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Bulletin Saginaw County Medical Society

Spring 2021 | Volume 79 | No 4

Register Now for May Annual Meeting 2021-22 SCMS Slate of Nominees p. 5 AMA Information Blocking Rules p. 9 MSMS 2021 Legislative Priorities p. 16 www.SaginawCountyMS.com

Cover Photo Courtesy of Jan Masica

Covenant Medical Group Cardiology MEET OUR HEART SPECIALISTS

Bashar Al Jayyousi, MD, FACC, FSCAI Interventional Cardiology

Umesh Badami, MD, FACC, FSCAI Interventional Cardiology

Mayar M. Jundi, MD, FACC Heart Failure Specialist

Bakri Kaakeh, MD Cardiothoracic Surgery

Loai F. Marouf, DO, FACC, FACOI Invasive Cardiology

Hossam Mustafa, MD, MSc, FACC, FHRS Electrophysiology

Mahir Sati, DO, FACC, RPVI, FANC, FASE Invasive Cardiology

Manoj Sharma, MD, FACC, FSCAI Interventional Cardiology

Michael Taipale, DO Cardiology

Pauline D. Watson, DO, FACC, FACP Clinical Cardiology

Anwar Zaitoun, MD, FACC, FSCAI, RPVI Interventional Cardiology

Covenant Medical Group Cardiology has exceptionally well-trained cardiologists and cardiothoracic surgeons, offering the region’s most comprehensive heart program with the latest medical innovation in cardiac diagnosis and treatment. CONTACT: 989.583.4700 Tel • 866.800.0995 Toll Free CovenantCardiology.com Bus. Dev. (AQ/RF) Rev. 7/20 13352


Bulletin Saginaw County Medical Society

2020-2021 OFFICERS AND DIRECTORS President Mildred J. Willy MD

contents 5 9

President-Elect Anthony M. Zacharek MD Past President Julia M. Walter MD Secretary Caroline G.M. Scott MD


Treasurer Miriam T. Schteingart MD

REGISTER NOW FOR MAY 18th ANNUAL MEETING 2021-22 SCMS Slate of Nominees AMA Information Blocking Rules *MSMS Health Law Update Ask MSMS Legal Counsel: Requiring COVID-19 Vaccination

Board of Directors


Keep a COVID-19 Diary: Document Now in Case of Future Lawsuits (TDC)

16-19 23

MSMS 2021 Legislative Priorities

SafeHavenTM Resources for Physicians & Health Care Providers to Manage Stress and Burnout

Jorge M. Plasencia MD


President-Elect’s Letter


Ascension St. Mary’s

Harvey K. Yee MD


From the Editor


In Memory

Elizabeth A. Paulus MD


Barb Smith SR&RN


Birthdays – May and June

Furhut R. Janssen DO


CMU College of Medicine CMU Health


Key Provider of the Month Ascension St. Mary’s Orthopaedics & Sports Medicine


Julia M. Walter MD


Covenant HealthCare

Mildred J. Willy MD


Tiffany K. Kim MD Mark G. Greenwell MD

Bulletin Editor Louis L. Constan, MD Resident Representative Anushka N. Magal MD MSMS Delegates Elvira M. Dawis MD

Anthony M. Zacharek MD Jorge M. Plasencia MD Christopher J. Allen MD Miriam T. Schteingart MD MSMS Alternate Delegates



Free Confidential Counseling

A New Day for Diabetics


Advertiser Index


Register Now for May 18th Annual Meeting

Caduceus Meeting for Recovering Health Care Professionals The Bulletin can be viewed online at www.SaginawCountyMS.com under the Bulletin tab.

Caroline G.M. Scott MD


Waheed Akbar MD Mohammad Yahya Khan MD Virginia R. Dedicatoria MD Steven J. Vance MD Joseph P. Contino MD Kristine K. Spence DO Karensa L. Franklin MD Scott E. Cheney MD Michael W. Warren MD Peer Review Ethics Committee Waheed Akbar, MD, Chair Caroline G.M. Scott, MD James R. Hines, MD MSMS Region 7 Director Thomas J. Veverka, MD Executive Director Joan M. Cramer Administrative Assistant Keri Benkert

EDITOR Louis L. Constan, MD EXECUTIVE DIRECTOR Joan M. Cramer DESIGNER Lori Krygier

PUBLISHER Saginaw County Medical Society 350 St. Andrews Rd., Ste. 242, Saginaw, MI 48638-5988 Telephone (989) 790-3590 | Fax (989) 790-3640 Cell (989) 284-8884 | jmcramer@sbcglobal.net Hours By Appointment | SaginawCountyMS.com

All statements or comments in the Bulletin are those of the writers, and not necessarily the opinion of the Saginaw County Medical Society. Contributions are welcome. We publish committee reports, letters to the editor, Alliance reports, public health activities of the members, and some personal items (birthdays, weddings, graduations and like events). The Editor determines which are accepted. Advertisements are accepted as space is available at our going rates. Members may advertise office information, professional services, skills, and procedures, also at our going rates. We do not accept advertisements from nonmembers, or non-Saginaw hospitals. The Bulletin is mailed free of charge to SCMS members as part of their membership. Complimentary copies are sent to various other parties. Others may subscribe at the rate of $50 per year.

The Bulletin | Spring 2021 3


Process Improvement in Health Care Anthony M. Zacharek, MD MHA From the Executive Director Due to the pandemic, the SCMS did not have an annual meeting in 2020 at which time the President-Elect would have taken office, and new officers, directors, delegates and alternates would have been elected. The 2019-2020 board graciously agreed to extend their service for an additional year. Dr. Millie Willy continues as President until the May 2021 annual meeting when Dr. Tony Zacharek takes office. Drs. Willy and Zacharek are sharing responsibilities until that time, with Dr. Zacharek agreeing to write articles for The Bulletin. We thank all of our leaders for their extraordinary service during a very difficult time.


n March 27, 1977, two Boeing 747 passenger jets, operating KLM Flight 4805 and Pan Am Flight 1736, collided on the runway at Los Rodeos Airport on the Spanish island of Tenerife. Resulting in 583 fatalities, this accident is the deadliest in aviation history. (Wikipedia, 2021) This airline disaster in 1977 is an example of how errors can occur in any industry. The pilot of the KLM flight spoke Dutch, the plane was leaving an area where the air traffic control operators spoke Spanish, it was a foggy day where visibility was low, and the KLM pilot was in a rush to get the airplane off the ground to avoid a delay in departure. All these events culminated in the disaster that led to 583 deaths, when the KLM airliner crashed into the Pan Am airliner which was still on the ground and hadn’t taken off, something the KLM

pilot did not realize because of poor visibility, language barrier to effective communication, and a rush to get the airplane into the air. The March 1977 airline disaster illustrates an important principle in process improvement called the Swiss cheese model of accidents. This model illustrates that, although many layers of defense lie between hazards and accidents, there are flaws in each layer that, if aligned, can allow the accident to occur. The Swiss cheese model of accidents can be applied to health care, and has shown how an error can pass through a health care system from one layer of protection through another, until an error occurs. An example of the Swiss cheese model in health care is a lab result that is abnormal, and the lab, doctor, nurse and office staff do not notify the patient. What may have been quickly corrected, for example a high potassium level in the blood, is left untreated for days, and the patient

may suffer a poor outcome, such as cardiac arrest. Process improvement in health care can be applied to any system that can benefit from more efficiency, higher quality care, lower costs and greater patient safety. These values in health care affect every aspect of health care, which is why process improvement in health care is so important. Two important and well known process improvement systems that have been applied to health care are Lean and Six Sigma. Both systems aim to improve health care outcomes by improving the process of caring for patients, and seeking to achieve minimal to zero patient harm. According to Thomas Zidel, the process improvement tool known as Lean creates a customer-focused culture that was derived from the Toyota Company. Lean is a system that aims to make every aspect of a business work in harmony for continued on page 5

The Swiss cheese model of accidents can be applied to health care, and has shown how an error can pass through a health care system from one layer of protection through another, until an error occurs. 4

The Bulletin | Spring 2021


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REGISTER NOW! The SCMS ANNUAL MEMBERSHIP MEETING and the SCMS FOUNDATION ANNUAL MEETING will be held concurrently via Zoom on Tuesday, May 18, 2021, at 7 p.m. Please register online at https://www.surveymonkey.com/r/SCMSAnnualMtg The Zoom link will be emailed to all of those who register.

the benefit of its customers (patients). Lean is a system that produces quality products, recognizes employees as the organization’s greatest asset, and constantly pursues perfection in everything that the organization does. (Zidel, “Lean Done Right”, 2012) While I will not get into all the details of Lean in this article, suffice it to say that it represents a great process improvement tool that many healthcare systems have used to improve patient care outcomes and to attempt to achieve zero patient harm. As physicians, we may all be able to relate to incidents either in our training or in our practice where a bad patient outcome may have been prevented if a mistake were caught earlier or avoided. According to a recent article, studies of medical errors have estimated errors may account for as many as 251,000 deaths annually in the United States, making medical errors the third leading cause of death. (Anderson & Abrahamson, Stud Health Technology Informatics, 2017) Statistics like this are scary and should be motivation for all physicians to seek ways to improve the processes of our institutions in ways that lead to better outcomes for all patients. In our current healthcare environment, process improvement can be applied to many areas including ways to efficiently distribute the COVID-19 vaccine, ways to improve efficiency in the operating room, and ways to deliver high quality care at lower costs, just to name a few. The more we as physicians begin to speak about ways to improve the healthcare systems in which we work, the more our healthcare systems and our communities will benefit.

The following, and more, will be on the Agenda: • The Slate of Nominees for 2021-22 will be voted on at the meeting and via electronic vote prior to the meeting. (see below) • Approval of updated and amended Foundation Bylaws. In 2019, the Foundation Bylaws were reviewed and revised to not only bring them up-todate as they were written over 50 years ago, but also to increase the size of the Board of Directors. The proposed Bylaws will be voted on at the meeting and via electronic vote prior to the meeting. o View the original 1968 Bylaws by clicking HERE. o View the proposed Bylaws by clicking HERE. o The Bylaws are also available on the SCMS website under the FOUNDATION tab www. SaginawCountyMS.com • Update on the CMU College of Medicine. Contingent on pandemic conditions, we tentatively hope to have in-person meetings on Tuesday, September 21 and Tuesday, October 19. Keep an eye on your inbox and The Bulletin for details when available. Questions? Contact Joan Cramer at jmcramer@sbcglobal. net (preferred method) or (989) 284-8884 (please leave message if I’m unable to answer).

