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FOCUS TOPICS MENTAL HEALTH WORKFORCE IMPROVEMENT

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PHYSICIAN SPOTLIGHT PAGE 3

Anand Shridharani, MD

By CINDy SANDERS

ON ROUNDS CLINICALLY SPEAKING: New breast cancer treatment options boost survival, offer new hope As a surgical oncologist focused on treating breast cancer, I see daily how devastating a breast cancer diagnosis can be. But I also see daily how new and often cutting-edge treatments give women the hope and courage they need to help manage ... 4

LEGAL MATTERS: Healthcare Surrogates Get Increased Powers – Including Admission for Mental Health Treatment Effective July 1, 2013, those individuals designated as healthcare surrogates for others have additional powers in areas concerning mental health treatment, medical records access, or consent to disclosure of protected health ... 5

ONLINE: EASTTN MEDICAL NEWS.COM

Research Uncovers New Clues to the Causes of Schizophrenia An insidious condition, schizophrenia is estimated to occur in about 1 percent of the population worldwide. Characterized by a breakdown in thought processes, the mental illness has been described for centuries through accounts of individuals suffering from delusions, paranoia and hallucinations. The chronic, debilitating disorder takes a heavy toll not only on affected individuals but also on their families and society as a whole. An early onset disorder, many patients are first diagnosed during the late teens or early adult years and struggle throughout their lifetime to manage symptoms. “It’s a horrible disorder,” stated Patrick Sullivan, MD, director of the Center for Psychiatric Genomics at the University of North Carolina School of Medicine. “It’s a huge, huge public health problem, and it’s one where the scientific discussion has been

dominated on partial information.” He added, “People have done the best they can with what information they have. We’ve been debating the cause of schizophrenia for the better part of a century now.” On Aug. 25, Sullivan and colleagues helped move that conversation forward with the online publication of a new genome-wide association study (GWAS) in the journal Nature Genetics. “This is the largest published study we’ve done in the field,” noted the lead author who also serves as a professor in the departments of Genetics and Psychiatry and UNC. Collaborators in the study include co-authors from the Karolinska Institutet in Sweden, the Stanley Center for Psychiatric Research at the Broad Institute of MIT (CONTINUED ON PAGE 10)

Happy, Safe Workforce Prerequisite for Patient Safety Report Emphasizes Impact of Workplace Culture on Patient Outcomes By CINDy SANDERS

If the workforce ain’t happy … ain’t nobody happy. This spring the Lucian Leape Institute at the National Patient Safety Foundation (NPSF) released a report, Through the Eyes of the Workforce: Creating Joy, Meaning and Safer Health Care, that underscored the fundamental importance the workplace environment plays on patient safety. The result of two roundtables on the topic, the report contends patient safety is inextricably linked to healthcare workers’ own sense of safety and well being since providers who feel disrespected or threatened are more likely (CONTINUED ON PAGE 10)

To promote your business or practice in this high profile spot, contact Sharon Dobbins at East TN Medical News. sdobbins@easttnmedicalnews.com • 865.599.0510

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PhysicianSpotlight

It’s a guy thing Doc finds satisfaction in new approaches to men’s reproductive health By JOE MORRIS

When Anand Shridharani, MD, first began shadowing his uncle and some other doctors to see if he was interested in a medical career, he had no idea that he’d become the stork for many, many infertile couples. “I am originally from Boston, but came to the Chattanooga area when I was younger to spend time with my uncle, who is an oncologist,” Shridharani said. “I wanted to check out what doctors do because I was in college and thought I wanted to go to medical school but hadn’t really gotten my feet wet. I wanted some experience.” In addition to getting a close-up view of oncology, he also spent time with a cardiologist and surgeon. That led to a strong desire to “do what cancer docs do, which is help people who are so sick and dealing with so much stress.” That desire was further fueled when his own father was diagnosed with non-Hodgkin lymphoma, but it also got him thinking about quality of life issues, as well as treatments. That, in turn, has led to a busy career in urology, where he tackles everything from postsurgical care to erectile dysfunction, including Peyronie’s Disease, incontinence, and infertility. “I loved surgery, but general surgery didn’t jibe with me,” said Shridharani, who now is with Erlanger Health System as a member of Academic Urologists at Erlanger. “I was drawn to helping with things like incontinence and erectile dysfunction because they affect a ton of people. So, I’ve ended up with a specialty that helps a guy’s chances of becoming a father by doing reproductive surgery.” Shridharani received his medical degree from the University of Massachusetts Medical School and completed a preliminary internship in urology and general surgery at the University of Louisville. He completed the urology residency program at the Medical College of Wisconsin in Milwaukee, and also received advanced fellowship training in andrology and erectile dysfunction from the Medical College of Wisconsin. Over the course of his practice, he says that the advances in microsurgery may be the most groundbreaking, but that there’s still room for further advancements at many levels. “For example, getting a vasectomy is basic male contraception,” he said. “It is considered permanent. But for 20 years, we’ve been able to reconnect the tubes using an operating microscope and sutures finer than hair. Those surgeries and outcomes continue to improve because we’re getting more advanced with the surgeries, but also with looking at all the factors, such as the patient’s age and history, to give an individual assessment and a better outcome.” easttnmedicalnews

