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The

Bulletin Saginaw County Medical Society

October 2019 | Volume 78 | No 2

HEALTH CAN’T WAIT! Prior Authorization Legislation HCW Action Day in Lansing 10/30/19

SEPTEMBER MEMBERSHIP MEETING

p. 13-14

p. 6 www.SaginawCountyMS.com

p. 16-17

SCMS FOUNDATION Make a Tax Deductible* Gift Today! p. 31

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The

Bulletin Saginaw County Medical Society

contents 6

2019-2020 OFFICERS AND DIRECTORS President Mildred J. Willy MD President-Elect Anthony M. Zacharek MD Past President Julia M. Walter MD Secretary Caroline G.M. Scott MD Treasurer Miriam T. Schteingart MD

Board of Directors Jorge M. Plasencia MD Tiffany K. Kim MD Mark G. Greenwell MD Harvey K. Yee MD Elizabeth A. Paulus MD Furhut R. Janssen DO Bulletin Editor Louis L. Constan, MD Retiree Representative Rustico B. Ortiz, MD Resident Representative Mary J. McKuen, MD MSMS Delegates Elvira M. Dawis MD Julia M. Walter MD Mildred J. Willy MD Anthony M. Zacharek MD Jorge M. Plasencia MD Christopher J. Allen MD Miriam T. Schteingart MD MSMS Alternate Delegates Caroline G.M. Scott MD Waheed Akbar MD

4 6 8 9 11 12 12 12 15

18 20 21 22

Free CME for Your MSMS/SCMS Membership Renewal by 11/15/19

13-14

16-17

HEALTH CAN'T WAIT! Prior Authorization Legislation • Share Your Stories • HCW Coalition Awareness Day SEPTEMBER MEMBERSHIP MEETING

16TH ANNUAL JINGLE MINGLE Benefitting the Pregnancy Care Center of Saginaw

President’s Letter Medical Mission Articles Needed From the Editor Attention Retired Members Barb Smith SR&RN Hope Starts Here November Birthdays

MSMS and Upcoming CME Opportunities

26 THRIVE 27 Caduceus Meeting 28 Peer Review Ethics Committee 28 Health Professional Recovery Program

Private Membership Directory Application for Membership

29 29 30 31

Key Provider of the Month HealthSource Saginaw Covenant HealthCare CMU College of Medicine | CMU Health

Physician Health & Well-Being Committee Who Sets MSMS Policy? You Do! Medical Records Advertiser Index SCMS Foundation Make a Tax Deductible* Gift Today

SCHD Medical Director’s Report

Key Providers

Ascension St. Mary’s

Calendar of Events

The Bulletin can be viewed online at www.SaginawCountyMS.com under the Bulletin tab.

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 District 8 Director Thomas J. Veverka, MD Executive Director Joan M. Cramer Administrative Assistant Keri Benkert

ON THE COVER: (l-r) Drs. Mary McKuen, Kris Spence, Tiffany Kim, Chris Allen and Tony Zacharek EDITOR Louis L. Constan, MD

PUBLISHER Saginaw County Medical Society

EXECUTIVE DIRECTOR Joan M. Cramer

350 St. Andrews Rd., Suite 242, Saginaw, Michigan 48638-5988. Hours: Tuesday, Wednesday, Thursday 8:30 AM - 3:30 PM. Web: SaginawCountyMS.com

DESIGNER Lori Krygier

Telephone: (989) 790-3590. Fax: (989) 790-3640 E-Mail: jmcramer@sbcglobal.net

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 | October 2019 3

PRESIDENT’S LETTER

Diversity, Equity and Inclusion Strategies: Changing Demographics in Patient Care By Mildred J. Willy, MD

arcia A. Perry MD, Assistant Professor, Department of Emergency Medicine, Director of House Officer Programs, Office for Health Equity and Inclusion, presented this interesting topic to us at our last Saginaw County Medical Society Membership Meeting. I have included some salient points, references and take-home points from the talk below. What is Implicit Bias? Implicit bias, or implicit stereotype, is defined as the unconscious attribution of qualities to a member of a certain social group. Implicit stereotypes are shaped by experiences and based on learned associations between particular qualities and social categories, including race and/ or gender, but extends beyond that when talking about our patients, and includes anyone who may be

disadvantaged or have different exposures and backgrounds to that of the physician taking care of them. Ultimately, this can lead to barriers in receiving health care that is equitable for all, and can lead to poor patient outcomes or outcomes different than the physician intended. An example of this may be as simple as becoming frustrated with a patient who fails to fill their prescription. The patient may not have transportation to a pharmacy if they live in a rural area, or the funds for a co-pay if they are poverty stricken and, therefore, never fills the script. If we take the initiative to listen and understand the life of each of our patients, we may be able to assist in a way we didn’t consider, ultimately providing better delivery of the care we intended from the beginning. We all have biases and stereotypes that affect our behaviors and decisions unconsciously. Some may have

been engrained in us during our upbringing, and some may not be ethical. I encourage you to assess yourself and see where yours may lie. You can take one or more of the many Project Implicit® tests at https:// implicit.harvard.edu/implicit/ takeatest.html to determine your biases and stereotypes, and discover what you need to work on personally. Why is This Important? Ultimately, we want the best care and the best outcomes for our patients (health equity). The Institute of Medicine, ACGME which provides accreditation and oversight for residency programs, and the LCME which is the accrediting body for educational programs at medical schools in the U.S. and Canada have all recognized that diversity, health equity and inclusion are very important for our practice, our learners and our patients. continued on page 5

Cultural competency is a lifelong process of self-reflection and self-critique that can enlighten one’s understanding of cultural differences, and how such differences require sensitive approaches to health care.

The Bulletin | October 2019

continued from page 4

Research has shown that minority patients receive less pain medication and have healthcare disparities independent of insurance status or ability to pay for care when compared to their white counterparts. These differences likely occur from social determinants of health, and may relate to implicit bias. Women also have experienced discrepancies in care. These disparities have been associated with more deaths. What are Social Determinants of Health? The World Health Organization states social determinants of health are conditions in which people are born, grow, live, work, and age, and are influenced by distribution of money, power and resources at global, national and local levels. The CDC adds where and how people learn, play and worship affects a wide range of health, functioning and quality-of-life outcomes and risks. What Should We Strive For? Cultural competency is a lifelong process of self-reflection and self-critique that can enlighten one’s understanding of cultural differences, and how such differences require sensitive approaches to health care. What are Microaggressions? Microaggressions are “the everyday verbal, nonverbal and environmental slights, snubs or insults, whether intentional or unintentional, which communicate hostile, derogatory or negative messages to target persons based solely upon their marginalized group membership.” This may appear as the inappropriate use of humor, stereotyping or sexist comments. It may be experienced by our colleagues, residents or students from patients. The acknowledgement of the problem is important, as well as, knowing when to intervene. The use of scripting lends to easy access when needed. An example may be if a patient says to a female resident, “This pretty girl can stay here with me while the rest of you finish rounds.” Her faculty could respond with, “This doctor needs to be with the rest of the physician team in order to have every opportunity to learn and ultimately take the best care of you.” It may also involve institutions and practices developing and posting behavioral expectations for all those employed, as well as, patients of a mutually respectful environment and/ or relationship. While this is not a new concept, it is one that is not practiced enough. The Mayo Clinic’s 5-Step Policy for Responding to Bias Incidents provides useful information. What are the Consequences of Microaggressions? • Disengagement. • Dissatisfaction in the workplace/burnout. • Negative impact on patient outcomes and safety. • More likely to change jobs.

To learn more about microaggressions, you may want to read “Microaggressions in Every Day Life: Race, General and Sexual Orientation” by Derald Wing Sue. How Do We Address Microaggressions and Create Safe Learning Environments for our Trainees? 1, 2 • Assess illness acuity of the patient. • Cultivate a therapeutic alliance. • Depersonalize the event. • Acknowledge that discrimination may be coming from the family’s lack of control. • Name the behavior. • Ensure a safe learning environment for trainees. • Develop strategies for faculty and trainee development including case discussions, setting up expectations early in training, sharing with the chain of command for escalation, debriefing with the team ASAP. • Develop strategies for institutional response including culture of support, mentoring, mental health services, increased flexibility and exit strategies. Whitgob EE, Blankenburg RL, Bogetz ALL. The Discriminatory Patient and Family: Strategies to Address Discrimination Towards Trainees. Acad Med. 2016 Nov;91(11): S64-S69. 1

Leisy HB, Ahmad M. Altering workplace attitudes for resident education (A.W.A.R.E.): discovering solutions for medical resident bullying through literature review. BMC Med Educ. 2016;16:127 2

What Do We Know About the Benefits of Diversity and Inclusion in Teams? • Diversity can lead to better quality performance, higher levels of functioning and overall excellence. • Inclusion can leverage talents to be more competitive. • Diversity fosters innovation. • Teams with diverse thinkers far outperform homogenous groups on complex tasks. • Lends to strong internal and external communication. • Higher satisfaction rates from faculty, staff, learners and patients ultimately leading to less turnover. How Do We Change Culture? • Promote diverse teams that value equity and inclusion. • Create a culture where everyone feels valued and can thrive. • Encourage spaces for authentic communication and sharing. • Foster a culture that everyone is learning. • Equip yourself with tools i.e., crucial conversations and bystander and ally training. • Assume everyone is doing their best. continued on page 6