SCMS SLATE OF NOMINEES FOR 2021-22 The following Slate of Nominees for 2021-22 was approved by the SCMS Board of Directors on Tuesday, April 20, 2021. The Slate will be voted on by the membership at the virtual Annual Membership Meeting on Tuesday, May 18, 2021. President

Anthony M. Zacharek MD


Tiffany K. Kim MD

Past President

Mildred J. Willy MD


Caroline G.M. Scott MD


Miriam T. Schteingart MD

Board of Directors

(Three year in line for presidency) Mark G. Greenwell MD Elizabeth A. Paulus MD Furhut R. Janssen DO

Board of Directors

(One year) Harvey K. Yee MD Mary J. McKuen MD Kai Anderson MD

MSMS Delegates Elvira M. Dawis MD Julia M. Walter MD Mildred J. Willy MD Anthony M. Zacharek MD

Christopher J. Allen MD Miriam T. Schteingart MD Kala K. Ramasamy MD Jennifer M. Romeu MD

MSMS Alternate Delegates Caroline G.M. Scott MD Waheed Akbar MD Mohammad Yahya Khan MD Steven J. Vance MD

Karensa L. Franklin MD Judy V. Blebea MD Elizabeth M. Marshall MD Nicholas E. Haddad MD

Peer Review Ethics Committee James R. Hines MD Waheed Akbar MD Chair Caroline G.M. Scott MD

The Bulletin | Spring 2021 5


Sisters By Louis L. Constan, MD


ast month, we celebrated Women’s History Month. My own family, which includes six sisters; a remarkable wife and daughter; many granddaughters, great nieces, and female cousins, is especially blessed to have the contributions of its female members. I applaud them all. I applaud my woman practice-partner and my two women mid-levels. I applaud the contributions, as I endeavored to be your Editor of this publication, of another woman, Joan Cramer, the real brains behind “The Bulletin,” and everything else that goes on with the Saginaw County Medical Society.1 The contribution of women to my life personally and professionally, over the years, has been immense. Now is high time we honor them. In our larger society, women have made their mark everywhere. Up to and including the Vice-Presidency of our nation. It seems somehow surreal, therefore, that you hear so much about women being mistreated by men. Our own governor was once raped. Secretaries are groped. Prominent celebrities come forward daily with stories of sexual misconduct, belittlement, discrimination, abuse. Women fighting for our country are raped by their very commanding officers.

Our own Underground Railroad is full of women fleeing abuse by their significant others, the fathers of their children. Shame on the men who perpetrate these injustices! Though I’d like to think that male physicians are not among those who harm and denigrate, certain inconvenient stories keep popping up of which we should be aware. Female doctorsin-training (medical students and residents) being subjected to “locker room” talk, lewd remarks, solicitations, unequal treatment compared to male trainees, and missed chances for advancement. Even more subtle sexist treatment, women colleagues say, can be demoralizing, and its day-in, dayout quality can damage promising careers. I would like to think that I myself have always treated men and women colleagues equally at all times, but I have to admit that I may not have always done so. Apologies are in order. Nevertheless, could it be that the stories you hear about sexual misconduct, discrimination, etc., are just isolated incidents, the exceptions that prove the rule? Could it be that, overall, the physician community customarily does treat men and women alike? As Benjamin Franklin would say, the proof is in the pudding. In other words,

we must look at how exactly the house of Medicine is constructed in actuality… then decide if, indeed, women are treated as well as their men colleagues. First, distribution within specialty organizations. Are women represented in equal numbers within the more rarified, prestigious, difficult-to-getinto and more well-paying surgical specialties? If our profession were gender neutral, if we treated women equally and fairly, we would have equal numbers of women in each and every specialty organization, wouldn’t we? But, that’s clearly not the case. The less lucrative specialties are where the women are: Family practice, pediatrics and obstetrics. The better paid specialties are populated by men. The proof is in the pudding. So: inequality. Second, teachers in our medical schools and residencies at all levels up to Deans and Directors of Residency programs. These are important positions. Not only because of prestige, but because they influence the next generation of physicians and are well compensated. If the House of Medicine practiced gender equality, these positions would be close to 50/50 men/women. Not the case in Michigan medical schools. Inequality. continued on page 7

I applaud the contributions, as I endeavored to be your Editor of this publication, of another woman, Joan Cramer, the real brains behind “The Bulletin,” and everything else that goes on with the Saginaw County Medical Society.1


The Bulletin | Spring 2021

continued from page 6

Third, physician administrators in hospitals, health care organizations and insurance companies. These positions are not always filled by physicians, but when they are, the physician is usually a male. These positions are well paid, which is always important and a fairness issue; but, perhaps more important, these doctors actually make policy decisions that affect the practice situations of myriad other physicians. The majority of these administrators are men, and we might question if they can reasonably represent the interests of half of the physician population which is female. If they are mostly men, then is there not some bias somewhere in the system? Again, inequality. Fourth, physician-scientists, scientific research company directors and administrators. Again, these are corporate jobs and carry high salaries (the fairness issue), but also have influence over the larger way physicians practice medicine. These male doctors set the research agenda for the country and may be the reason why women are underrepresented in double-blind research studies; as well as, the dearth of studies on traditional women’s issues such as contraception and abortion. Further inequality. Fifth, and perhaps most important. The biggest influencers in our society are politicians. The United States Congress currently has 15 physician members, who certainly have an outsized influence when said Congress considers health legislation (1/5th of our economy and always on the docket). And how many of those physicians are women? Zero. The ultimate inequality! Let’s MAKE history and actually encourage and support women physicians in all these roles! For regular readers of this column: You may enjoy “Two Minds, Your Body,” which contains some of my favorite articles. You can get it by typing “Louis Constan Book” into any search engine. 1 It’s important to point out the SCMS has a rich history of involvement by women physicians in leadership roles.

All statements or comments in The Bulletin are those of the writer, and not necessarily the opinion of the Saginaw County Medical Society.

If you find it difficult to communicate with your doctor; if you find it hard to get personal attention from an 'impersonal healthcare industry'; if you don't understand all those insurance-company rules; if you don't know how to change your bad health habits; if you think you may be on unnecessary medications; if you are perplexed by those annoying health-product advertisements; and if you'd like to know which are your greatest health risks - you'll appreciate this Family Doctor's advice, gleaned from 44 years of practice. 1 Each chapter is illustrated with real-life examples from his and other doctors' practices. Each chapter ends with 'bonus' essays written by the author and published in newspapers and magazines giving the doctor's viewpoint. This will give you a unique perspective and allow you to 'get into the mind' of a doctor. Sweet! Available on Kindle (different cover but same book) and paperback. Available on Amazon by clicking HERE

www.SaginawCountyMS.com The Bulletin | Spring 2021 7

Michigan Suicide Prevention Commission Report Makes Lowering Suicide Rate a Priority, Offers Recommendations Someone dies by suicide every six hours in the state With someone dying by suicide every six hours in the state, the Michigan Department of Health and Human Services (MDHHS) released a report that makes recommendations on how to reduce the suicide rate. The Michigan Suicide Prevention Commission Initial Report is from a group appointed by Gov. Gretchen Whitmer in March 2020 which includes Barb Smith. “In Michigan, anyone who needs help should be able to get it,” said Gov. Whitmer. “This task force will do critical work to collect data, expand resources, and implement best practices so we can save lives. We must work together to reduce suicide rates in Michigan and make sure that everyone knows that it’s OK to not be OK and help is always here.” The recommendations address the Commission priorities of: • Minimizing risk for suicidal behavior by promoting safe environments, resiliency and connectedness. • Increasing and expanding access to care to support Michiganders who are at-risk. • Improving suicide prevention training and education. • Implementing best practices in suicide prevention for health care systems. • Enhancing suicide-specific data collection and systems.


The Bulletin | Spring 2021

The Commission has been charged to work with state departments, nonprofit organizations and universities to research the causes and possible underlying factors of suicide in the state. Provisional 2020 data for Michigan shows 1,282 suicide deaths. That number is expected to increase as more suicide reports are finalized. In 2019, there were 1,471 suicides in Michigan. Suicide is the 10th leading cause of death in Michigan. In 2017, more than four times as many people died by suicide in Michigan than by alcohol-related motor vehicle accidents. The report notes that MDHHS has taken steps to address mental health issues that could be worsened by the COVID-19 pandemic. This has included providing mental health and substance use services, as well as, emotional support resources. These resources can be found at michigan.gov/StayWell. Anyone who needs help can call the National Suicide Prevention Lifeline 24 hours a day, seven days a week, at 1-800273-8255 or 1-800-273-TALK. Press 1 for the Veterans Crisis Line. Anyone under age 21 can ask to talk to a peer at Teen Link, 1-866-833-6546. TTY users can use their preferred relay services or dial 711 then 1-800-273-8255. Are you in a crisis? Call 800-273-8255 or text TALK to 741741