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Male reproduction issues, ranging from vasectomy reversal to infertility, are being treated more commonly now as many women wait longer to have children, and so often their partners have their own medical issues, or need to undo a familyplanning decision that was made years or even decades before. “If you’re at an advanced age, you need to look at your reproductive capabilities,” Shridharani said. “I often work side by side with reproductive endocrinology and infertility doctors who are working with women, so both partners are being treated at the same time.” That can mean everything from surgery to intra-cytoplasmic sperm injection, or ICSI, which involves DNA retrieval and subsequent in-vitro fertilization. “We have the ability now to do things

for people that two decades ago we could not help,” he said. “It’s opening up a whole new world for men who were thought to be sterile.” But to make all this happen, a fairly robust medical evaluation is required. This, too, is a departure from years past, when men would provide a sperm sample while their partner would endure much more in the way of testing and evaluation. “Usually when a couple is having issues getting pregnant, the first thing that will happen is the wife will get worked up, or they’ll say that it’s much easier and quicker to just check the guy’s semen,” Shridharani said. “We’re finding now that guys who have issues with fertility, that may be the tip of the iceberg. It could be linked with metabolic syndrome, cancer, genetic disease, and other things that we’re not finding out just by checking a semen analysis. There’s a lot more awareness now that a guy needs to be checked out and evaluated fully.” Because many of these other conditions link with male fertility, catching them at this point can lead to evaluation and treatment, he said. Beyond fertility issues, Shridharani said he enjoys his other quality of life treatment areas, such as post-surgical functional

restoration and erectile dysfunction. “When it comes to fertility, it really just breaks down to getting that couple pregnant,” he said. “The procedures may be a success, but I’m looking for them to have a baby. Finding the best option for them, the most effective and safe way to get them pregnant, that’s what makes me happy. But for men who are just looking to have an intimate relationship with their wife or partner, that’s a different kind of win. I want them to be happy with their sex lives, which can be really difficult after cancer surgery hasn’t taken away their bladder or prostate, and they have a high rate of erectile dysfunction and urinary leakage.” Curing cancer is, of course, the desired outcome from these surgeries. Restoring pre-surgery function is an equally important goal, Shridharani added. “After surgery, radiation, chemo, he’s left with something less than what he had prior,” he explained. “I enjoy trying to give that back. We can run the gamut from medications to injections, and even surgical technologies such as prosthetics. I follow the leaders in my field and keep up with the research because I want to make sure that I’m not shortchanging anybody. I’m here for them.”

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Italian Inspiration featuring Members of the East Tennessee State University Symphonic Wind Ensemble and Concert Band Saturday, November 16, 7:30 p.m.

Johnson City Symphony Orchestra

Mary B. Martin Auditorium at Seeger Chapel, Milligan College

A wind ensemble made up of local brass musicians, coordinated by Christian Zembower, joins with the Johnson City Symphony Orchestra for an evening of music composed by Gioacchino Rossini, Felix Mendelssohn, and Ottorino Respighi.

Evening Program

Gioacchino Rossini: Overture to “La Gazza Ladra” Felix Mendelssohn: Symphony No. 4 in A Major, Op. 90 “Italian” Ottorino Respighi: The Pines of Rome

Tickets: $35; Seniors (65+) $30; Students $10 For more information: 92-MUSIC (926-8742) or visit www.jcsymphony.com Free bus service: 6:15 (Colonial Hill); 6:30 (Maplecrest & Appalachian Christian Village); 6:45 (City Hall) This concert is funded under an agreement with the Tennessee Arts Commission and the National Endowment for the Arts.

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OCTOBER 2013

ClinicallySpeaking BY ANITA JOHNSON, MD

New breast cancer treatment options boost survival, offer new hope As a surgical oncologist focused on treating breast cancer, I see daily how devastating a breast cancer diagnosis can be. But I also see daily how new and often cutting-edge treatments give women the hope and courage they need to help manage or overcome the physical, mental and emotional challenges of breast cancer, and in many cases, beat the disease altogether. One in eight women will develop breast cancer in her lifetime. While the leading risk factors are well known – older age, family history, mutations in certain genes – the most important risk factor for breast cancer is simply being a woman. The fact that any woman can develop breast cancer is one reason annual mammograms and clinical breast exams are so important; regular screening helps detect cancer early. As with every type of cancer, when breast cancer is discovered early there are more treatment options available, survival rates are longer and the cure rate is higher. In the U.S., trends in breast cancer are encouraging. Data from the National Cancer Institute show consistent declines in both new cases and deaths from breast cancer since 1990. Further, the U.S. Centers for Disease Control and Prevention (CDC) reports that from 2000 to 2009 the incidence of breast cancer in the U.S. decreased by 0.9 percent per year, while mortality decreased 2.1 percent annually. What’s most notable about these data is that breast cancer mortality is decreasing at more than twice the rate of incidence – meaning that women with breast cancer are living longer. That trend also is borne out by CDC data: although less than 75 percent of women with breast cancer survived more than five years in the 1970s, in 2005 more than 90 percent did. There may be several reasons behind the decline in breast cancer deaths. However, new technologies and improvements in existing treatments are very likely contributing to higher survival rates and improved quality of life for women with breast cancer. In addition to continued refinements in breast-conserving and reconstructive oncoplastic surgery techniques, there is an array of advanced treatment technologies available today. For example, genomic testing is an innovative new diagnostic tool that allows tumors to be examined on a

