offering, with prices below current levels! Palm Beach Medical Society offers an exclusive, association type health insurance opportunity to physician practices in Palm Beach County. The plans provide affordable health insurance to member EMPLOYER-physicians, their fulltime employees, and their families. It offers comprehensive plans, and a range of benefit levels. The Trust Plans are a Co-Op/Association type plan, where the members merge assets together to create a larger group. The Trust Plans have both traditional plans and High Deductible Health Plans (HDHP) that utilize Health Savings Account (HSA). Most plans are BCBS Blue Options Network plans (Their all-encompassing National/International network). Two new HMO plans have become available, to enhance the overall offering. If you are interested in receiving a proposal for your group, please reach out to Barry Levi or Jeremy Cohen, at 561-353-1234.
For those who might be interested in a HDHP with an HSA, here are the features: • HSA contributions are made pre-tax • Earnings on accounts are tax-free • Withdrawals for qualified medical expenses are tax free
• Unused funds and interest are carried over, without limit, from year to year • The HSA is yours to keep, even when you change plans or retire. After age 65, withdrawal penalty goes away. • Accumulated funds in the account can be invested in stocks and bonds or traditional savings accounts. Everyone enrolled in a qualified High-Deductible Health Plan is eligible to participate. Individuals cannot be covered under another health plan that isn’t a qualified High-Deductible Plan or covered through a spouse’s FSA. In addition, they must not be eligible For Medicare or be eligible to be claimed as a dependent on another person’s tax return.
If you are interested in receiving a proposal for your group, please reach out to Barry Levi or Jeremy Cohen at 561-353-1234.
OnCall • Q3 2019
(Back row) Dr. Stuart Miro, Mary Paulk CareerSource PBC, Charlene Edwards, Annie Pollack, Genevieve Victoria Smith, Milatresse JosueMenelas, Deborah Ruffing, Kathy Conyers, Alexis Monet Jackson, Dr. Jose Arrascue (Front row) Dailyn Miriam Rivera, Herma May Hamilton, Karen Harwood PBCMS, Beth A. Banes, Dore Miller
Community Health Workers Palm Beach County Medical Society Helps Fill a Growing Need for Community Health Workers Patient Navigator for Palm Beach County HealthCare District Michaëlle Schütt-Ainé is among more than 100 people who have completed Care Coordination Training through the Palm Beach County Medical Society (PBCMS). She is a Certified Community Health Worker (CCHW), an emerging occupation in the health care industry and one of the state’s top six evolving health care occupations, according to a recent report prepared by the Florida Center for Nursing. These individuals serve as a critical link between a patient’s clinical health and social services providers and the community. The 30-hour training, says Schütt-Ainé, has benefited her career as well as the patients she serves. Following completion of the course, she was promoted to a management role, where she supervises a group of eight other Patient Navigators. “Motivational interviewing training, for example, has truly been effective with many of my patients,” Schütt-Ainé said. “With this skill, we are able to listen attentively to patients, concentrate on the important matters, and ask the open-ended questions necessary
Q3 2019 • OnCall
to lead them to their personal goals. When we accomplish those goals, it’s truly rewarding– their smiles are priceless.” Community Health Workers, according to Chair of the Care Coordination Initiative Jose F Arrascue, MD, are trusted members of the community who patients feel comfortable going to for non-clinical support such as access to medications, transportation, healthy living or eating guidance. “This area of health care is evolving in Florida but has proven to be successful in other areas of the country. The course we offer provides the required training hours as part of the state’s certification process,” he said. PBCMSS is a certified education provider for Florida Certification Board, Florida Certification Board Provider number 5284-A. Dr. Arrascue added that more than one third of the courses focused on communications skills that help the workers gain a comfort level from patients that leads to less stress and better care outcomes. Students also
cover 10 separate topics, such as the background on the U.S. health care delivery system, ways to help identify and prevent health risk factors, how to be more culturally sensitive, understanding patient privacy and effectively working in teams. “The training prepares individuals to provide patientcentered support that improves the health of highrisk people, many dealing with chronic conditions,” Dr. Arrascue said. “The ultimate goal is to achieve greater care plan adherence, improved health care experiences and lower care costs.” The PBCMS CHW Care Coordination Training is fully funded by a federal grant provided through CareerSource Palm Beach County, the local workforce development board chartered by the State of Florida to provide training and recruitment services for Palm Beach County businesses and residents.