Information Blocking Rules: What You Need to Know and Where to Get It Last year, the Office of the National Coordinator for Health Information Technology (ONC) released a rule implementing provisions of the 21st Century Cures Act requiring physicians to comply with new regulations on the access, exchange and use of patients' electronic health information (EHI). Information blocking is defined as practices that are likely to interfere with, prevent, or materially discourage the access, exchange or use of EHI. Physicians, hospitals, electronic health record (EHR) vendors, health information exchanges (HIE) and health information networks (HIN) are all subject to ONC's rule and are collectively referred to as "Actors." Actors whose actions are likely to interfere with the access, exchange, or use of EHI could be considered information blockers and subject to penalties or disincentives. EHR vendors and HIE/HINs can receive up to $1 million in civil monetary penalties per violation. Penalties and other "disincentives" for physicians and other health care providers have yet to be determined by the U.S. Department of Health and Human Services (HHS). However, physicians participating in the Promoting Interoperability (PI) Program could see an impact to their Centers for Medicare and Medicaid Services Merit-based Incentive Payment System (MIPS) incentives if they are found to be information blockers. The AMA is urging HHS to refrain from creating any new or additional physician penalties. The AMA is also engaged with the Administration to address concerns that HHS' rule forces physicians to release office notes and test results prior to physicians reviewing the information with the patient. The AMA is working to reduce the complexity and costs required to comply with these new regulations. Two-Part Educational Resource Actors are required to comply with ONC's information blocking regulations starting April 5, 2021. To help meet the new requirements, the AMA has created a two-part educational resource to help physicians and their medical practices understand the requirements and develop an information blocking compliance program. Part 1 outlines what information blocking is, key terms to know, examples of information blocking practices and a summary of exceptions for when physicians may restrict the access, exchange or use of EHI. Part 2 will help physicians start down the path of compliance, including questions to consider, considerations

for maintaining a compliance program and next steps. The new rules also regulate your EHR vendors and restrict them from blocking information. Your EHR vendor is prohibited from blocking your access, exchange, or use of medical information through contractual, technical or financial limitations. This could include, but not limited to, excessive fees charged by your vendor to connect to the local HIE, contracts limiting your ability to send information to a clinical data registry, or implementing proprietary technology in a way that prevents you from exporting reports, connecting to diagnostic facilities or switching EHR vendor products. Like all Actors, EHR vendors must comply with these regulations by April 5, 2021. Information blocking not only affects patients but also physicians; you should reach out to your EHR vendor to discuss what they are doing to come into compliance. The AMA will continue to update these resources as the federal government releases new guidance. Below are several additional resources to help navigate the regulations: • ONC webinars • ONC fact sheets • Information Blocking Resource Center for physicians and other providers • Information on how to file a complaint on information blocking Actors—EHR vendors or otherwise (Report Information Blocking)

New MSMS Health Law Update on Information Blocking Rule MSMS Legal Counsel created a new resource to help physicians and their practices comply with the 21st Century Cures Act (the “Cures Act”) and related final rule on Interoperability, Information Blocking, and the ONC Health IT Certification Program (the “Final Rule”). The Cures Act and its administrative rules regulate healthcare providers (including physicians in private practice and their medical practices), HIT developers of certified health IT, health information exchanges and health information networks. To read the Health Law Update, CLICK HERE. Log-in is required. Click on LEGAL and scroll down to the last item - ONC Cures Act Information Blocking Final Rule, published March 16, 2021. The Bulletin | Spring 2021 9

ASK MSMS LEGAL COUNSEL: REQUIRING COVID-19 VACCINATION By Daniel J. Schulte, J.D. QUESTION: Despite the fact that the vaccine has been made available to all my employees, at this point a couple of them have refused to get it. Other employees say that they have been vaccinated but I wonder if I am being told the truth. I was told I should not be asking whether an employee has been vaccinated and that I cannot terminate the employment of an employee who refuses to be vaccinated. Is this true? Can I require proof that an employee has been vaccinated? Can I terminate employees or place them on leave if they refuse to be vaccinated? ANSWER: You have been given incorrect or outdated information. On December 16, 2020, the U.S. Equal Employment Opportunity Commission (“EEOC”) issued guidance for employers regarding COVID-19 vaccination. One thing the EEOC’s guidance makes clear is that it is legal to ask an employee whether he/she has been vaccinated and to require proof of the vaccination. Generally, the EEOC guidance states that a healthcare employer with a valid job-related reason can require an employee to receive a COVID-19 vaccine as a condition of employment. However, there are two exceptions. The first apples to employees who are unable to receive the vaccine due to a disability recognized by the Americans with Disabilities Act. The second applies to employees having a “sincerely held religious practice or belief” (as contemplated by Title VII of the Civil Rights Act) preventing them from being vaccinated. Employers are also entitled to ask questions regarding an employee’s disability to make a reasonable determination that a recognized disability exists. An employee’s generalized claims of “chemical sensitivities, allergies and the like” has been held by one federal appellate court in a recent case to not constitute a disability under the Americans with Disabilities Act. These inquiries must be job related and consistent with business necessity. Generally, prior to excluding an employee with a recognized disability preventing him/her from receiving the vaccine, the employer must determine that the unvaccinated employee would pose a direct threat due to a significant risk of substantial harm to the health or safety of the employee or others that cannot be eliminated or reduced by reasonable accommodation. In a medical practice setting, such reasonable accommodation might include requiring the unvaccinated employee to wear a different type and grade 10 The Bulletin | Spring 2021

PPE that vaccinated employees are no longer utilizing. All determinations of what reasonable accommodations will be made for an employee unable to receive a vaccination due to a disability should be made on a case-by-case basis. An employer is similarly required to accommodate employees who have a sincere religious belief that prevents them from being vaccinated, unless doing so would be an “undue hardship.” This undue hardship standard is less stringent than the standard used for determining a reasonable accommodation for an employee with a disability, requiring only that the employer show that providing an accommodation imposes “more than a de minimis cost or burden on the employer.” Again, in a medical practice setting, such an accommodation might include requiring the employee to continue to utilize PPE that vaccinated employees are no longer utilizing. The EEOC guidance states that employees who are not vaccinated due to a disability or a sincerely held religious belief and that cannot be reasonably accommodated may be “excluded” from the workplace. Excluded does not mean only terminated. If an employee can perform his/her job functions remotely, this possibility must be considered. Obviously, in a dental practice setting, remote work is not going to be a possibility for many employees (e.g., hygienists, assistants, dentists, etc.). Employees who do not have a disability or sincerely held religious belief preventing them from being vaccinated are currently not subject to the protection of any law that would prevent them from being disciplined or terminated for their refusal to be vaccinated and/or providing proof of vaccination when requested by an employer.

Legal Services from MSMS MSMS members can access MSMS Legal Counsel by contacting the MSMS Health Care Delivery Department at (517) 336-5723 or (517) 336-5766. General legal questions on a variety of issues of concern to physicians statewide (e.g., medical record retention, medical records charges, privacy issues, Stark, etc.) are answered for FREE as a benefit of MSMS membership. Please note, if the scope of the inquiry requires more than general legal assistance/clarification or if individual representation is needed, MSMS Legal Counsel and the MSMS member would discuss options, including charges, before proceeding.

Dean’s Message: Match Day 2021 and Commencement The mission of the College of Medicine is to educate diverse students and train culturally competent physicians to provide comprehensive care to underserved populations (both rural and urban) in Michigan and beyond. We see our mission fulfilled each March with Match Day, the day when medical students across the nation learn where they will conduct their residencies. Friday, March 19, was Match Day, with 90 CMU College of Medicine students participating in the process. • 61% of our students matched to primary care residencies • 47% of our students matched within the state of Michigan • Five students matched with the CMU Medical Education Partners residency programs in Saginaw o Carmen Avramut – Psychology/MIDOCS o Ryan Guthrie – Emergency Medicine o Danielle Hebert – General Surgery o Trusha Patel – Psychology o Kyla Walworth – Ob/Gyn • Three students matched to our branch campus at Ascension St. John Hospital in Detroit. o Rabia Mahmood – Internal Medicine o Raghuram Palepu – Internal Medicine o Tamara Siblini – Ob/Gyn Our medical students take with them lessons learned on the front lines of a global pandemic - experiences that will shape their residencies and the remainder of their careers. As they voluntarily staffed testing and vaccination clinics, the students confirmed their capacity for compassionate care, and they witnessed how public health infrastructure and science-based community health measures have direct implications for patients’ lives. Their successful navigation of this national health crisis is a testament to our mission and their commitment to advancing health care for all people. As we move forward toward Commencement, I am pleased to announce CMU is planning an in-person, outdoor ceremony for May 7, 2021, for the Classes of 2020 and 2021 College of Medicine students. Though audience capacity will be limited, a livestream of the ceremony will be available for those unable to be physically present.

I am incredibly proud of our students, faculty and staff whose determination and resilience brought the College of Medicine through a turbulent year. Thank you for your patience, your dedication and your steadfast support of one another. Sincerely, George E. Kikano, MD CMU Vice President for Health Affairs Dean, CMU College of Medicine  

Student Spotlight

Michael Megaly, Sterling Heights, matched into General Surgery at the University of Minnesota. “The past four years have been the most exciting, rewarding, humbling, and eye opening years I have ever experienced. I’m looking forward to this next phase of my life and continued education in residency. I would have never made it this far without my faith, family, and friends, so thank you all!”

CMU Pediatricians Lead the Way in COVID-19 Research for Children $1.5M in federal grants awarded to diagnose and manage severe illness Pediatrics professors in CMU’s College of Medicine are researching a method to fundamentally change the diagnosis and management of severe COVID-19 related illness in children using saliva samples. The study is one of only eight in the nation funded by the National Institutes for Health to develop approaches for identifying children at high risk for Multisystem Inflammatory Syndrome in Children (MIS-C), a rare and severe after-effect of COVID-19 or exposure to the virus that causes it. Usha Sethuraman, MD, co-principal investigator, professor of pediatrics at the CMU College of Medicine, and University Pediatricians emergency department physician at the Children's Hospital of Michigan, and her team are studying the role of salivary biomarkers known as miRNA, cytokines (indicators of inflammation), plus Artificial Intelligence to develop a predictive model of severe COVID-19 disease. "If proven effective, this will be a game-changer because this model could be used in health care settings to identify continued on page 13

The Bulletin | Spring 2021 11


Ascension Medical Group Orthopaedics & Sports Medicine Joint care personalized for you Age, arthritis and injury are all possible reasons for joint pain. Living with joint pain can stop you from enjoying the things you love. Our orthopaedic and sports medicine specialists treat a variety of conditions and injuries so you can get back to living your life with less pain. They work with you to create a comprehensive care plan for your specific condition and needs. They utilize a range of treatments from nonsurgical options to same-day surgery and minimally invasive procedures to advanced surgical techniques. Because each patient’s journey and time to heal are different, they also provide personalized physical therapy plans.