The Bulletin | October 2019 5

continued from page 5 What Should We Do? • Take the implicit bias tests referred to above to assess our own biases and develop strategies to reduce them. • Utilize patient-centered communication strategies in order to listen and understand our patients a bit more in order to provide the best delivery of care. • Stand up for colleagues, students and residents when we see them experience microaggressions from patients or others in medicine. Use the following: • DIRECT – confront the situation right away. • DISTRACT – create a diversion to interrupt the situation. • DELEGATE – tell someone else and decide together when to intervene. • DELAY – check in later with those involved. • Consider adding diversity and inclusion statements into your mission statement as a practice, organization or committee and openly discuss and advertise the value. • Provide implicit bias or diversity training to all. • Discuss best practices for recruitment and retention of a diverse healthcare workforce to lead change in health equity. This may include developing pipelines and mentorship for grade school, junior high and high school students and travelling for recruitment to those without resources to come to you. Other References: Curriculum for Culturally Responsive Health Care: The Stepby-step Guide for Cultural Competence Training 1st Edition by Ring, Jeffrey M. and Nyquist, Julie G. (2008) Paperback Diversity and Inclusion in Quality Patient Care: Martin, Marcus L.; Heron, Sheryl; et al (2016) https://www.aamc.org/initiatives/diversity/ In the Nation’s Compelling Interest: Ensuring Diversity in the Health-Care Workforce. IOM report https://www.aamc.org/initiatives/diversity/450468/ gender-and-sexual-history1.html

SCMS MEMBERSHIP MEETING REGISTER NOW!

Tuesday, October 15, 2019, Membership Meeting Register now for our Tuesday, October 15, 2019, Membership Meeting at HealthSource Saginaw. The social starts at 6:30 p.m., followed by a buffet dinner, meeting and program at 7 p.m. ONLINE RESERVATIONS REQUIRED, AND SPACE IS LIMITED! Program: "Beyond Run, Hide, Fight: Workplace Violence” (CME Credit Available) Speakers: Bradford L. Walters, MD – Emergency Medicine, Beaumont Hospital and Howard K. Mell, MD – Emergency Medicine, National Reservist, Vituity Place:

NOTE LOCATION OF MEETING! HealthSource Saginaw, 3340 Hospital Road, Saginaw Enter main drive closest to Shattuck Road and adjacent to Community Village. Proceed to the right of the yellow wing and enter the doors under the large canopy.

Time:

6:30 p.m. Social, 7 p.m. Dinner & Program

REGISTER ONLINE AT https://www.surveymonkey.com/r/101519WorkplaceViolence QUESTIONS: SCMS office 790-3590 or keri.benkert@sbcglobal.net This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Central Michigan University College of Medicine and the Saginaw County Medical Society. Central Michigan University College of Medicine is accredited by the ACCME to provide continuing medical education for physicians. Central Michigan University College of Medicine designates this live activity for a maximum of 1.25 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

MEDICAL MISSION ARTICLES NEEDED The SCMS will again feature the Medical Missions of our members (physicians, residents and medical students) in the December 2019 Bulletin. If you or someone you know of has participated in a medical mission (at home or abroad) within the last year or so, please contact Joan Cramer at jmcramer@ sbcglobal.net. We are looking for articles of approximately 400-800 words in length (submitted in Word format) along with photos (submitted individually as JPEGs) to publish for each Medical Mission article. The deadline for submission is Wednesday, November 20, 2019, to jmcramer@sbcglobal. net. Depending on the number of articles received, we may need to publish some of the articles in future issues of The Bulletin.

The Bulletin | October 2019

Free CME for Your MSMS/SCMS Membership Renewal by November 15 Dear Members: We wanted to take a moment and thank you for your membership with the MSMS and SCMS . We understand the value of your membership, and know your voice will help impact health care in the state of Michigan. MSMS has developed a member tool-kit for your convenience. The resources outlined below will help you and your practice in the year to come. As always, please let us know if there are other ways we can assist you. • • • • • • • • • • • • •

MSMS Member Portal Request a MSMS Window Cling for your Office MSMS Resource Directory MSMS Health Law Library MSMS On-Demand Webinars MSMS Alerts, Guides, and Checklists MSMS Human Resources MSMS Unclaimed Property Search MSMS Policy Manual MSMS Latest News Michigan Medicine Medigram MSMS Member Directory

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For 2019-2020, MSMS’s primary strategic initiative is to reform prior authorization and step therapy. As a result, MSMS is the founding member of Health Can’t Wait, a coalition of patients, physicians, health care providers and associations (including the SCMS) dedicated to putting Michigan patients first and ending delays in patients’ access to health care. In order to change hearts and minds in Michigan, we need your prior authorization and/or step therapy stories. Please consider sharing them by visiting http://HealthCantWait.org. If prior authorization and step therapy is an administrative burden for you or your staff, please consider contributing at https://www. healthcantwait.org/contribute. Your support helps us fight back in Lansing, and across the state of Michigan. Please see pages 13-14 in this issue of The Bulletin for more information on the Health Can’t Wait initiative. We look forward to many years of partnership! Thank you for choosing to be a MSMS and SCMS member in 2020. As always, Joan M. Cramer, SCMS Executive Director, can also assist and direct you on local and state issues at jmcramer@ sbcglobal.net, (989) 790-3590 or (989) 284-8884. Sincerely, Julie L. Novak MSMS, Chief Executive Officer

Free CME for Your MSMS Membership Renewal by November 15 As a thank you for your loyalty as a member of the SCMS/MSMS and for paying early all physicians who pay their 2020 dues by November 15 will receive a coupon for a free CME course at a MSMS educational session. The strength and effectiveness of MSMS/SCMS as your professional association is predicated on strong membership. The free CME course is just a small token of appreciation for your continued support of organized medicine. For questions about membership, please contact membership@msms.org. The Bulletin | October 2019 7

FROM THE EDITOR

Your Money and/or Your Life By Louis L. Constan, MD

he mugger creeps up behind you, sticks his revolver in your ribs, “Your money or your life.” A simple transaction ensues, occurring perhaps hundreds of times each day, leading to the quick transfer of a wallet. You have no choice - your life is more important than your money. Sometimes it seems as though our pharmaceutical industry, which once set an example of civic virtue, now takes lessons from the mugger. It’s learned that people will usually hand over their wallets when they believe their lives are at stake. And it’s used that knowledge to abuse the public trust. Let me illustrate. Today’s lifesaving drugs have seen an alarming, staggering and unconscionable increase in price. In the case of insulin, for example, diabetics, even those with insurance coverage, often struggle just to cover their copays. For many, drug costs exceed those for food and shelter. After paying for meds, there is nothing left to live on! So the patients often skip doses of insulin and other meds to stretch their supply, and you know what happens next - life shortening complications. In my offbeat imagination, I can visualize an overpaid pharmaceutical company executive tapping our diabetic on the shoulder and saying: “Hello there, give me your money or your life.”

That scenario can apply to pretty much each and every brand name drug on the market today, where the drug companies twist the patent laws into knots in successful attempts to prevent generic competition. Even generic drugs it seems are not immune to outrageous prices. How in the world can potassium chloride, hardly something that even needs to be manufactured, cost $120 for a script? Tap, tap. “Your money or your life.” Of course, all the new drugs are biologics - monoclonal antibodies, antivirals, immune suppressants. They target previously untreatable diseases like Hepatitis C, cancer, autoimmune diseases. They’re good, very good. And they’re expensive, very expensive. You could buy a nice house to be treated with one of these. Of course, your insurance company might not cover the treatment, or the copay might be beyond your means. The pharmaceutical company “might be able to help.” But they also might not be. What happens to the patient? No treatment. Slow decline. Organ failure. Eventual death. Tap, tap. “Your money or your life.” The latest is a drug for a previously fatal childhood disease. The cost? $2 million.1 I don’t even want to think about the conversation that might occur between that child’s parent and the

pharmaceutical executive. Would it go like this? Tap, tap. “We can cure your child for $2 million, otherwise he will die. Cough up.” All this behavior by pharmaceutical companies seems pretty awful, but their most egregious behavior actually started about 20 years ago when they realized that they had a very special class of drugs that was capable of exponential growth in all segments of the population. The demand for this class, unlike that for many other classes of drugs, just grew and grew. The more they sold, the more demand there was. I’m talking about, of course, the opiates. The challenge, of course, was to convince doctors that opiates were not addicting, and they did this by creating several entirely new opiates, which were actually more addicting than the previously prescribed opiates; then fabricating medical studies purporting to show that these new opiates were not addicting at all; then presenting these bogus studies in slick shiny brochures, using armies of drug reps; basically lying to doctors; convincing them to prescribe for their patients, then addict entire communities; contributing to the deaths of probably 400,000 Americans over those 20 years. Tap, tap. “Your money and your life.” continued on page 9

Today’s lifesaving drugs have seen an alarming, staggering and unconscionable increase in price. In the case of insulin, for example, diabetics, even those with insurance coverage, often struggle just to cover their copays.