Dunn, Director of Business Services at CareerSource Palm Beach County. “We are proud to support a training program that will help improve health care delivery to the people of Florida.” Training participants must be at least 18 years old and have a high school degree. Past graduates have been employed by or found positions with both for-profit and non-profit organizations, including Medical Specialists of the Palm Beaches; Healthy Mothers, Healthy Babies Coalition of Palm Beach County, Inc.; and the Health Care District of Palm Beach County.
For more information about this training program, contact Karen Harwood, Program Director at 561-433-3940, ext. 119 or email@example.com.
“Programs like this one offered by the Medical Society help us fulfill our mission of matching qualified workers with employers that need specific training,” said Judy
JOIN US FOR OUR 100th BIRTHDAY PARTY & DOCS GOT TALENT EVENT
o t s r e e h C
! s r a e y 100
G T TALENT
FRIDAY, SEPTEMBER 20
ATLANTIS COUNTRY CLUB — 190 Atlantis Blvd. Atlantis, Fl 33462 6:00 – 7:00 Reception • Dinner and Entertainment 7:00 – 9:00 pm $75 Per Person RSVP BY MONDAY, SEPTEMBER 16, 2019 Proceeds support Palm Beach Medical Services – Project Access, Care Coordination, Disaster Services, Physician Leadership Academy, Physician Well-Being & My Health Access
WWW.PBCMS.ORG OR CALL 433-3940 OnCall • Q3 2019
PRST STD US POSTAGE
PAID WEST PALM BEACH, FL PERMIT NO.515 3540 Forest Hill Blvd. Suite 101 West Palm Beach, FL 33406 RETURN SERVICE REQUESTED
3540 Forest Hill Blvd. Suite 101 West Palm Beach, FL 33406 RETURN SERVICE REQUESTED
Celebrating a Century of Medical Excellence
Celebrating a Century of Medical Excellence
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Women in Medicine Celebration Dinner Thursday, September 12, 2019
In honor of Women in Medicine month we are hosting a dinner celebrating female physicians. The event will be held at Benvenuto’s in Boynton Beach from 6-8 pm and will feature an inspirational speaker, networking, reception and dinner. Sponsorship opportunities range from $500 - $1000.
100th Year Birthday Party & Docs Got Talent Friday, September 20, 2019
S E P T
Join us as we celebrate our 100th birthday at the Atlantis Country Club from 6-9 pm . Guests will enjoy a reception, networking and dinner along with an amazing array of talent from our local physicians in our 2nd Annual “Docs Got Talent Show”. Sponsorship opportunities range from $500 - $1000.
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Physician Well Being Symposium Saturday, October 19, 2019
In support of our commitment to physician well being, a continuing medical education program for physicians will be held on Saturday, October 19 at the Atlantis Country Club. Featured speakers will address the causes of physician burnout, strategies to reduce stress and burnout and promote work life balance. Limited sponsorships are available from $500 – $ 2,500.
PBCMS & Services 2019 Gala Saturday, November 16, 2019
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The 2019 Centennial Gala and Festival of Holiday Trees and Lights will be at the Kravis Center, Cohen Pavilion. The evening will honor president Marc Hirsh, MD, and welcome incoming president Larry Bush, MD. Sponsorship/Underwriting opportunities available ranging from $500-$10,000. For additional information, contact Katherine Zuber, 561-433-3940, ext. 123, firstname.lastname@example.org or Deanna Lessard, 561-433-3940, ext. 105, email@example.com.