Meet our specialized orthopaedic and sports medicine team

Waheed Akbar, MD

Angel Bermudez, MD

Nathan Krebs, DO

Kevin Lawson, MD

Specialized in treating: • Advanced surgical techniques including Mako TM robotic-arm assisted surgery

David Lemos, MD

Laura Reitz, DPM

Tarek Taha, MD

Pervez Yusaf, MD

Our sports medicine doctors and care teams will design a comprehensive care plan for specific injuries and needs. Your personalized treatment plan may include a combination of: • Medical treatments

• Spine surgery

• Concussions

• Foot and ankle surgery

• Revision hip, knee and shoulder replacements

• Arthroscopic surgery

• Advanced surgical options

• Acetabulum (hip socket) and pelvic fractures

• Sports injuries - operative and nonoperative

• Outpatient minimally invasive procedures

• Trauma including complex fracture care, malunions, nonunions

• Shoulder surgery • Fractures and sprains • Complex joint fractures • Dislocated joints and joint pain

• Sports rehabilitation, strength • Performance psychology and training and conditioning nutrition counseling

Meet our advanced practice providers

• Arthritis • Carpal tunnel syndrome • Trigger finger • Ganglion cysts and painful swelling • Nerve pain and muscle weakness • Tendon conditions and more

Toby Blosser, MS, AT, ATC

Molly Bonnington, NP

Tiffany Wirtz, NP

Saginaw 4677 Towne Centre Road Second Floor Saginaw, MI 48604 t 989-790-6719 f 989-497-3128

To make a referral, call our office at 989-790-6719.

Ascension Michigan

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those children most likely to develop severe COVID-19 related disease," Dr. Sethuraman said. "University Pediatricians serves the inner-city population of Detroit, one of the areas hit the hardest by COVID-19 in Michigan. We have an opportunity to dramatically improve the care and long-term outcomes of these children."

Investigators want to see if there is a difference in the levels of salivary miRNA and cytokines in children with severe infection compared those with mild cases of the disease. The research study was funded through the NIH Eunice Kennedy Shriver National Institute of Child Health and Human Development. The grant is awarded in two phases, providing $735,449 for the first year and, based on funding availability, $698,020 in the second year.

While COVID-19 has impacted adults more than children, MIS-C does occur in children exposed to COVID-19. More than 1,500 children in the U.S. have developed MIS-C, and some have required critical care. In severe cases, MIS-C has caused heart dysfunctions with long-term implications. Dr. Sethuraman said that early recognition is the key to successfully managing the disease and ensuring positive outcomes. "For a health care provider, it is difficult to distinguish the one child who is going to develop severe disease," she said. "All of the current screening tools lack sensitivity and specificity, and those tests involve blood draws. The model we are researching is completely non-invasive, requiring only two saliva samples." Artificial Intelligence also will be used in the predictive model to integrate a child's social, demographic, clinical and laboratory data, along with miRNA and cytokines from the child's saliva. One of miRNA's functions in the body is to regulate the inflammatory process in response to infection.

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The Bulletin | Spring 2021 13

Keep a COVID-19 Diary: Document Now in Case of Future Lawsuits Debbie Kane Hill, MBA, RN, CPHRM, CPPS

What the future holds relative to the evolution of COVID-19 remains unknown, but it is certain that litigation for COVIDrelated claims is on the horizon and will impact physicians in all medical specialties and practice models. According to attorney John E. Hall Jr., founding partner of Hall Booth Smith in Atlanta, Georgia, which specializes in defense of high-exposure cases involving hospitals and medical malpractice claims, COVID-19 claims are looming in the next one to three years. Mr. Hall addresses the most important questions and provides his expert guidance. Are there existing medical liability protections in place? The Public Readiness and Emergency Preparedness Act (PREP Act) provides a significant safeguard for physicians. The PREP Act provides complete preemption, meaning that “any state law or other federal law that contravenes the PREP Act is replaced by the PREP Act. Except in cases of death or severe injury caused by willful misconduct, the PREP Act provides complete immunity, with no liability under those circumstances” if the claim is COVID-19 related and the case is tried in the federal court system, according to Mr. Hall. In addition to the PREP Act, states have established some level of

immunity for medical practices through healthcare immunity orders or executive limited liability orders. What types of claims are anticipated? It is expected that COVID-driven claims will take a variety of forms. Some claims may allege: • Delayed or missed diagnosis due to lack of patient follow-up • Failure to triage/assess including testing issues, resulting in missed COVID-19 diagnosis/intervention • Failure to immunize • Delayed care in office visits, testing, labs and procedures • Failure to adhere to infection control protocol and/or lack of PPE • Limited healthcare resources (hospital beds, ventilators, etc.) What steps can physicians take now to prepare to defend claims in the future? Mr. Hall suggests that one of the best ways to establish defense of these claims is for practices to begin developing continued on page 15

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a timeline/diary now describing how COVID-19 events unfolded within their specific practice and community. Some considerations may include: • Was your practice ever unable to obtain PPE? • What was the infection rate within your community at a given time? • Did you follow infection control protocols per Centers for Disease Control and Prevention (CDC) guidelines? If so, what were those guidelines at the time? Documenting these items now ensures information is captured in its most accurate form, rather than trying to reestablish the facts years later. This information will not appear in patient medical records, yet it paints the landscape as to how the practice adapted to a very volatile crisis. It will form the foundation for your defense. Crucially, he adds, “It is important to note that this information should be gathered at the direction of an attorney, peer or quality committee so as to protect the information from discovery.” Appoint a practice historian who is responsible for developing and keeping the timeline up to date and well documented. This can be a physician, practice manager or risk manager, but it should be someone familiar with the overall operations of your COVID-19 response who will reliably


of mid-Michigan’s well-established medical community. Our highlyexperienced, sub-specialized radiologists are the region’s trusted leaders for professional diagnostic and interventional services.

maintain the timeline from start to finish. To provide guidance on what types of items to document, The Doctors Company provides a sample checklist of important record-keeping elements and recommends keeping this in an administrative diary. 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. 10/20


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The Bulletin | Spring 2021 15

MSMS 2021 LEGISLATIVE PRIORITIES The following are the legislative issues we are prioritizing in 2021. The majority of our resources and efforts will be dedicated to action on these issues.

Prior Authorization and Step Therapy Reform

Team-Based Care/ Scope of Practice

The prior authorization process diverts valuable resources away from direct patient care, can delay the start or continuation of necessary treatment, and can negatively impact patient health outcomes. Step therapy, also known as fail first, is another practice that disrupts patient care by requiring patients to try other therapies before being approved for the treatment that their doctor originally prescribed. MSMS will work closely with the Legislature, regulators and stakeholders on ways to streamline, standardize and make the prior authorization and step therapy process more transparent, clinically appropriate, and evidence based.

Patients are best served by a teambased approach that provides the maximum amount of choice for their care while ensuring that they benefit from the additional training and expertise having a physician on the team. A highly functioning health care team is the best way to serve patients while addressing the other access issues, not legislation that creates silos. MSMS will continue to promote the role of the physician as the leader of the health care team and oppose any efforts to expand allied health professionals scope of practice that may put patients at risk.

POLICY OBJECTIVE: Reform prior authorization and step therapy with a focus on clinical validity, continuity of care, transparency and fairness, and timely access and administrative efficiency.

and safety of patients by opposing efforts of health care practitioners to seek licensure or recognition to perform tasks or procedures for which they lack the education, training or experience.

cine parity for payment and services.

ACTION: Proactively promote phy-

ACTION: Advocate for legislation that

sician-led, team-based care efforts, including holistic approaches to scope of practice and licensure that meaningfully address care.

ensures payment and service parity for the use of telemedicine services in clinically-appropriate scenarios.

ACTION: Advocate for legislation to

reform prior authorization and step therapy, including efforts that promote transparency, appropriate clinical decision-making, and timely processing of requests.

POLICY OBJECTIVE: Protect the health

The Bulletin | Spring 2021 // FEBRUARY michigan 14 14 16michigan MEDICINE® MEDICINE® || JANUARY JANUARY FEBRUARY2021 2021

Telemedicine While telemedicine provided an avenue for health care providers to safely treat patients during the COVID-19 pandemic, it has proven to be an effective care delivery method that ensures convenient and timely access to patients. Further, regardless of whether a patient receives care in-person or virtually, the standard for medical care does not change. Before the outbreak of COVID-19 insurers previously covered telemedicine visits to varying extents, however, there were often obstacles such as low reimbursement, restrictions on where the patient can be located, and types of services covered. While payers did respond by removing some of the regulatory and administrative burdens during the pandemic, these policies are now reverting to pre-pandemic times. POLICY OBJECTIVE: Achieve telemedi-

Graduate Medical Education

Auto No-Fault Reform

Studies repeatedly demonstrate that one of the best ways to recruit and retain physicians is via local medical schools and residency programs. Graduate Medical Education (GME) helps fill the gap in under-served areas by providing extremely low-cost care to those most in need. Michigan has been a leader in expanding medical school class sizes to address the projected demand for physician services, it is imperative that we continue to fund GME slots to allow these future physicians to learn here in Michigan, train here in Michigan, and stay here in Michigan.

Michigan was a leader in providing care to those injured in auto accidents by virtue of our no-fault statute. For 40 years, Michigan required drivers to purchase coverage in the event of a catastrophic injury. Unfortunately, in 2019, Michigan approved a sweeping change to the no-fault law, which will, among other things, have serious consequences for victims of car accidents who will need access to trauma and rehabilitation care. In addition, the new law will burden taxpayers by allowing the injured to be shifted to the Medicaid program, and it will also increase the uncompensated load and regulatory burden on physicians and facilities.

POLICY OBJECTIVE: Recruit and retain medical talent in Michigan through an emphasis on GME funding models that appropriately reflect the health care needs of the state.

POLICY OBJECTIVE: Pursue appropriate standards and criteria for utilization review through the Department of Insurance and Financial Services’ (DIFS) rulemaking process, including procedures for: • Acquiring necessary records, medical bills, and other information concerning the treatment, products, services, or accommodations provided; • Allowing an insurer to request an explanation for and requiring a physician, hospital, clinic or other person to explain the necessity or indication for treatment, products, services or accommodations provided, and; • Appealing determinations. ACTION: MSMS will continue to work with its partners in the Coalition for Protecting Auto No-Fault (CPAN) on reforms that bring fairness to insurance rates, increase transparency, crack down on fraud, reduce lawsuits and lower health care prices for accident victims.