The Bulletin | October 2019

MEDICAL MISSION ARTICLES NEEDED

continued from page 8

There is no excuse. One might ask why all this happens; why a previously respectable industry has morphed into one that puts profits ahead of the welfare of the people it serves. Another question might be whether any for-profit organization can prevent itself from being corrupted in this way. Clearly, the public has had enough. Changes are coming. No one knows what is ahead. Some have asked for more regulation, some for new laws, some for a total change in our healthcare system to cut out the profit motive. What would you like to happen? And when?

The SCMS will again feature the Medical Missions of our members (physicians, residents and medical students) in the December 2019 Bulletin. If you or someone you know of has participated in a medical mission (at home or abroad) within the last year or so, please contact Joan Cramer at jmcramer@ sbcglobal.net. We are looking for articles of approximately 400-800 words in length (submitted in Word format) along with photos (submitted individually as JPEGs) to publish for each Medical Mission article. The deadline for submission is Wednesday, November 20, 2019, to jmcramer@sbcglobal. net. Depending on the number of articles received, we may need to publish some of the articles in future issues of The Bulletin.

1 The previous record high drug price was about $100,000. This drug is 20 times that. Will the next big drug cost twenty times $2 million, or $40 million?

ATTENTION RETIRED MEMBERS! Retired physicians meet for lunch every Wednesday at 12 noon at IHOP, 2255 Tittabawassee Road in Saginaw. Those attending are responsible for their own lunch, and the informal gathering lasts about an hour. Join your retired colleagues whenever you like! If you have any questions, please contact Joan Cramer at the SCMS office at 790-3590 or by email at jmcramer@sbcglobal.net.

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Healthway Compounding Pharmacy 2544 McLeod Dr. N. | Saginaw, MI 48604 | 989.791.1691 | www.healthwayrx.com The Bulletin | October 2019 9

The Saginaw County Medical Society Alliance Presents:

16th Annual “Jingle Mingle”

Purchase Some of the Area’s Most Unique Gifts

ST TO O C O N IN STOP OP! H AND S

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Saturday, November 23, 2019 Saginaw Country Club 4465 Gratiot Road, Saginaw 10:30 a.m. to 2:30 p.m.

Lunch | Unique Shopping | Christmas Piano Music | Specialty Drink | Mingling with Friends! No charge to stop by and shop, but if you plan to stay for lunch, a reservation and payment must be received by November 14. Extra lunches will not be available the day of the event. n Please make a reservation for _____ people at $40 per person (Only RSVP’s will be included in the prize drawings!) Names of those attending

n I/we would like to sponsor a table in the amount of $50* (name listed below) *Note: Table sponsorship does NOT include a ticket for lunch

Name of table sponsor

Total Enclosed: $_________

All proceeds benefit

Pregnancy Care Center of Saginaw 10 The Bulletin | October 2019

Please return this form with your check made payable to the SCMS Alliance no later than Thursday, November 14, 2019, to: SCMS Alliance • 350 St. Andrews Road • Suite 242 Saginaw, MI 48638-5988 Questions? Contact Keri Benkert at (989) 790-3590 or keri.benkert@sbcglobal.net

Were you aware that the Saturday before Thanksgiving is recognized as a National Day to support loved ones bereaved by a loss to suicide? For over 20 years, the Barb Smith Suicide Resource & Response Network has been host to Hope Starts Here, an annual event to recognize this day. This year, Hope Starts Here will be held on Saturday, November 23, from 9:30 a.m. to 2:30 p.m. at the Bavarian Inn Lodge in Frankenmuth. We will gather more than 200 participants to hear a guest speaker, visit resource tables, participate in art therapy, enjoy a meal and connect with others. We are pleased to announce our guest speaker, Gwen Kapcia, LBSW, CT. Gwen is the Director of Program Development at Starlight Ministries, a licensed Social Worker and certified in Thanatology. She has been involved in grief work her entire career, spanning over 30 years. A majority of that time was spent as Director of Grief Support at a large funeral home in the Lansing area where she led a suicide

survivor group. In addition, her experience includes facilitating support groups, teaching educational series on grief and providing individual support. She has directed six summer camps for bereaved children. She speaks frequently to community groups, churches and professional organizations, and has extensive experience in helping families who are hurting.

How Can You Help?

We are currently seeking sponsors for our Hope, Health, Connection and Friends packages. These packages help to offset the cost of our guest speaker, food and marketing/registration materials for the event. Your sponsorship will help make this a minimal registration fee event for all of our families. As you may know, many survivors have incurred hardships following the loss of a tragedy; it is our intention to bring them hope and healing without the added burden of financial stress. Hope Sponsor $2,000 | Health Sponsor $1,000 | Connection Sponsor $500 | Friends Sponsor $100 Please consider sponsoring this event by emailing Stacey Urbani at stacey@suicideresourceandresponse.net or calling (989) 781-5260 by Friday, November 15, 2019.

The Saginaw County Medical Society is a proud sponsor of this yearâ€™s Hope Starts Here.

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NOVEMBER BIRTHDAYS Raya C. Beiz MD Michael T. Bergeon MD Vedang J. Bhavsar MD John Blebea MD Michael A. Butman MD Jessica N. Buttinger (Student) Jeffery W. Carney MD Meagan A. Crofoot MD Anthony deBari MD Peter Drake (Student) Michael J. Fazzini DO Matthew C. French DO Christopher M. Gill DPM Mark G. Greenwell MD Zeina Habib MD Ronald C. Hazen MD Christopher R. Heberer DO Danielle L. Hebert (Student) Furhut R. Janssen DO Beverly A. Jarema DO Adebambo M. Kadri MD Phadej Keopunna MD George E. Kikano MD Nikolai Kinachtchouk MD John M. Kosanovich MD Neil W. Love MD

Mona Mahmoud MD Michael Megaly (Student) Asad I. Mehboob DO Kirstan K. Meldrum MD Bernard D. Noveloso MD Loretta R. O’Donnell MD Christopher J. Osterbauer DO Jorge M. Plasencia MD Tracie I. Potis MD Christopher L. Price MD J. Eugene Rank MD Rita S. Ratani MD Pallavi Rath MD Deborah L. Russell MD Anastasiya Shchatsko MD Julie Taylor MD Spencer J. Thornock MD Patricia V. Valia MD Happy Special Birthday! Brett T. Vander Baan MD Chandler G. Veenhuis DO Melissa J. Victor MD Michael W. Warren MD Mildred J. Willy MD Pervez Yusaf MD

Find Us and Like Us on Facebook! Visit Us At www.SaginawCountyMS.com

P 989.755.2116 F 989.755.2120 Let us build a relationship with you. Please call Dornbos for your printing needs! 12 The Bulletin | October 2019

2019 SCMS Private Membership Directory Reminder! The 2019 SCMS Private Membership Directory is available electronically and for download by clicking on the picture of the cover at www.SaginawCountyMS.com under the “Membership” tab. If you did not receive a hard copy of the new Directory in the spring, please contact the SCMS at keri.benkert@ sbcglobal.net

APPLICATION FOR MEMBERSHIP SECOND READING: Application for membership that may be recommended for acceptance at the Tuesday, October 15, 2019, Board Meeting: Elizabeth M. Marshall, MD (Ascension Medical Group Frankenmuth Family Physicians) Specialty: Family Medicine (Board Certified 2019) Medical School: University of Michigan Medical School, 2016 Internship/Residency: University of Michigan Medical School, 6/16-8/19 Sponsors: Doctors Brian F. Perry and Michael J. Wolohan

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Patients, Doctors, Providers say Health Can’t Wait Prior authorization red tape and step therapy delays care and treatment for Michigan patients

Michigan physicians, clinicians and health care providers see it every day. They examine patients and together form a plan of care, often including additional tests, prescription medicines and treatments – before insurance companies step in with prior authorization and step therapy red tape to prevent patients from immediately accessing the care they need. When insurance company bureaucracy gets between a physician and his or her patient, patients get sicker, health conditions worsen and the cost of care skyrockets. That’s not right. Health Can’t Wait, and we’re doing something about it. Health Can’t Wait is a coalition of patients, health care providers and patient-support groups working together to put Michigan patients first by ending dangerous delays in patients’ access to health care caused by insurance company bureaucracy, including prior authorization red tape and step therapy requirements. The coalition is being led by more than a dozen patient advocacy and health care organizations, including the American Cancer Society Cancer Action Network, Susan G. Komen Michigan, Michigan State Medical Society, Saginaw County Medical Society and many, many more. You can learn more about Health Can’t Wait, the growing coalition, and its work online at HealthCantWait.org.

BUT WE NEED YOUR HELP! There are three things you can do to make a difference. First, share your story. Have you, a patient or a member of your health care team witnessed or experienced a delay in care caused by prior authorization or step therapy? You can share your story – and your patients can share theirs – online at HealthCantWait.org . Your patients’ willingness to speak out about the impact insurance company red tape has had on their health couldn’t be more important, and sharing their story couldn’t be easier. Second, share the news about the coalition and the

importance of this reform. Share the website on social media. Speak out to your friends, family and colleagues, and consider reaching out to your own lawmaker to encourage reform. The team at MSMS is standing by to help you craft and share your story, and to connect you directly with your state legislators. Third, please consider a donation to Health Can’t Wait. Simply click “contribute” on the website to join our team. Your contribution could make all the difference. The HealthCantWait.org coalition’s work couldn’t be more important. Ninety-four percent of Michigan physicians report that prior authorization red tape causes delays in care for their patients. Prior authorization red tape is part of a staggering 92 percent of all care delays, and those delays can be devastating. In fact, 78 percent of physicians trace prescription and treatment non-adherence to prior authorization delays. In other words, when red tape and bureaucracy prevents patients from timely access to the medicine and treatment they need, those patients are dramatically more likely to suffer the devastating health effects that come from nonadherence. Sicker patients. More frequent visits to the emergency room. Longer hospital stays. Bigger bills. That’s not right. HealthCantWait.org. SHARE YOUR STORY! Following is a shocking example of what can happen when treatment is delayed because of prior authorization. It is the story of SCMS Executive Director, Joan Cramer’s husband. With his permission, their story has been shared on the HealthCantWait.org website, with lawmakers at a prior authorization roundtable hosted by MSMS/SCMS in August, and on social media. Joan’s husband is quick to say it is not “his story,” but “their story” - he as the patient and she as the caregiver. Speak up. Share your story. You could save a life.

Joan’s Story In 2005, at the age of 44, Joan’s husband had two vertebrae in his neck fused. The procedure had gone well enough, but Joan and her husband were told to expect some complications further down the line. “After the procedure, the neurosurgeon told my husband he expected to see him back in 10-15 years, thinking complications and pain would likely reemerge as my husband aged.” And like clockwork, that’s exactly what happened. “In 2016, my husband started experiencing pain similar to what he had felt prior to his fusion in 2005. Unfortunately, it escalated very quickly - twice in the coming months, I had to take him into the emergency room because the pain was so severe.” On both visits, Joan’s husband was instructed to follow up with his primary care physician, which he did. “For the next few months, we were stuck in this weird limbo. My husband’s symptoms would suddenly emerge and then randomly disappear within two to three days. His primary care doctor wanted him to have an MRI but Blue Cross wouldn’t authorize it until he had completed physical therapy, but each continued on page 14

The Bulletin | October 2019 13

HEALTH CAN’T WAIT ACTION DAY

continued from page 13

time he was able to actually get into see a physical therapist he was pain free, so there really wasn’t anything they could do for him.” Joan and her husband found themselves stuck in this loop for the next two months. That changed in February of 2017 when Joan’s husband woke up and couldn’t move a muscle. He was completely paralyzed. “I called the ambulance and they rushed him off. This time they finally ordered the MRI. The doctor that saw him that day was amazed he had been walking around and worked the day before. He spent a few days in the hospital and was then sent home on an intense steroid regime just to calm down the nerves and spinal cord enough for surgery.” Eventually surgery came. Joan’s husband’s cervical spine was opened and his spinal cord was decompressed, and all the vertebrae in his neck were fused with a titanium plate and screws. He was off work for an entire year for recovery. “My husband had to relearn how to do everything - walking, eating, bathing, getting dressed - everything. It was such a terrible ordeal.” And it could have all been avoided. “It should have never happened this way. Had my husband’s primary care doctor been allowed to order the MRI when these symptoms first started to reappear, they could have addressed the issue surgically before things got so bad. He would have never had to spend a full year off work and on disability. Prior authorization almost cost my husband his life.”

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Wednesday, October 30, 2019 | 9 a.m. to 3 p.m. Radisson Hotel, 111 N. Grand Ave., Lansing, MI Reform won’t be possible without the collective voice of Michigan’s physicians, practice managers and patients, standing together and taking on this fight. Your voice is the key to our success at the Capitol! Agenda: 9-9:15 a.m. 9:15-9:45 a.m. 10-11:50 a.m. 12-1 p.m. 1-3 p.m.

Check-in Briefing on Legislation and Advocacy Meetings in the State House Lunch Meetings in the State Senate

Note: You may attend the morning session, afternoon session or all day. Walk away having learned firsthand how to participate and make a difference in the legislative process! Sign up to attend HERE or contact Joan Cramer at jmcramer@sbcglobal.net or (989) 790-3590 if you would like attend by October 25.

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The Saginaw County Medical Society Membership Meeting was held on Tuesday, September 17, 2019, at Horizons Conference Center. The meeting was the 20th Annual Joint Meeting with the Saginaw Valley Osteopathic Society (SVOS). Mildred J. Willy MD, President, called the meeting to order at 7:05 p.m. Dr. Willy welcomed SVOS members and the evening’s speaker, Dr. Marcia Perry.

The next Membership Meeting will be held on Tuesday, October 15, 2019, at HealthSource Saginaw.

Dr. Willy thanked the following Key Providers in attendance for their ongoing support of SCMS programs: • Bieri Hearing Specialists – Cathy Bieri-Ryan and Jerd Clayton • CQ Technologies – Randy Norton, Sam Ramirez, Dave Root and Mark Vogel • Healthway Compounding Pharmacy – Larry Greene Dr. Willy welcomed and introduced new members attending their first meeting: 1) Karensa L. Franklin MD, Covenant MedExpress Family Medicine and new Alternate Delegate 2) Elizabeth M. Marshall MD, Ascension Medical Group Family Medicine (member in process) 3) Jennifer M. Romeu MD, CMU Family Medicine 4) CMU Emergency Medicine Residents: a) Igor D. Middlebrook DO b) Rupinder K. Sekhon MD c) Vina V. Tran MD d) Christopher D. Trumph DO e) Samantha A. Wong DO

September Memb

(from left) Larry Greene of Healthway Pharmacy and Dr. Tom Raymond SCMS Board meets prior to membership meeting Welcome new Key Provider CQ Simple 16 Dr. Brenda Coughlin and Cathy Bieri-Ryan of Bieri Hearing

Dr. Willy then conducted the following business: • The Minutes of the May 21, 2019, Annual Membership Meeting were attached to the Agenda and published in the May/June Bulletin. MOTION: Accept the May 21, 2019, Meeting Minutes as printed. MOTION APPROVED. • Noted today was National Physician Suicide Awareness Day. The third Tuesday in September has been designated as the day to help spread awareness about physician suicide. Dr. Willy told those attending if they would like more information on suicide awareness and training opportunities to contact Joan at the SCMS. • Reminded members the 2019 Private Membership Directory is available at www.SaginawCountyMS.com under the “Members Only” tab, and to click on the picture of the cover to access and download. • Referenced Attachment #2 regarding Prior Authorization, and asked members to contact their lawmakers. • Referenced Attachment #3 regarding Surprise Billing, and asked members to contact their lawmakers. • Reminded members about upcoming programs: 1) “Has Michigan Gone to Pot? Current Cannabis Practices & Controversies” presented by CMU College of Medicine OCME to be held on Saturday, September 28 at Horizons. 2) Deepak Chopra MD at the Temple Theatre on Thursday, September 19.

3) 28th Annual Robert M. Heavenrich MD Endowed Lecture on Thursday, October 17 at Horizons. • Asked if anyone from the SVOS had any business or announcements, but no one did. Dr. Willy welcomed Marcia A. Perry MD, Clinical Assistant Professor in Emergency Medicine at the University of Michigan. Dr. Perry’s program was “Diversity, Equity and Inclusion Strategies: Caring for Changing Population Demographics.” Members were reminded to sign in at the registration table and complete the online CME evaluation through CMU OCME to obtain credit. The next Membership Meeting will be held on Tuesday, October 15, 2019, at HealthSource Saginaw. Drs. Bradford Walters and Howard Mell will present “Beyond Run, Hide, Fight: Workplace Violence.” There being no further business, the meeting was adjourned at 8:43 p.m. Respectfully submitted, Joan M. Cramer Executive Director

bership Meeting

Clockwise from top Audience listens to presentation Dr. Marcia Perry (l-r) Drs. Dan Duffy, Dave Wiersema, Mike Sullivan and Millie Willy (l-r) Drs. Peter Bistolarides, Judy Blebea and John Blebea

Medicare Advantage It was recently announced that Covenant HealthCare and Physicians Health Plan (PHP), part of Sparrow Health System, will launch a Medicare Advantage (MA) plan across 12 counties in 2020. Covenant Advantage will be available in Bay, Saginaw and Tuscola counties. Sparrow Advantage will be available in Clinton, Eaton, Gratiot, Ingham, Ionia, Montcalm and Shiawassee counties. In Calhoun and Kalamazoo counties, seniors will have access to care through PHP Advantage. Eligible enrollees can begin to sign up for the new plan during the Medicare annual enrollment period starting October 15, 2019. Coverage for beneficiaries will begin January 1, 2020. Covenant Sports Medicine Offers One-Call Services Covenant Sports Medicine is comprised of ten physicians plus a team of medical experts. They provide sports injury care, rehabilitation and fitness information, consultation over the phone or in person (available by appointment) and “on call” after hours sports injury care for high school, collegiate and recreational athletic practices and events. The team can be reached at: 989.583.7778 In addition to the above, the following services are available: • Evaluation and management of athletes/active individuals with surgical and nonsurgical musculoskeletal injuries. • Treatment of muscle strains, ligament sprains, contusions, fractures, joint injuries and pain. • Pre and post-ImPACT testing and treatment for concussions. • Prompt evaluation of injuries, providing safe and rapid return to activity. • Sports physicals. • Onsite x-rays.