ACTION: Advocate for state funding for innovative initiatives, like MIDOCS, which seek to place high need specialties in underserved areas of the state.

michigan JANUARY JANUARY/ /FEBRUARY FEBRUARY 2021 | | michigan MEDICINE® MEDICINE® 15 The2021 Bulletin | Spring 2021 17 15

2021 MSMS LEGISLATIVE & REGULATORY PLATFORM The following provides an overview of some of the top issues that comprise the MSMS legislative and regulatory advocacy platform in 2021. These are the ongoing issues we are monitoring annually on behalf of our 15,000 physician members.

Insurance and Regulatory Advocacy Support mental health parity Advocate for adequately sized physician networks Regulate narrow networks Ensure appropriate access to telemedicine Advocate regulation of silent PPO/rental networks Reduce unnecessary administrative costs Ensure payment and service parity for telemedicine

Public Health and Prevention Restore Michigan’s helmet law Support vaccine availability and oppose efforts to weaken Michigan’s vaccine laws Reduce prescription drug diversion Promote policies advancing health equity goals Reduce childhood environmental hazards Support efforts to reduce unintended pregnancies Support school-based nutrition and exercise standards Reduce gun violence through health screening, patient counseling and expanded access to mental health services

Medicaid Seek funding parity with Medicare Oppose taxes that are limited only to physicians

Professional Liability Preserve existing tort reforms Advocate for higher negligence thresholds in medical liability cases Eliminate the lost opportunity doctrine Restore legislative intent of tort reforms related to meaningful caps on noneconomic damages Restore legislative intent of tort reforms related to court rules and procedures to level the playing field for physicians Seek pilot projects of medical courts and other non-judicial alternatives to the tort system


The Bulletin | Spring 2021

16 michigan MEDICINE®

Seek funding sources that are fair and sustainable Support state funding for the Healthy Michigan Plan Ensure access to physician-directed care

Insurance Contracting Reform


Limit retroactive audit timeframes Support adequate disclosure of fee screens Support appeals process that includes independent reviews Prohibit down-coding in purposes of determining medical necessity

Physician Supply and Training Increase graduate medical education funding at state level Minimize burden of medical school debt

Scope of Practice Support education over legislation as the means of increasing scope of practice Oppose independent prescriptive authority by non-physicians Support the physician-led, team-based approach to health care Support patient right-to-know/health professional credentials disclosure Advocate for liability relief for legislatively mandated standards of practice

2021 MSMS LEGISLATIVE ACTION AGENDA & STRATEGIES 2021 MSMS Legislative Action Agenda These specific items align with MSMS's legislative priorities. The majority of our resources and efforts will be dedicated to the following action items:

Strategies for Accomplishing Action Agenda Work closely with county medical societies, physician specialty societies, stakeholder groups and other partners to promote legislative agenda.

Advocate for legislation to reform prior authorization and step therapy, including efforts that promote transparency, clinically appropriate decision-making, and timely processing of requests.

Continue grassroots efforts on prior authorization and step therapy reform with the Health Can’t Wait Coalition.

Advocate for payment and service parity for the use of telemedicine.

Facilitate physician engagement with new lawmakers in 2021.

Advance health equity by advocating for policy changes necessary to support public health, address structural determinants of health, and reduce health inequities.

Meet regularly with lawmakers and staff to foster relationships, particularly leadership and health policy committees.

Advocate for expanded access to evidence-based, non-opioid therapies and evidence-based treatment for opioid addiction. Pursue legislation that makes maintenance of certification voluntary. Advocate for state funding for innovative health care workforce initiatives, like MIDOCs, which seek to place high need specialties in underserved areas of the state. Advocate for appropriate utilization review standards and criteria under Michigan’s new auto no-fault law. Proactively promote physician-led, team-based care legislative and regulatory efforts, including holistic approaches to scope of practice and licensure that meaningfully address care.

Facilitate physician lobbyist meetings.

Prioritize grassroots engagement, including: • Lansing Lobby Days • Doctor of the Day • Very Influential Physician (VIP) Advocate Program • In-district "Coffee Hour" lobby day Align MDPAC fundraising strategy with MSMS legislative agenda. Promote member usage of Engage website, including Action Center. Deploy targeted and meaningful Action Alerts to engage physician members on issues. Provide regular legislative updates to membership and county medical societies.

Oppose unfunded mandates that could—through additional financial or administrative hurdles— undermine physicians' ability to care for patients.

The Bulletin | Spring 2021 19


michigan michiganMEDICINE® MEDICINE® 17 17

Covenant Medical Group Welcomes This Month’s New Providers

More on the Covenant Breast Health Center at www. covenanthealthcare.com/ch/breast-health-center

Dr. Jahangir Khan Joins Covenant Hospital Medicine Covenant HealthCare welcomes Jahangir Khan, MD. His office is located at 1447 North Harrison, Saginaw, MI 48602 and the team can be reached at 989.583.4220. Dr. Sarala Masti Joins Covenant Medical Group- Family Medicine Covenant HealthCare welcomes Sarala Masti, MD, as a member of the Covenant Medical Group. Dr. Masti joins the Covenant Primary Care team. The office is located at 1910 Pine Avenue, Alma, MI 48801 and can be reached at 989.463.3101. Covenant HealthCare Recognized for Achieving NAPBC Accreditation The National Accreditation Program for Breast Centers (NAPBC), a quality program of the American College of Surgeons (ACS), has again granted three-year Accreditation to Covenant HealthCare. To achieve voluntary NAPBC accreditation, a breast center demonstrates compliance with the NAPBC standards that look at a center’s leadership, clinical services, research, community outreach, professional education and quality improvement. As an NAPBC-accredited center, Covenant HealthCare is committed to maintaining levels of excellence in the delivery of comprehensive, patient-centered, multidisciplinary care resulting in high-quality care for patients with breast disease. Patients receiving care at an NAPBC-accredited center have access to information on clinical trials and new treatments, genetic counseling, and patient-centered services including psycho-social support, and a survivorship care plan that documents the care each patient receives and seeks to improve cancer survivor’s quality of life. "Having achieved and maintained NAPBC accreditation since 2011 solidifies our team’s ongoing commitment to providing the highest level of quality care to patients with disease of the breast.” – Sandra Johnson, Director of the Covenant Cancer Care Center. Receiving care at this NAPBC-accredited center ensures that patients have access to: • Comprehensive care, including a full range of state-of-theart services • A multidisciplinary team approach to coordinate the best treatment options • Information about ongoing clinical trials and new treatment options 20 The Bulletin | Spring 2021

COVID-19 Vaccines Continue Teams continue working together to distribute the COVID-19 Vaccine to the community. As of April 15, 2021, the Covenant HealthCare team has helped distribute more than 34,000 doses. Additionally, we have supported vaccinating priority groups and community-based clinics through the collective coordination of the Saginaw County Health Department. Grateful to be part of this caring community, and hopeful to put an end to the pandemic.

Thank You to Our Amazing Doctors! Every year, National Doctors’ Day is a reminder to appreciate all of the doctors at Covenant HealthCare who help our entire healthcare team shine. Our gratitude, though, is felt every single day as we witness countless acts of compassion extended to patients by doctors who bring invaluable talent, creativity and teamwork to our halls of healing. Behind that well-earned white coat, you are also people with great heart and soul. Your ability to balance the human element of caring and respect with the professional aspect of treating ailments is a core reason why Covenant HealthCare is a leader in the healthcare industry. Because of you, we can all bring extraordinary care to every generation. Sincerely, Covenant HealthCare Employees and Clinical Staff

SCMS Affiliate Member 2020

Favorite 2019


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In the United States, 30.3 MILLION people are living with diabetes – 84 million are living with prediabetes. Covenant HealthCare is the region’s most experienced diabetes management team. Our program is certified by the Association of Diabetes Care & Education Specialists (ADCES) through the Michigan Department Health and Human Service (MDHHS). We are certified to provide education for patients of all ages and diabetes diagnoses, including pregnant women. Put your trust in the region’s most experienced diabetes management team – your Patient-Centered Medical Home partner. We also have a Diabetes Prevention Program to help prevent or delay Type 2 diabetes.

To refer a patient or for more information call:


©2020 Covenant HealthCare. All rights reserved. PK 2/20 13001

The Bulletin | Spring 2021


Latest COVID-19 Relief Includes COBRA Subsidy — Employer Action Required (Action required by May 30, 2021) The American Rescue Plan Act (the “Act”) requires COBRA covered employers to fully subsidize health insurance to COBRA eligible individuals suffering a loss of insurance coverage due to involuntary termination of employment or reduction in hours. The subsidy is available for a six-month period in 2021. Special election rules apply to individuals who previously declined coverage. A refundable tax credit (similar to the paid leave credit) is available to reimburse employers. Employers must identify eligible individuals and provide written notice by May 30, 2021. Employers having 20 or more employees are familiar with the normal COBRA rules requiring COBRA eligibility notices, continuation coverage following a “qualifying event,” etc. The Act requires additional specific actions by employers. Employers will need to act quickly to identify eligible persons and comply with the notice requirements in the Act. READ MORE.

New MSMS Health Law Update on Information Blocking Rule MSMS Legal Counsel created a new resource to help physicians and their practices comply with the 21st Century Cures Act (the “Cures Act”) and related final rule on Interoperability, Information Blocking, and the ONC Health IT Certification Program (the “Final Rule”). The Cures Act and its administrative rules regulate healthcare providers (including physicians in private practice and their medical practices), HIT developers of certified health IT, health information exchanges and health information networks. To read the Health Law Update, CLICK HERE. Log-in is required. Click on LEGAL and scroll down to the last item - ONC Cures Act Information Blocking Final Rule, published March 16, 2021.