Medication Take Back Event Scheduled for October 26 Covenant HealthCare, in collaboration with the Saginaw County Health Department (SCHD) and Saginaw Police Department, will host a Medication Take Back event on Saturday, October 26 from 10 a.m.-2 p.m. in the parking lot of 800 Cooper in Saginaw (Physician Office Building). Community members can drive-thru and drop-off unwanted or unused prescription medications, including pills and capsules (no liquid filled), patches, pet medications and expired or unwanted prescriptions (including controlled substances). No needles, syringes, inhalers, lancets or liquids will be accepted. Saginaw City Police and Covenant employee volunteers will be on-site. Here is how you can help: • Bring your own unused medications and tell a friend. • Spread the word in your community and your patients. • Share the event on social media. Properly disposing of medication can save a life. Free Mammograms Available Year-Round by Appointment Free breast screening mammograms are available by appointment for those who qualify by calling the Covenant Breast Health Nurse Navigators at 989.583.5154 or 989.583.5263. Patients must meet the below criteria: • Age 40 or over • Uninsured • Have not had a mammogram in the past 12 months • Eligibility based on household income Advance sign-up is required.

Physicians on the Covenant Sports Medicine Team include:

Bryon Chamberlain, MD

Adam Cote, DO

Board Certified Orthopaedic Surgeon

Colleen Linehan, MD

Kurt Menapace, MD

Board Certified Orthopaedic Surgeon

18 The Bulletin | October 2019

Danielle Duncan, MD

Board Certified Orthopaedic Surgeon

Jeffrey Osborne, MD Board Eligible Orthopaedic Surgeon Fellowship - Sports Medicine

Lance Freeman, MD

Board Certified Emergency Physician CAQ, Sports Medicine

Brian Purchase, DO, FACOEP Board Certified Emergency Physician CAQ, Sports Medicine

James Jesko, DO

Board Certified Orthopaedic Surgeon

Michael Wolohan, MD Board Certified Orthopaedic Surgeon

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Extraordinary care for every generation. The Bulletin | October 2019 19

College of

Medicine New Patient Vaccination Policy for CMU Health Because we are committed to protecting the health of our patients and their families, CMU Health Saginaw locations now require all patients 18 years of age and younger be up-to-date on recommended vaccines by the Michigan Department of Health & Human Services to foster a safe, healthy environment in our medical clinics and community. We firmly believe that vaccinating children and young adults may be the single most important health-promoting intervention we perform as health care providers, and that one can implement as parents/caregivers.

Annual Report Published The CMU College of Medicine is proud to announce that we have completed and published the 2018 - 2019 Annual Report. Our Annual Report provides an overview of the recent achievements of our faculty, staff, students and residents, as well as, highlighting the progress of the college over the past year. Please take the time to access the report and review our year of accomplishments.

SAVE THE DATE & REGISTER NOW! 4th Annual Psychiatry Update Conference “Psychiatry for the Non-Psychiatrist” Friday, November 1, 2019 | 12-5 p.m. CMU College of Medicine | Saginaw Campus CMU Health – Psychiatry Department Registration Fees: $50 Physicians | $40 Allied Health Care Professionals $15 Non-CMU Residents/Students ACCREDITATION STATEMENT: Central Michigan University College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Central Michigan University College of Medicine designates this live activity for a maximum of 5.0 AMA PRA Category 5 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

For more information and to register, contact Katherine Flores at Katherine.flores@cmich.edu or (989) 746-7785.

Drs. Paulus and WintonLi Talk Surgical Oncology at SVSU Lifelong Learning Conference Elizabeth Paulus, MD, Surgical Oncologist, and Lisa WintonLi, MD, Breast Surgical Oncologist, recently represented CMU Health’s Department of Surgery and Ascension St. Mary’s Hospital Department of Oncology at the Saginaw Valley State University Osher Lifelong Learning Institute (OLLI) Conference. Saginaw Valley State University OLLI is a member-based organization that offers non-credit educational programs and travel opportunities for the over-50 population. The event saw almost 400 people, and Ascension was well-represented with members from its stroke, orthopedic and cancer service lines. Drs. Paulus and WintonLi gave an engaging presentation Elizabeth Paulus, MD focused on debunking myths and communicating facts about cancer. The duo also featured a few of the impressive surgical oncology services they offer through Ascension St. Mary’s Hospital.

Lisa WintonLi, MD

20 The Bulletin | October 2019

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Medical Director’s Report Najibah K. Rehman, MD MPH Mosquito-Borne Disease Michigan is experiencing the worst outbreak of Eastern Equine Encephalitis (EEE) in more than a decade, with eight human cases diagnosed in SW Michigan as of September 20. EEE is a mosquito-borne disease that was first classified in horses in the early 1800s. The case fatality rate for EEE is very high at ~33 percent. Three of our Michigan cases were fatal. Symptoms include fever, chills, body aches, joint pain, headache, disorientation, tremors and seizures, which can lead to permanent brain damage, coma and death. Individuals under 15 and over 50 are at greatest risk of developing severe disease. Children, individuals living in wooded areas, and those that work outdoors are at highest risk for exposure. MDHHS is encouraging individuals in affected counties to avoid participation in events that occur after dusk and to remain vigilant until the first hard frost of the year. As of September 17, Equine (horse) and white-tailed deer deaths caused by EEE were identified in Barry, Cass, Genesee, Kalamazoo, Lapeer, St. Joseph and Van Buren counties. Although there is no vaccine for humans, it is available for horses. Of nine horses diagnosed with EEE, none were vaccinated and all cases were fatal. All five deer diagnosed with EEE were euthanized due to severity of symptoms. Equine cases have since increased to 15. The Saginaw County Mosquito Abatement Commission (SCMAC) has one of the most comprehensive mosquito control programs in the State, led by an ever-impressive multidisciplinary team. They monitor mosquito populations for West Nile virus (WNV), St. Louis Encephalitis, Jamestown River Canyon virus, EEE and La Crosse Encephalitis. Locally, there has been an increase in WNV activity, detected in six birds and one mosquito. There have been no human cases in Saginaw County. Although detection of WNV is low compared to previous years, additional control efforts have been implemented in those areas. St. Louis encephalitis and Jamestown Canyon virus have also been found in mosquitos locally, and therefore important to include in your differential diagnosis. Protect against mosquito bites by using repellant containing DEET or any other product labeled with EPA approval. Wear long-sleeved shirts and pants when outdoors, apply insect repellant on clothing, maintain secure windows and doors to prevent mosquito entry, and do not allow water to pool, i.e. buckets or old tires - these are ideal mosquito breeding sites. SCMAC recycles used tires from May-August,

as well as, many other services! I urge you to review their website to learn more about how they protect our community: https://scmac.org/. Vaping Injuries As you are all aware, the country is experiencing an outbreak of severe pulmonary disease associated with e-cigarettes and vaping. Locally, Michigan became the first state to announce the ban of flavored nicotine vaping product sales to minors. Governor Whitmer released emergency rules on September 18 whereby retailers have 14 days to comply with the new laws. As of September 17, there have been 530 cases of lung injury associated with e-cigarette use or vaping in 38 states and one territory. There have been seven confirmed deaths. The CDC has been unable to identify a substance or product linked to the cases. Most cases have reported the use of THC or CBD, although nicotine use alone was also present. Most patients were hospitalized for respiratory illness, received treatment for infectious causes and some have responded to steroids with or without antibiotic therapy. For clinicians, a confirmed case definition includes the following: 1) Using an e-cigarette or dabbing within 90 days prior to symptom onset, AND 2) Pulmonary infiltrate on plain film or ground glass opacities on CT, AND 3) Absence of pulmonary infection on initial workup, AND 4) No evidence of alternative plausible diagnosis (cardiovascular, cancer, rheumatologic). The FDA is requesting retrieval of equipment used by patients within 90 days prior to illness onset to aid in testing for potential causative agents - please do your best to obtain these while reassuring the patient that it is for investigation purposes only. Additionally, the CDC’s pathology lab is requesting obtainment of tissue blocks from lung biopsies - please call the Saginaw County Health Department (SCHD) for guidance on sending samples out. If you suspect any cases, the SCHD will aid in the investigation. We are required to investigate and report any cases to MDHHS using standard operating procedures as provided by the CDC. Your clinical expertise is crucial, and we continue to appreciate and value your contributions to the public’s health. For any questions or concerns, please do not hesitate to contact our CD program at (989) 758-3887 or (989) 758-3880. If you have any topic requests, please contact me at (989) 758-3719 or nrehman@saginawcounty.com before the 15th of the month. The Bulletin | October 2019

25th Annual Ascension St. Mary’s Cornette Ball to Honor Dr. Rao Gudipati

or tamera.weighman@ascension.org, or visit stmarysofmichiganfoundation.

Ascension St. Mary’s Foundation is pleased to announce that Rao V.C. Gudipati MD, FACC, FAHA will receive the prestigious Spirit of St. Vincent Award. Dr. Gudipati will be honored during the 25th Annual Cornette Ball on Saturday, November 16 at 5:30 p.m. at Horizons Conference Center. Dr. Gudipati began his practice with Valley Heart Institute in 1990 and Michigan CardioVascular Institute in 1998, totaling almost 30 years of service to the Saginaw and surrounding communities. He served as president of MCVI for eight years. He also served on the board of the Saginaw County Medical Society from 2004 to 2012, including as President from 2007-2008. He served as president of the SCMS Foundation from 2010-2012, and started the annual golf outing which is their primary fundraiser. He served as a member of the Board of Medicine of Michigan from 2008 to 2011. Dr. Gudipati specializes in cardiology and is board certified in internal medicine, cardiovascular disease, interventional cardiology and adult comprehensive echocardiography. He has received numerous honors and awards throughout his time in the medical field including Fellow of the Year at St. Louis University Medical Center, Division of Cardiology and Chief Resident in the Department of Medicine at the Chicago Medical School. He was major contributor to the Central Michigan University College of Medicine, and has been a clinical associate professor at CMU College of Medicine since 2014. He previously taught at Michigan State University College of Human Medicine and the Chicago Medical School. He has conducted many medical research projects, and has published a multitude of scholarly papers and other works. He was also Best All-Around Student at Guntur Medical College in 1976. The Ascension St. Mary’s Foundation Cornette Ball is one of the grandest black-tie galas in the region. The festive evening includes a cocktail hour, a magnificent five-course gourmet meal and live music by Detroit’s Intrigue. The Spirit of St. Vincent Award is presented annually to at least one highly respected physician or group who has rendered long and noteworthy service to the Great Lakes Bay community and beyond. For sponsorship information or details about attending the event, please contact Tammy Weighman at 989.907.8875

Health & Wellness Care for the Business Community

The Bulletin | October 2019

Ascension Michigan at Work is joining the lineup of programs available at Ascension St. Mary’s. Solely focused on the health and wellness for the greater Saginaw area business community, Ascension Michigan at Work is committed to providing the highest quality medical care and preventative services, as well as, safety and health education to area employers. Services can be customized to meet the needs of each business. The new Ascension Michigan at Work clinic is at the Ascension St. Mary’s Towne Centre facility, 4599 Towne Centre Road, in Saginaw. Services offered include: • DOT and employment physical exams • Drug and alcohol testing • Employee wellness programs • Return to work programs • OSHA Complaint Medical Surveillance Programs In addition to Saginaw, there are 14 other locations including Grand Blanc, Howell, Rochester, Novi, Livonia, Madison Heights, Macomb Township, Southfield, Grosse Pointe Woods, East China, Battle Creek, Coldwater, Kalamazoo and Portage. Ascension Michigan at Work is the largest hospital based occupational health program in the state. For more information, contact Rachael Wilson, Account Executive, at 989-907-8244.

Ascension St. Mary’s Parking Lot to Close for Emergency Care Center Construction Project Effective September 30, the Emergency Department parking lot will be closed for the construction of the new Emergency Care Center. Physicians and providers can park in the designated medical staff parking lot located near the Human Resources entrance. Visitor parking will be redirected to the other main parking lots at the front of the hospital. Associates working evenings, nights and weekends will also be able to park in the front hospital parking lots.

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

Welcome New Physicians Ascension Medical Group and Ascension St. Mary’s are pleased to welcome these new physicians to our employed medical staff.

• Cardiothoracic Surgery Chris Liakonis, DO | (989) 754-3000

• Family Medicine

Chris Liakonis, DO Cardiothoracic Surgery

Roma Srivastava, MD Hematology/Medical Oncology

Elizabeth Marshall, MD Family Medicine

Iftikhar Khan, MD Neurology

Angel Bermudez, MD Orthopedics

Eric Bialaski, DO Neurosurgery

Medley Larkin, DO Gastroenterology

Timothy Gates, DO Neurosurgery

Erika DeGayner, DO Gastroenterology

Nnenna Mbabuike, MD Neurosurgery

Shawn Ingles, DO Gastroenterology

Thomas O’Hara, MD Neurosurgery

Harprabhjit Singh, MD Gastroenterology

Kevin Lawson, MD Orthopedics

Rajeev Tummuru, MD Gastroenterology

Laura Reitz, DPM Podiatrist/Foot and Ankle Surgery

Elizabeth Marshall, MD | (989) 652-5220

• Family Medicine - Sports Medicine Angel Bermudez, MD | (989) 799-1350

• Gastroenterology Medley Larkin, DO Erika DeGayner, DO Shawn Ingles, DO Harprabhjit Singh, MD Rajeev Tummuru, MD The physicians of Ascension Valley Gastroenterology practice throughout the region. | (989) 791-9133.

• Hematology/Medical Oncology Roma Srivastava, MD | (989) 497-3226

• Neurology Iftikhar Khan, MD | (989) 799-2640

• Neurosurgery Eric Bialaski, DO Timothy Gates, DO Nnenna Mbabuike, MD Thomas O’Hara, MD They join neurosurgeons E. Malcolm Field, MD; Joseph Adel, MD; and Naman Salibi, MD. | (855) 298-9888

• Orthopedics Kevin Lawson, MD | (989) 799-1350

• Podiatry Laura Reitz, DPM | (989) 790-6719

The Bulletin | October 2019 23 83293_Ascentions_WelcomePoster.indd 1

5/2/19 7:47 AM

Michigan’s Ban of Flavored Vaping Products to Protect Children’s Health Effective Immediately with Rules Filing Retailers will have 14 days to comply with emergency rules Gov. Whitmer’s emergency rules banning flavored nicotine vaping products were released on September 18. The flavored nicotine vaping ban was developed in response to the Michigan Department of Health and Human Services (MDHHS) finding of a public health emergency created by skyrocketing levels of youth vaping. Michigan was the first state in the nation to announce a ban on the sale of flavored nicotine vaping products such as e-cigarettes. Whitmer announced her intention to issue these emergency rules on September 4, and they are effective immediately, although retailers and resellers – including online sellers – have 14 days to comply. “I’m proud that Michigan has been a national leader in protecting our kids from the harmful effects of vaping,” Whitmer said. “For too long, companies have gotten our kids hooked on nicotine by marketing candy-flavored vaping products as safe. That ends today. This bold action will protect our kids and our overall public health.” Following Whitmer’s announcement of the flavored vaping product ban, the White House followed Michigan’s lead with a call for similar actions by the U.S. Food and Drug Administration. Additionally, New York Gov. Andrew Cuomo and California Gov. Gavin Newsom announced plans to move forward with flavored nicotine vaping product bans, and the New York plans have been approved. The MDHHS Bureau of Health and Wellness filed the Protection of Youth from Nicotine Product Addiction Emergency Rules with the Secretary of State. READ MORE

Surprise Billing: Unanticipated Out of Network Billing Debate to Unfold in Michigan – What You Should Know Lawmakers in Michigan, in Congress and around the country are debating the appropriate recourse to address unanticipated out-of-network bills. Patients are receiving these high bills because the care they believed was covered actually was not. This is a problem, but is also a complex issue tied up in provider-payer negotiations and market dynamics. Unfortunately, the sponsors of legislation introduced in Michigan – HB 4459 and 4460 – believe there is a simplistic answer, namely implementing a payment standard of 125 percent Medicare for out-of-network cases. As proposed, Michigan’s approach to out-of-network billing would constitute the most aggressive form of rate-setting in the nation. MSMS supports holding patients harmless from unanticipated, out-of-network medical bills and believes 24

The Bulletin | October 2019

the most effective approach – and where we have seen robust success in other states – allows the insurers and provider to negotiate in good faith with an independent dispute resolution process in place for the rare cases when negotiations break down. We do not, however, support codifying a payment standard that could, paradoxically, lead to more widespread out-of-network cases. We could see debate on this issue in the House of Representatives Health Policy Committee as soon as October, with pending activity in the Senate as well. As we near the debate, MSMS has prepared talking points to assist members in speaking to their respective lawmakers. Also, depending on the trajectory of the debate, be on the lookout for updates and action alerts. Please contact your Congressional representative today by clicking HERE.

Gov. Whitmer Signs Bill to Mitigate Harmful Effects of Medicaid Work Requirements, Calls for Further Action to Protect Health Coverage Governor Gretchen Whitmer recently signed Senate Bill 362 into law, which will reduce the harmful impacts of Medicaid work requirements and protect Michiganders’ access to quality health care. “The Healthy Michigan Plan I worked to pass with Governor Snyder was a landmark bipartisan accomplishment, extending coverage to more than 680,000 people, increasing primary care usage, reducing dependence on emergency rooms, and strengthening our economy. But the work requirement legislation that passed last year puts that progress at risk,” said Gov. Whitmer. READ MORE

Michigan Joins the Interstate Medical Licensure Compact Commission In 2018, the Governor signed into law Public Act 524 of 2018 and Public Act 563 of 2018 which made Michigan a member of the Interstate Medical Licensure Compact Commission (IMLCC). The compact allows physicians (both MDs and DOs) who are licensed in other compact member states the ability to get licensed easier in the State of Michigan based on having a compact license. It also allows Michigan physicians to get licensed in other compact member states. Since the passage of this law, the Bureau of Professional Licensing has been working with the IMLCC to implement the program. As of September 24, 2019, Michigan physicians and physicians in other compact states will be able to take advantage of the IMLCC. LARA has published Medical Compact FAQs, a downloadable frequently asked question (FAQ) document with information pertaining to the IMLCC. You may also visit the IMLCC’s website for additional information. Should you have additional questions, please contact Brian DeBano, Licensing Director at 517-335-4282 or Kim Gaedeke, Chief Deputy Director of LARA and member of the IMLCC at 517-243-5044.