Health Can’t Wait: Patients and Providers Once Again Ask Legislature to Limit Health Care Delays and Insurance Company Red Tape Hopes for reducing dangerous and unnecessary delays in the delivery of care and treatment to Michigan patients were renewed on April 14, 2021, with members of the Senate Health Policy and Human Services committee hearing testimony on SB 247 - legislation that reforms the prior authorization practices insurance companies use to slow the delivery of life saving health care.


The Bulletin | Spring 2021

Sponsored by State Sen. Curt VanderWall, chairman of the Senate Health Policy and Human Services committee, SB 247 introduces new transparency and clinical validity requirements that would protect Michigan patients from costly and dangerous delays in access to health care. The legislation is the reintroduction of prior authorization reform, which previously took the form of SB 612 during the last legislative session. READ MORE.

MSMS Foundation Hosts NEW Monday Night Medicine Series The MSMS Foundation has created a new virtual series for physicians and their teams. The Monday Night Medicine series will take place on the first Monday of the month in both the Spring and Fall. This new 1.5-hour monthly evening series will focus on Team Based Care in the spring and Implicit Bias and Health Disparities in the fall to aide your practice. Upcoming topics include: Monday, May 3, 2021 Practicing Wisely - Save 2 Hours Each Day Marie Brown, MD, FACP, Director of Practice Redesign, American Medical Association Approved for 1.5 AMA PRA Category Credit(s)™ Monday, May 24 Creating a Manageable Cockpit for Clinicians Christine A. Sinsky, MD, MACP, VP Professional Satisfaction, American Medical Association Approved for 1.5 AMA PRA Category Credit(s)™ Monday, June 7 100% Virtual Collaborative Care for Behavioral Health Outcomes Eunice Yu, MD, FACP, Henry Ford Health System Approved for 1.5 AMA PRA Category Credit(s)™ For more information on each course or to register, please click HERE. Registration Fees per Session: Members - $50 | Non-Members - $75 Member Students/Residents – FREE Register for Full Conference Members - $125 | Non-Members - $190 Member Students/Residents - FREE Statement of Accreditation The Michigan State Medical Society (MSMS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. AMA Credit Designation Statement The MSMS designates this live activity for a maximum of 4.5 AMA PRA Category Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

SafeHaven™ Now Offering Michigan Physicians & Health Care Providers Resources to Manage Stress and Burnout New program offers physicians and health care providers with the resources they need to meet the demands of their personal and professional lives. In an effort to better serve and support clinicians struggling with stress, burnout and the effects of COVID-19, MSMS has launched SafeHaven™, a comprehensive and confidential physician and health care provider wellbeing program offering clinicians with the resources and support they need to address career fatigue and behavioral health concerns. The Medical Society of Virginia (MSV) conceived and manages SafeHaven™, which is implemented in partnership with VITAL WorkLife. SafeHaven™ was created by the passage of the Virginia legislation, which is the first of its kind in the nation, signed in March 2020. During the 2021 Virginia General Assembly Session, legislation was passed to include additional provider groups to the SafeHaven™ protections including nurses, nurse practitioners, pharmacists and medical, PA, nursing and pharmacy students. The law allows healthcare providers to seek professional support to address career fatigue, burnout and behavioral health concerns with confidentiality and civil protections. SafeHaven™ provides a host of discreet and confidential set of tools and resources that physicians and health care providers can access to stay well, avoid burnout, and connect to their purpose without the fear of undue repercussions to their medical license. “Most who work in health care do not see themselves as heroes and don’t do well seeking help for themselves,

Caduceus Meeting for Recovering Health Care Professionals Third Thursday of each month at 7 p.m. Zion Lutheran Church 454 7th Street, Freeland, Michigan (Behind Pat’s Grocery Store on Midland Road in Freeland)

Caduceus meetings are available to health care industry professionals, and have adopted many of the principles of 12-Step programs. Caduceus meetings are “closed” meetings for recovering health care professionals including, but not limited to, nurses, doctors, dentists and pharmacists. We engage in group discussions where members may want to speak up, ask questions or share thoughts with fellow members.

instead focusing on the needs of others in their care,” said Terri Babineau, MD, CMO of SafeHaven™. “Being only human, health care workers need the opportunity to seek help for mental health reasons without fear of harm to their career. The SafeHavenTM Program offers necessary mental health resources that are truly confidential and actually support health care workers.” SafeHaven™ resources are available to providers and their families and include the following: • In-the-moment telephonic support, available 24/7 • Counseling sessions • Peer coaching • Legal and financial consultations and resources, available 24/7 • WorkLife Concierge - a virtual assistant to help with tasks, available 24/7 • VITAL WorkLife App providing mobile access to SafeHaven™ resources For more information about SafeHaven™, please visit MSMS.org/SafeHaven. Check out this video for more information

Creating a

safety network for our

community Our goal is to save lives through prevention, intervention, and aftercare.

Our Network trains individuals in evidence-based suicide prevention with the hope of destigmatizing suicide, increasing help-seeking behaviors, and caring for those impacted by suicide. To request trainings or resources, contact info@srrn.net I www.srrn.net I 989.781.5260 The Bulletin | Spring 2021 23

COVID-19 Antibody Combo Therapy Offered at Ascension St. Mary's Ascension St. Mary's is proud to share an opportunity for individuals to receive an enhanced intervention for mild to moderate COVID-19 that can help prevent the progression to more severe forms. The therapy is a combination monoclonal antibody infusion with Bamlanivimab and Eteresivimab under EUA from the FDA. This combination has better results against the newer strains than Bamlanivimab monotherapy. The therapy is available at Ascension St. Mary's - Towne Centre, Ascension Standish Hospital and Ascension St. Joseph Hospital. Previously, Ascension St. Mary's was using Bamlanivimab but is converting to the combination medication (Bamlanivimab and Eteresivimab). The inclusionary and exclusionary criteria is listed below. Generally, this treatment is intended for mild to moderate COVID-19 positive patients - adults and pediatric patients at least 12 years of age who do not require hospitalization but are at high risk for progressing to severe COVID-19 and/or hospitalization. High risk is defined as patients who meet at least one of the following criteria: • have a body mass index (BMI) greater than or equal to 35 • have chronic kidney disease • have diabetes • have immunosuppressive disease • are currently receiving immunosuppressive treatment • are 65 years of age and older If you are notified that one of your patients is COVID-19 positive and they meet the criteria for inclusion in the therapy, contact your patient to discuss the option of receiving this treatment. Contact any of the clinics listed for details on referring a patient. • Ascension St. Mary’s - Towne Centre in Saginaw 989-907-4187 • Ascension Standish Hospital in Standish - 989-846-3439 • Ascension St. Joseph Hospital in Tawas City - 989-362-9433 Wig Room Helps Patients Self-Image Soar Ascension St. Mary’s Towne Centre is helping cancer patients boost their self-esteem during cancer treatments thanks to a new wig room created and funded by the oncology team. The group hosted various fundraisers to create the wig room which is filled with items to help a patient feel good about themselves while in treatment. Chemotherapy-induced hair loss has been shown to lower patient self-esteem and deprive patients of their privacy because the public commonly associates hair loss with cancer. “Patients can benefit from the wigs, hats and scarves to help

them feel beautiful on the inside and outside,” said Angelina Porras, Practice Supervisor at Ascension Medical Group Medical Oncology & Hematology. Developing the wig room has been a goal of Porras since she began working with cancer patients in 2016. “Besides the cancer diagnosis, losing your hair is one of the scariest things for the ladies and men. I want them to be able to feel beautiful. I want them to come into the wig room and pick out a wig and not worry about the cost. I want them to leave the building and feel special,” said Porras. “Losing hair is a devastating experience for our patients, and our wig room makes it less challenging. It helps boost their self-esteem,” said oncologist, Asma Taj, MD. “Thank you to our staff for helping our male and female patients find a wig or hat that fits their personality. You can see their confidence soar immediately.” According to oncologist Ernie Balcueva, MD, “The financial burden of cancer care can sometimes be so overwhelming that any support we can give to our patients (and their families), to assist them in the transition of their life, becomes an empowerment in their fight against cancer. We care very much about improving their quality of life and the wig room is a very small part of helping them.” Dennis Durek was the first patient to utilize the room. "Thanks to the staff for the supplies. It was fun, being the first one to use the room. It is really cool for people who need wigs and such. It is a wonderful way to help people. Every little bit helps improve our spirits,” said Durek. "I can get through chemo, but the hardest thing was losing my hair and the wig room helped," said patient Amy Delgado. The wig room needs ongoing donations to support supplies. If you are interested in contributing, please click here or contact the Ascension St. Mary’s Foundation office at 989-9078300. Wound Care Receives "Going the Distance" Quality Award The Wound Care Center at Ascension St. Mary's Towne Centre earned the 2020 Going the Distance quality award from RestorixHealth®, an organization that specializes in the development and management of comprehensive wound healing and Amputation Prevention Center® facilities. The award acknowledges the center as a nationwide leader in wound healing patient outcomes. continued on page 26


The Bulletin | Spring 2021

Saginaw’s only Comprehensive Stroke Center Advanced stroke care close to home Ascension St. Mary’s is certified as a Comprehensive Stroke Center which means we provide the highest level of care available anywhere in the greater Saginaw area. Should you or your loved one need it, you’ll have access to advanced training, technology and capabilities all located within Ascension St. Mary’s Hospital. Our stroke specialists work quickly to understand your situation and deliver the care you need, including follow-up care, when you need it.

To talk to a doctor about your risk for stroke - call 844-960-1435..

If you are experiencing a life-threatening emergency, go directly to the ER or dial 911.

© Ascension 2020. All rights reserved.