A Day of Board of Medicine Requirements Friday, November 1, 2019 9 a.m. - 2:45 p.m.

CONTINUING MEDICAL EDUCATION One of the many benefits you receive as a MSMS member is access to DISCOUNTED continuing medical education. For a full list of upcoming events visit msms.org/eo or call the MSMS registrar at (517) 336-7581.

Holiday Inn 3600 Plymouth Road Ann Arbor, MI 48105 Members - $195 Nonmembers - $275 Retired - $105

On-Demand Webinars MSMS has a catalog of on-demand webinars available, allowing you to watch and learn at your convenience. Check out the available series on Human Trafficking, Pain and Symptom Management, Medical Ethics and more HERE.

ASM 2019: Earn Up to 28.25 AMA PRA Category 1 Credit(s)TM One of the best ways for Michigan physicians to learn the latest in clinical sciences and implement this knowledge into their everyday practice while earning up to 28.25 AMA PRA Category 1 Credit(s)™, is to attend MSMS Foundation’s 154th Annual Scientific Meeting (ASM). The ASM will be held Tuesday through Saturday, October 22-26, at the Sheraton Detroit Novi.

AAFP Credit Pending October 22-26, 2019 Sheraton Detroit Novi The ASM features: • A selection of 25 courses during the five days • Two FREE one-hour plenary sessions • FREE Friday William Beaumont Lecture • Several options for courses on “Pain and Symptom Management” • Many opportunities to network with colleagues and exhibitors

For More Information For questions or additional information, contact Marianne BenHamza at (517) 336-7581 or mbenhamza@msms.org. 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 28.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only credit commensurate with the extent of their participation in the activity.

Let MSMS be your resource to earn the new mandated Michigan Board of Medicine CME - all in one day. From 9 a.m. - 2:45 p.m., presentations will address Pain and Symptom Management, Medical Ethics and Human Trafficking, fulfilling these additional requirements. 9 a.m. - 12 p.m. Pain and Symptom Management 12 - 12:45 p.m. Lunch 12:45 - 1:45 p.m. Human Trafficking 1:45 - 2:45 p.m. Medical Ethics For More Information For questions or additional information, contact Beth Elliott at (517) 336-5789 or belliott@msms.org. 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 5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

23rd Annual Conference on Bioethics – End of Life Care Saturday, November 2, 2019 9 a.m. - 4 p.m. Holiday Inn 3600 Plymouth Road Ann Arbor, MI 48105 Members - $195 Nonmembers - $275 Retired - $105 For More Information For questions or additional information, contact Beth Elliott at (517) 336-5789 or belliott@msms.org. REGISTER ONLINE

READ MORE REGISTER ONLINE The Bulletin | October 2019 25

Deprescribing By Louis L. Constan, MD Your grandmother fell and broke her hip. A common occurrence for aging adults in America. Just another accident. And yet, you wonder, was it entirely an accident? Could it have been prevented? Let us consider your grandmother’s medical situation. Like many aging adults, she is on several medicines for a variety of medical problems. And it turns out, according to medical experts who have been sounding the alarm recently, she may have, like many in her age group, accumulated entirely too many medications. She has pills from her family physician, several more from her cardiologist, another from her orthopedist, another from her chiropractor, another from the urgent care, another over the counter, another from her friend next door. And no one knowledgeable about pharmacology quite knew just what she was taking. This is quite common - in America today, fully 40 percent of older adults are on five or more prescription medicines, and this can be quite dangerous. • First, statistically, when you reach the magic number of five medicines, it becomes much more likely that there will be a drug-drug interaction between two of those drugs. Which two is never clear, but the statisticians say that the risk is there. • Second, many drugs in the elderly have side-effect profiles that include, at times, light-headedness or confusion, both of which increase the risk of falls and fractures. • Third, aging adults generally suffer from declining excretion of drugs over time. That is, their kidneys and livers, the two major avenues of eliminating drugs from their bodies, lose effectiveness over time. Therefore, a drug that they tolerated last year…they may not tolerate this year. • Fourth, their capacity for excretion via the kidneys and liver may, with their current load of drugs, be at maximum, so that should, for any reason, someone decide to add an additional drug, they might easily get into an overdose situation. For instance, should grandmother go to urgent care and get a new medicine; or decide to take some OTC medicines for a

The Bulletin | October 2019

cold; or be given some herbal medicines by a friend to “pep her up.” As you can see, there are so, so many reasons why older Americans might inadvertently take too many medicines which can cause harm. Just how big is this problem? A recent review in “Health Affairs” reports that, every day, 750 people over 65 are hospitalized for an adverse drug event which will result in 150,000 premature deaths over the next decade costing $60 billion. This is a problem deserving of attention from both physicians and patients. The first step is to become familiar with the Beers Criteria Medication List (after the geriatrician Dr. Mark Beers), the definitive list of potentially inappropriate drugs in aging adults. This list, put out by the American Geriatric Society and updated frequently, includes many tranquilizers, sedatives, antihistamines, muscle relaxers, antireflux drugs, NSAIDS and some antibiotics. Doctors need to consult this list before prescribing these drugs to the elderly. If a drug must be used that is on the Beers criteria, the patient must be made aware of the potential side effects, and should be seeing the doctor regularly to monitor for those side effects. And for the 20 percent of elderly patients who are on ten or more drugs, (yes, you read that correctly), there is something called “deprescribing.” Under certain conditions, carefully, and only under medical supervision, some medicines may be deprescribed: • IF there are adverse effects experienced by the patient that are greater than the benefits. • IF the medicine was for symptoms which are now resolved. • IF the medicine is for prevention in a patient who has a limited life expectancy because of cancer or other severe life-shortening illness. Medicines may be deprescribed with careful monitoring, but only one at a time and, again, only under a doctor’s supervision. Going forward, and practically speaking, every older patient, at every visit, by every specialty, needs a medicine review, especially if they are on five or more medicines, and this includes OTC medicines and herbal remedies. Medicines that are no longer useful, or that may cause more harm than good, need consideration for being cut out of the list. Granted, this may get complicated when there are several different physicians involved, and this might require some sort of communication back and forth between physicians, or at least between the patient and those prescribing physicians; but how else to prevent needless suffering, hospitalizations, and deaths? And it could just be YOUR grandmother you save.

Caduceus Meeting for Recovering Health Care Professionals

How Can You Help? Do you want to raise awareness, volunteer or participate in an upcoming event? Contact Barb Smith at barb.smith@suicideresourceandresponse.net or 989-781-5260 and schedule a training or educational event or get more information.

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.

Barb Smith Suicide Resource & Response Network is supported solely by donations and grants. To make a donation, please make your check payable to Barb Smith SR&RN and mail to: Barb Smith SR&RN PO Box 6712, Saginaw, MI 48608-6712

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.

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The Bulletin | October 2019 27

Peer Review Ethics Committee The Saginaw County Medical Society has a Peer Review Ethics Committee (“Committee”) which is comprised of Waheed Akbar, MD – Chair, Caroline G.M. Scott, MD and James R. Hines, MD. Members of the Committee are elected by the membership. The following is the definition of the Committee pursuant to Chapter IX Conduct and Discipline of Members of the SCMS Bylaws: Section 5. PEER REVIEW ETHICS COMMITTEE. This Society shall have a standing committee designated the Peer Review Ethics Committee, charged with duties and powers concerning the maintenance of standards of conduct and discipline of

members including the duties and powers specifically set forth in this chapter. Whenever any matter of alleged misconduct is referred to the Peer Review Ethics Committee, such Committee shall have the right to conduct investigations and hearings thereon, both informal and formal, and to make findings of fact and recommendations for discipline. If you need to refer a matter to the Committee, please contact Drs. Akbar, Scott or Hines, or Joan Cramer at the Saginaw County Medical Society office. All matters are confidential and are not to be disclosed to the Board or membership.

Program Helps Impaired Health Care Professionals Health care professionals are not immune to substance abuse or mental health disorders. Many otherwise highly qualified professionals may develop these problems due to stress, long hours, a genetic predisposition, or a tendency to self-medicate. To assist health care professionals impaired by these disorders, consider the care monitoring services of the Health Professional Recovery Program (HPRP). The Michigan HPRP was established by legislation in 1993 to assist impaired professionals before their actions harm a patient or damage their careers through disciplinary action. Any licensed or registered health care professional in the State of Michigan is eligible to participate in the program. To maintain participant confidentiality, the HPRP is operated by a privatesector contractor under the authority of the Health Professional Recovery Committee (HPRC), a committee comprised of a representative from each of the health professional licensing boards. The Michigan Department of Community Health, Bureau of Health Professions provides administrative services to the HPRC.