The Bulletin | Spring 2021 25

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Healthcare professionals have been tasked with maintaining quality through patient outcomes despite a daunting global pandemic. The Going the Distance award acknowledges those outpatient wound healing centers who have achieved or exceeded nationwide patient outcome standards within a set period of time during 2020. Results are calculated by comparing the center’s patient outcomes against RestorixHealth® nationwide benchmarks. The staff at the Wound Care Center brings a wealth of talent to the wound healing workplace and that fuels a positive impact on patients’ outcomes. Amidst a pandemic, their dedication to healing is a sign of resilience and strong work ethic. Congratulations to the Ascension St. Mary's Wound Care Center and staff who are “Going the Distance.” Save the Date! Ascension St. Mary’s Foundation Announces 2021 Golf Classic Events It is with great hope and excitement that we share the tentative dates for summer golf classic events across the region. Hosted by the Ascension Mid and Northern Michigan Foundations, individuals will enjoy a day on the course while feeling good about supporting each hospital’s mission to provide the latest health care technology and treatments to everyone, every day. Foursomes will enjoy 18 holes of golf with a cart, a complimentary gift package, course contests, raffles, refreshments and meals. The tentative dates are: • Ascension St. Mary’s Charity Golf Classic Wednesday, May 26 at Apple Mountain Golf Club • Ascension Standish Hospital Charity Golf Tournament Friday, June 11 at Pine River Golf Club • Ascension St. Joseph Charity Golf Classic Thursday, June 24 at Red Hawk Golf Club • Ascension Genesys Charity Golf Classic Monday, June 28 at Warwick Hills Golf and Country Club. Watch for additional details or contact the Ascension St. Mary’s Foundation office at 989-907-8875 or via e-mail to Tamera. Weighman@Ascension.org.


The Bulletin | Spring 2021

Ascension Northern Michigan Foundations Raise More Than $16,000 With Winter Basket Raffle Physicians, providers, associates and the community at large participated in the recent Lucky Winter Basket Raffle that was hosted by the foundations and volunteer services departments of Ascension St. Mary's, Ascension Standish and Ascension St. Joseph. A total of 39,523 tickets were purchased to raise $16,767 to benefit projects to support the purchase of tablets for patient communication and cell phone docking stations; associate educational scholarships; and activities and outings for skilled nursing program participants. Hats off to staff members and departments for working together to donate the 47 unique-themed baskets.

All statements or comments in The Bulletin are those of the writer, and not necessarily the opinion of the Saginaw County Medical Society.

Focusing our practice on the needs of our community, we provide the following services for both individuals and businesses: n Monthly Accounting n Tax Planning n Financial and Business Consulting Service n Payroll Service n Tax Preparation Service n Retirement Planning Contact us for a complimentary visit at 989-791-1040. Three convenient locations to serve you in: Saginaw | Vassar | Frankenmuth

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Victor L. Hill Jr., MD, much loved father, grandfather, great-grandfather and physician left the world peacefully on March 4, 2021, from the same building in which he helped bring many lives into this world. Dr. Hill was born July 13, 1928, in Saginaw, Michigan to Victor L. Hill Sr. MD and Marie (Marcotte) Hill. He graduated Saginaw High, and attended Central Michigan University and Michigan State University, briefly working for General Motors. He married Mary Katherine Schnettler in Saginaw in 1949. Shortly after, he made the decision to follow in his father’s footsteps and returned to studies at Michigan State University, and The University of Michigan School of Medicine. However, he was 100% a Wolverine. Following internship and residency, he joined the Obstetrics and Gynecology practice of Drs. Sargent, Bruggers and Heilbronn, which later evolved into Valley OB-GYN Clinic. Dr. Hill served in various roles at Saginaw General Hospital, including Chief of Staff, and, in later years, worked at HealthSource Saginaw in consulting and advisory capacities. Together the Hills raised three children, Victor L. Hill III, Jody Brehm (Marty) and (much) later Jennifer Warren (Brad), whose arrival kept him youthful in his senior years. Dr. Hill was forever busy, spending every moment, when not

on call, fly fishing on the AuSable River, and salmon fishing with his pals, and son Vic. He also enjoyed summers at the cottage on Torch Lake, spring breaks and shelling on Sanibel Island, and taking on many unique construction projects (“Jen’s Den,” still stands behind their beloved Baskins Place home), as well as, dabbling in drawing, painting and photography. He was a man of many talents, boundless energy, and had a meticulous nature, as anyone who has seen the inside of his garage, can attest. He was a long-time member of St. Dominic’s Parish and the Saginaw Country Club. He loved his home and yard, and spent hours working on them well into his senior years - planting flowers, shoveling (always down to the concrete), and sharing his pruning skills with his son Vic. In addition to his children, Dr. Hill is survived by his grandchildren Scott (Heidi), Katie (Kevin), Tracy (Mike), Molly (Steve), Paige (Alex), Elle, Ava, Josie, Lila and Tyrion; greatgrandchildren Leila, Steven, Violet and Lenna; and many nieces and nephews. He is also survived by his dear friend, Kay Smith, who brought happiness to his sunset years, and to whom his children are forever grateful. He was preceded in death by his wife of 69 years, Mary Katherine, sister, Donna Heitkamp, and brother, Robert Hill. continued on page 28

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Also the family would like to thank New Hope Valley Assisted Living for their compassionate care of their father in his final years. Honoring Dr. Hill’s wishes, cremation has taken place with a service celebrating his life planned for a later date. Memorial contributions can be made to your favorite charity. Dennis Moore Tibble, MD, 84, of Bay City, our caring, hardworking, intelligent, and most adventurous husband, father, and grandfather passed away on Friday, March 5, 2021, at his residence, under the loving care of his family. Dennis was born in Pontiac, Michigan on September 19, 1936, the son of the late Dennis Joseph and Juliette Emma (Moore) Tibble. Dennis proudly served in the U.S. Navy as a Corpsman during the Korean War, after which he completed his undergraduate studies at Albion College, where he majored in pre-med. Dennis continued his studies at the University of Michigan, receiving his Medical Doctor degree in June 1964, graduating Cum Laude. After settling in Saginaw, he ultimately founded Great Lakes Eye, where he led a thriving practice until his retirement in 1996. Dennis was a well-respected ophthalmologist and ophthalmic surgeon throughout his career, inspiring many with his generosity and his passion for work. It was at Albion College where Dennis met the love of his life, the former Joanne Gilbert. Dennis and Joanne dated, fell in love, and were married on June 16, 1964. After settling in Saginaw, Dennis and Joanne raised three children - Martin “Marty” Tibble, Cindy Tibble and Jay Tibble - and together as a couple and as a family they traveled the world - helicopter skiing in the Canadian Rockies, sailing in the Virgin Islands and scuba diving in the South Pacific. Dennis was an adventurer and threw himself into many pursuits. He was an expert scuba diver, windsurfer, biker, snowboarder and devout skier. He was always up for new experiences and passed along that spirit of adventure to his children and grandchildren. Dennis leaves his wife and children to carry on his legacy, and well as, Marty’s wife Heather Tibble; grandchildren, Morgan and Lauren Tibble and Fae and Lowa Bossung; brother, RJ (Carla) Tibble; sister, Andrea (Jim) Murdock; in-laws, Kathy Gilbert and Jim Halliday, along with many nieces, nephews and friends. In addition to his parents, he was preceded in death by his son-in-law, Seth Bossung and sister-in-law, Sue Halliday. A Life Celebration was held on Saturday, April 17, 2021. Memorial contributions may be directed to YMCA Great Lakes Bay Region, 1104 Washington Ave., Bay City, MI 48708. Expressions of sympathy may be shared with the family online at www.skorupskis.com. 28

The Bulletin | Spring 2021

Prabhundha "Prapon" Vanasupa, MD, FACS, of Bay City died in the comfort of his home on Thursday, March 11, 2021, at the age of 92. "Prapon" enjoyed the hobbies of model ship and airplane building, playing and building classical guitars, photography, cooking, and reading voraciously, especially history. He was a Board Certified Neurosurgeon, practicing neurosurgery in Bay City and Saginaw for 32 years, happily retiring in 1996. He is survived by his wife Verna (Toni); three children, Ted (Marianne), Linda (Michelle), and Diane; and five grandchildren, Mitchell, Casey, Shilu, Lily and Ryan. At this time, no memorial or funeral services are planned. Memorial contributions can be made to your favorite charity. Virginia L. Jarvi, beloved mother, grandmother and great-grandmother passed away Monday, March 8, 2021, at McLaren Bay Region at the age of 93. The daughter of the late Alex and Gladys (Morgan) Adams, Virginia was born November 23, 1927, in Port Huron, Michigan. She married Dr. Rudolph M. Jarvi on July 17, 1948. He predeceased her on August 18, 2012. Virginia was a member of Countryside Trinity Church and a past member of Warren Avenue Presbyterian Church. She volunteered at Saginaw General Hospital, was a member of the Saginaw Bay Yacht Club and enjoyed playing Bridge. Most of all, Virginia loved spending time with family and friends. Surviving are four sons and their spouses, David and Karen Jarvi, Grayling; Martin and Maria Jarvi, Cedarburg, Wisconsin; Rich and Lois Jarvi, Oxford, Ohio; Ron and Cheryl Jarvi, Grand Blanc, Michigan; 12 grandchildren; 17 great-grandchildren; several nieces and nephews. Virginia was preceded in death by two sisters and one brother. Honoring Mrs. Jarvi’s wishes, cremation has taken place and a memorial service will be scheduled at a later date. Those planning an expression of sympathy may wish to consider memorials to Countryside Trinity Church or the Navigators. Memorial donations are graciously accepted by the Saginaw County Medical Society Foundation. Donations are used to provide low interest loans to medical students with strong ties to Saginaw, encouraging students to return to Saginaw to practice after completion of their residency at which time their student loans may be forgiven. The Foundation provides awards and scholarships to high school juniors and seniors interested in a career in medicine, as well as, medical students and residents for research through the CMU College of Medicine. The Foundation also assists the SCMS Alliance in funding nursing scholarships. To make a tax deductible donation, please send your check payable to the SCMS Foundation to 350 St. Andrews Road, Suite 242, Saginaw, MI 48638-5988. A receipt will be provided upon request.


Joseph G. Adel MD Michael S. Albosta Student Fares Alghanem Student Marina I. Ananich MD Binish Ather MD Kaitlyn Bates Student Eventure D. Bernardino MD Sultan M. Bhimani MD Adam Z. Cote DO Kenneth W. Distler MD Daniel J. Dymek MD Carly Farr MD Douglas B. Forsyth MD Pruthvi Goparaju MD Suhasini Gudipati MD George J. Gugino MD Enam B. Hanna MD Mayar M. Jundi MD Shweta Kambali MD Waqas M. Khan MD Sai Srikar Kilaru Student Ryan J. Kim MD Jacob M. Long Student Michael T. McAvoy MD Igor D. Middlebrook DO Jeffrey S. Milewski DO Thomas M. Minnec MD Rajesh Mithalal MD

Brent A. Oldham MD Yvonne V. Pacquing MD Trusha Patel Student Jill M. Paveglio MD Olivia A. Phifer-Combs MD Gregory A. Pinnell MD J. M. Prasad MD Kala K. Ramasamy MD Chalichama A. Rao MD K. K. Ravindran MD Happy Special Birthday! Thomas M. Raymond MD Stuart J. Rupke MD Payton Salomon Student Insija I. Selene MD Samuel J. Shaheen MD Jonathon G. Skurya Student William T. Starbird Student Lauren Stull Student Faiz Tuma MD Vivek Variar MD Lester E. Webb MD Happy Special Birthday! Thomas G. Weiss Student Derek Wolfe Student William Yuen MD Harrison J. Zeitler MD Hani H. Zreik MD

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Khurshid Ahmad MD Sukaina A. Alali MD Christopher J. Allen MD Abishek Bala MD Cynthia L. Blount DO Usha K. Bulusu MD William M. Capina MD George A. Carty MD Rachel A. Cleminson Student Sara Dadashzadeh Student Steven G. Fettinger MD Joshua D. Forsyth MD Laura M. Fritsch Student Michael D. Gallo MD Frances Greathouse Student Rao V.C. Gudipati MD Val Hereza MD Happy Special Birthday! James R. Hines MD James J. Jesko DO Christina K. Jung Student Tareq Q. Kamal MD Larry S. Kelly MD Asim A. Kichloo MD Tiffany K. Kim MD John A. Kremski MD Eric R. Kuhn Student

responding to an increased need for services with expanded hours at multiple locations. As people grapple SCCMHA is offering hospital with how to deal with stress and anxiety employees, first responders, healthcare caused by the pandemic, behavioral professionals and their immediate family health services have never been members, throughout the Great Lakes more important. To increase access Bay Region, an opportunity to seek to care, SCCMHA is extending case and receive mental health counseling management, clinical and crisis service assistance free of charge, beyond hours, including mental health and support provided by an Employee substance use disorders, to better serve Assistance Plan (EAP). consumers and our community. Hours have been extended at all COVID-19 has Increased the SCCMHA locations, including their main Demand for More Care. We are site on Hancock Street and the Towerline Responding with More Hours. and Bay Road locations. These facilities Due to the COVID-19 pandemic, will now be open on Mondays and Saginaw County Community Mental Wednesdays from 8 a.m. to 7 p.m. and Health Authority (SCCMHA) is Fridays from 8 a.m. to 6 p.m.

Jacob M. Lynn Student Lakshmana R. Madala MD Binu Malhotra MD Albert S.M. Manlapit MD Lydia T. Mansour DO Elizabeth M. Marshall MD Rama C. Mulpuri MD Robert Muterspaugh Student Manuel M. Perea MD Juliette M. Perzhinsky MD Isaac T. Prows DO Nasser O. Qadri MD Todd G. Richardson MD Chad D. Ringley MD Kyle J. Rutledge DO Raghu Sarvepalli MD Robert A. Sasso MD Keith E. Scharf MD Benjamin R. Schoener MD Nadia R. Sion Student Rajeev S. Sudhaker MD Joseph E. Talbot MD William G. Underhill MD Thomas J. Veverka MD Antonio J. Williams, Sr. MD Susanna M. Zurecka MD

Additional hours will provide greater access to services that include case, clinical and crisis management with services like evaluation, screenings, treatments and referral. Substance use intervention services are also available. SCCMHA is committed to getting our community through this crisis with important supports and services. For more information or to schedule an appointment, visit sccmha.org or call 989-797-3400 or 800-258-8678. Crisis Services remains open 24 hours a day, 7 days a week, including holidays, at 989-792-9732 or 800-233-0022.

The Bulletin | Spring 2021 29

A New Day for Diabetics By Louis L. Constan, MD

There’s an old saying in military circles that goes: “The beatings will continue until morale improves.” It seems crazy that this approach would actually work in the military, much less in civilian life. But this may be what diabetic patients feel like given the expectations, demands and treatment approaches used by generations of doctors and nutritionists. “You had better lose weight or I will put you on an even more stringent diet; you’ll be even hungrier than you are now.” Or, even worse, “I’ll make you take shots of Insulin, which will increase your appetite, so it will be even harder to restrain yourself.” It should be no surprise that Diabetes (now at 34 million Americans) and this disease’s little brother, Prediabetes (now at 88 million Americans) have been steadily increasing year over year. The beatings continue, but morale does not improve. And, of course, the sequalae of these conditions - heart attacks, strokes, kidney failure, blindness, limb amputations - all continuing to haunt Americans. Turning their Golden Years into endless doctor visits, painful treatments, ever more expensive medicines. This situation cries out for a new approach. Fortunately, very fortunately, over the last 10 years there have been some astounding medical scientific developments that point at a less stressful future and more effective approach to these patients: • The discovery that certain bacteria in one’s gut affects how high one’s blood sugar rises immediately after eating. It has long been known that the height of such spikes determines the onset and severity of diabetes. • The ability to quickly analyze those gut bacteria (one’s “microbiome”) with a simple stool sample; to determine if any particular individual has a microbiome conducive to the diabetic state. • The ability to correlate different types of foods with different types of bacteria, so as to pair the correct diet with one’s bacterial type, and prevent those blood sugar spikes; thereby preventing or ameliorating diabetes. There are some complexities of course, related to factors such as body type, age and activity level. There are several hundred different bacterial species and sometimes the percentages are important and sometimes the ratios between species are important. A company called DayTwo has worked

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out most of these complexities and marketed a clinically useful program, using computer algorithms and artificial intelligence to determine the optimal diet for diabetics and pre-diabetics. One example of their discoveries is that there are actually two very different types of bread, depending on whether Baker’s Yeast or Brewer’s Yeast were used as a leavening agent. If you eat the wrong type of bread for your specific microbiome, you get a sugar spike; if you eat the right kind of bread, no sugar spike. It’s as easy as that. You just need to do the test, find out what type of bread your microbiome bacteria “like” and you can eat that bread with impunity. Really. No measuring out “carb calories,” no guilting from the doctor and nutritionist. The beatings can stop right there. DayTwo’s research was done in Israel and validated by the Mayo Clinic. They enroll diabetics, collect their personal data, lab data, then do a stool genetic analysis to discover what types of bacteria are in each patient’s individual microbiome. After that, they can recommend a specific, personalized diet. Two companies in our area, Covenant Healthcare and Morley Companies, have completed an initial pilot using DayTwo for their diabetic employees, and results for this pilot group are available now and they are very favorable. With no change in medicines, these diabetics have lost weight and decreased their blood glucose, A1C and lipids. All more effectively than by the usual approach described in the first paragraph above. Patients had an average 1.6 drop in A1C, 18 lbs. in weight, 34 percent reduction in medication usage, 45 percent reduction in hunger and 45 percent decrease in stress. They report their sugars were in the normal range 63 percent more often; they feel engaged 80 percent more; they feel 72 percent more energy; they have 55 percent better sleep quality; and a 95 percent Net Promoter Score (NPS) for the program. Overall, 90 percent feel this is a good program and want to continue it. Morale is, indeed, improved. It appears to be a new day for diabetics. Using a personalized approach and this new understanding about how one’s microbiome affects sugar metabolism, it becomes much easier to control blood sugar in diabetics, while improving their overall sense of well-being. A new day for diabetics…and perhaps the beginning of the long-promised era of personalized medicine for everyone!

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covenant In an emergency, seconds count. Count on Covenant HealthCare Emergency Center for: • The region’s only specialized pediatric and senior emergency care • The region’s first Accredited Geriatric Emergency Department • The only Level II Trauma Center in the area verified for both adult and pediatric trauma care • Extraordinary safety, awarded an “A” grade in patient safety from the Leapfrog Group • Board-certified emergency physicians and specially trained nurses, named Team of the Year by Press Ganey Associates in 2019 • 65 private patient rooms Don’t settle for less. In an emergency, no one beats Covenant.

The Bulletin | Spring 2021 31


350 ST. ANDREWS ROAD | SUITE 242 SAGINAW, MI 48638-5988



These Area Businesses Support Saginaw County Medical Society Membership Meetings. When you have a need for a service, please consider our Key Providers.

REGISTER NOW FOR SCMS ANNUAL MEETING REGISTER NOW! The SCMS ANNUAL MEMBERSHIP MEETING and the SCMS FOUNDATION ANNUAL MEETING will be held concurrently via Zoom on Tuesday, May 18, 2021, at 7 p.m. Please register online at https://www.surveymonkey.com/r/SCMSAnnualMtg The Zoom link will be emailed to all of those who register. The following, and more, will be on the Agenda: • The Slate of Nominees for 2021-22 will be voted on at the meeting and via electronic vote prior to the meeting. (see page 5) • Approval of updated and amended Foundation Bylaws. In 2019, the Foundation Bylaws were reviewed and revised to not only bring them up-to-date as they were written over 50 years ago, but also to increase the size of the Board of Directors. The proposed Bylaws will be voted on at the meeting and via electronic vote prior to the meeting. o View the original 1968 Bylaws by clicking HERE. o View the proposed Bylaws by clicking HERE. o The Bylaws are also available on the SCMS website under the FOUNDATION tab www.SaginawCountyMS.com • Update on the CMU College of Medicine. Contingent on pandemic conditions, we tentatively hope to have in-person meetings on Tuesday, September 21 and Tuesday, October 19. Keep an eye on your inbox and The Bulletin for details when available. Questions? Contact Joan Cramer at jmcramer@sbcglobal.net (preferred method) or (989) 284-8884 (please leave message if I’m unable to answer).

All statements or comments in The Bulletin are those of the writer, and not necessarily the opinion of the Saginaw County Medical Society.

Joan Cramer/SCMS | Office 790-3590 | Fax 790-3640 Cell 284-8884 jmcramer@sbcglobal net www.SaginawCountyMS.com

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