Participation in the HPRP is confidential. If a licensee/ registrant is referred to the program, has a qualifying diagnosis and complies with the HPRP requirements, his/her name will not be disclosed to state regulatory authorities or the public. Provided there is no readmission, records of HPRP participants are destroyed five years after successful completion. Referrals to the HPRP may come in the form of a selfreferral from a licensee/registrant or from colleagues, partners, employers, patients, family members or the State. Any of the 20 health professional licensing boards may also refer licensees/ registrants to the HPRP for monitoring as a condition to regain or retain their license to practice. The names of individuals reporting a licensee/registrant suspected of impairment are also kept confidential. For more information on the HPRP, call 1-800-453-3784 or visit www.HPRP.org. Informational presentations on the HPRP are available to employers and health professional groups at no charge. Call the toll-free number to arrange a presentation at your facility.

TO MAKE A REFERRAL OR SELF REPORT, CALL 1-800-453-3784 SCMS Physician Health & Well-Being Committee Confidential assistance to physician members with personal issues affecting their private and professional lives The SCMS Physician Health & Well-Being Committee is a CONFIDENTIAL resource for SCMS members who have issues affecting their private and/or professional lives. The Committee acts totally independently, and NO INFORMATION is shared with the SCMS Board, members or staff. If you are in need of confidential assistance, or know of another member who is having a difficult time, please contact Joan Cramer, Executive Director, at (989) 790-3590 or cell (989) 284-8884 and she will CONFIDENTIALLY direct you. 28

The Bulletin | October 2019

Call for Resolutions: Who Sets MSMS Policy? You Do! The Michigan State Medical Society (MSMS) House of Delegates (HOD), comprised of 319 elected delegates, is the official legislative and policy-making body of MSMS and its component societies, including the Saginaw County Medical Society (SCMS). Resolutions debated during the annual MSMS HOD are the vehicles by which MSMS policies, priorities and directives are determined. Deadline for resolutions is March 1 at 5 p.m. Resolutions must be submitted via the online submission form. If you have any questions, contact Stacey Hettiger at (517) 336-5766. The best way to get your idea or recommendation adopted as MSMS policy or directive is at the grassroots level. As a member in good standing of MSMS/SCMS, you have the right to bring your ideas to the annual HOD for consideration by MSMSâ€™ "legislators." To do so, present your suggestion and rationale at the SCMS meeting. If the SCMS agrees, the SCMS will work with you to draft a resolution to be presented at the next HOD meeting. The resolution should specify the desired MSMS policy or directive for MSMS action. If the SCMS does not agree with your idea, you may ask another delegate to submit a resolution on your behalf as an individual delegate. It is also prudent to check MSMSâ€™ current Policy Manual and, if relevant, the AMA Policy Finder to determine if policy on the issue already exists.

MEDICAL RECORDS The SCMS does not, and never has, had possession of any patient medical records. If a physician was a member of the SCMS and is either retired or no longer practicing in Saginaw, we may know where the records are located. Generally, if a patient is looking for records from a specialist, we advise them to check with their primary care physician if the specialist is no longer practicing. Minimum Required Retention Period Unless a longer retention period is otherwise required under federal or state laws or regulations or by generally accepted standards of medical practice, a licensee (physician/health care provider) is required to keep and retain each record for a minimum of seven (7) years from the date of service to which the record pertains. Destruction of Medical Records Less than Seven (7) Years Old A licensee may destroy a record that is less than seven (7) years old only if both of the following are satisfied: a. The licensee sends a written notice to the patient at the last known address of that patient informing the patient that the record is about to be destroyed, offering the patient the opportunity to request a copy of that record, and requesting the patient's written authorization to destroy the record. b. The licensee receives written authorization from the patient or his or her authorized representative agreeing to the destruction of the record. Fees Pursuant to the Michigan Medical Records Access Act, licensees may charge a fee for the records. For 2019, the maximum charges are: o An initial fee of $25.06 per request for a copy of the records o $1.25 per page for the first 20 pages o $.63 per page for pages 21-50 o $.25 per page for pages 51+ For more information, review the Medical Records Guide under the Resources/Health Law Library at MSMS.org (member login required).

The Bulletin | October 2019 29

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The Bulletin | October 2019

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SCMS FOUNDATION Make a Tax Deductible* Gift Today!

WHAT IS THE PURPOSE OF THE FOUNDATION? • Provides low interest loans to medical students with ties to the Saginaw area, with a maximum of $20,000 over four years. The Foundation’s ultimate goal is to have loan recipients return to Saginaw to practice. • All interest is forgiven if the student returns to Saginaw upon completion of their residency to practice. • If the loan recipient returns to Saginaw to practice upon completion of their residency and they are a dues paying member of the SCMS/MSMS, 25 percent of the principal balance will be forgiven at the end of each year they are practicing in Saginaw County, with a maximum of $5,000 per year forgiven. • In the next seven years, the Foundation has the potential to forgive $120,000 in loans for those who are expected to return to Saginaw to practice. • Assists the SCMS Alliance (spouses of members) in awarding scholarships to Saginaw County nursing students. • Awards scholarships to high school juniors and seniors interested in becoming a physician and practicing in Saginaw County. • Provides scholarships, grants and awards to CMU medical students and residents for research projects. The annual Golf Outing raises approximately $20,000 per year for these programs, but the Foundation also relies on donations to continue to increase funding programs in order to assist as many students as possible. With the anticipation of forgiving loans for those who return to Saginaw to practice, the Foundation is calling on members to donate now so it can increase assets and continue to provide support as noted above. ➢ If you would like to honor a colleague who is living or deceased, please make a contribution to the SCMS Foundation ➢ Please remember the SCMS Foundation in your Will *The SCMS Foundation is a 501(C)(3) nonprofit. Gifts have charitable tax benefits so please consult with your tax advisor for specifics. A tax receipt will be provided. PLEASE COMPLETE AND RETURN THE FOLLOWING WITH YOUR CHECK (We are unable to accept credit card payments) -----------------------------------------------------------------------------------------------------------------------------------------------------------------------Enclosed is my contribution made payable to the SCMS Foundation (please designate amount): m $1,000

m $500

m $250

m $100

m $50

m Other __________

Donor’s Name ______________________________________________________________ Mailing Address ___________________________________________ City, State, Zip _____________________________________ Daytime Phone (_____) ________________ Email __________________________________________________________________ How would you like to receive your receipt?

r Email

r Postal Mail

If you wish to make your gift as a memorial or tribute, please provide the following: My gift is: m in honor of m in memory of Occasion/Person to be honored: _______________________________________ Please send notice of my gift (without specifying amount) to: Name _____________________________________________________________________ Mailing Address ___________________________________________ City, State, Zip _____________________________________ Checks should be made payable to the SCMS Foundation and sent to the SCMS office at 350 St. Andrews Road, Suite 242, Saginaw, Michigan 48638-5988. Thank you!

The Bulletin | October 2019 31

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

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2019-2020 KEY PROVIDERS

These Area Businesses Support Saginaw County Medical Society Membership Meetings. When you have a need for a service, please consider our Key Providers. Please mark your calendar for the following meetings and events in 2019. You will receive an email meeting notice and reminder each month for SCMS events. Non-SCMS events are listed as a courtesy and you must contact the sponsor directly to register. SCMS Membership Meetings are held on the third Tuesday of January, April, May, September and October. The SCMS Board meets on the third Tuesday of every month (except July and December) at 5:30 p.m. Thursday, October 17, 2019 Horizons Conference Center - 28th Annual Robert M. Heavenrich, MD Endowed Lecture. Charles C. Dike, MD, MPH, Associate Professor of Psychiatry, Law and Psychiatry Division, Associate Program Director, Law and Psychiatry Fellowship Program, Yale University School of Medicine will present “Social Determinants of Health, Adverse Childhood Experiences and Dangerousness: Opportunities for Intervention.”

Friday, November 1, 2019 Holiday Inn, Ann Arbor, Michigan - MSMS presents “A Day of Board of Medicine Requirements.” See page 25 for details and to register. Saturday, November 2, 2019 Holiday Inn, Ann Arbor, Michigan – MSMS presents “23rd Annual Conference on Bioethics – End of Life Care.” See page 25 for details and to register.

Tuesday-Saturday, October 22-26, 2019 Sheraton Detroit Novi – MSMS Foundation’s 154th Annual Scientific Meeting. See page 25 for details and to register.

Saturday, November 16, 2019 Horizons Conference Center - Ascension St. Mary’s Hospital’s “2019 Cornette Ball” honoring Rao Gudipati MD. See page 22 for details and ticket information.

Wednesday, October 30, 2019 Radisson Hotel, Lansing, Michigan - Health Can't Wait Coalition Action Day. See page 14 for details.

Tuesday, November 19, 2019 CMU College of Medicine, 1632 Stone Street – SCMS Board meets at 5:30 p.m.

Friday, November 1, 2019 CMU College of Medicine | Saginaw Campus, CMU HealthPsychiatry Department. Fourth Annual Psychiatry Update Conference, “Psychiatry for the Non-Psychiatrist” from 12-5 p.m. See page 20 for details and to register.

Saturday, November 23, 2019 Saginaw Country Club – 16th Annual Jingle Mingle benefitting the Pregnancy Care Center in Saginaw from 10:30 a.m. to 2:30 p.m. Visit www.SaginawCountyMS.com and click on Jingle Mingle under the Alliance tab. See page 10 for details.