genetic level. By identifying mutations that occur in a cancer cell’s genome, doctors can better understand what caused the tumor and tailor treatment based on these findings. Genomic testing might suggest a drug normally used for another type of cancer could be an appropriate treatment for breast cancer based on the genetic properties of the tumor. Another example is intraoperative radiation therapy (IORT), one of many new technologies that deliver radiation more precisely, helping minimize damage to healthy tissue and treatment times. With IORT, radiation is delivered directly to the tumor site after a surgeon has removed the tumor. A 30-minute dose of IORT can often replace weeks of traditional radiation. In addition to radiation, there have been numerous advances in chemotherapy treatments for breast cancer. Targeted therapy blocks specific molecules involved in tumor growth by directing drugs or other specially-created compounds (e.g., man-made immune system proteins) to attack cancer cells. A targeted therapy called chemoembolization delivers medication through a catheter directly into a tumor using image guidance. The chemotherapy drugs are mixed with particles, called microspheres, which block blood flow to the tumor. With so many options available to treat breast cancer today, treatments can almost be tailored to the individual based on factors such as her genetic profile, location of the tumor, the type of tumor and whether the cancer has spread, among others. However, which treatment a woman ultimately chooses is a very personal decision best made in collaboration with her family, personal physician and oncologist. The specter of breast cancer can be frightening, but it is important to remember that most women will not develop the disease. Women who are at an increased risk should talk to their doctors about how often they should receive mammograms and what other screenings, such as genetic testing, might be beneficial. Although breast cancer continues to claim too many lives – more than 35,000 each year – advanced treatment options are having a significant impact on survivability and quality of life. Anita Johnson, MD, FACS, is medical director of breast surgical oncology at Cancer Treatment Centers of America at Southeastern Regional Medical Center in Newnan, Ga.

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LegalMatters BY JENNIFER PEARSON TAYLOR

Healthcare Surrogates Get Increased Powers – Including Admission for Mental Health Treatment Effective July 1, 2013, those individuals designated as healthcare surrogates for others have additional powers in areas concerning mental health treatment, medical records access, or consent to disclosure of protected health information. What is a healthcare surrogate? Tennessee law allows any adult or emancipated minor to designate any individual to act as surrogate decision maker for the patient. In order to make such a designation, the patient need only inform his or her healthcare provider, either orally or in writing, of his or her decision (1). A surrogate then has the ability to make a healthcare decision for the patient when the designated physician deems that the patient lacks capacity to make his or her own decisions and no other agent or guardian has been appointed or is reasonably available. Can a healthcare provider designate a healthcare surrogate for a patient? Yes. If a patient lacks capacity and has not designated a surrogate or agent, and does not have a guardian or other legal agent, then the supervising healthcare provider must identify the patient’s surrogate and document the designation in the patient’s medical records. Tenn. Code Ann. § 68-11-1806 describes the hierarchy of individuals to whom the healthcare provider should look when designating a patient’s surrogate: • the patient’s spouse (unless legally separated) • the patient’s adult child • the patient’s parent • the patient’s adult sibling • any other adult relative of the patient who has exhibited special care and concern for the patient, who is familiar with the patient’s personal values, who is reasonably available, and who is willing to serve. Can a healthcare provider act as a surrogate for a patient? Yes, but only under a very narrow set of circumstances. If there are no eligible persons reasonably available to act as the patient’s surrogate, then the physician may make health care decisions for the patient, but only after physician either one, consults with and obtains the recommendations of an institution’s ethics mechanism or two, obtains concurrence from a second physician who is not directly involved easttnmedicalnews

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in the patient’s healthcare, does not serve in a capacity of decision-making, influence, or responsibility over the designated physician, and is not under the designated physician’s decisionmaking, influence, or responsibility (2). Does the physician designated surrogate have the same powers as the patient designated surrogate? No. A surrogate who has been designated by the healthcare provider, rather than the patient, may make all healthcare decisions for the patient that the patient could have made on his or her own behalf, except that artificial nutrition and hydration may be withheld or withdrawn only by a patient-designated surrogate, or by physician-designated surrogate when the designated physician and a second independent physician certify in the patient’s medical records that the continuation of artificial hydration or nutrition is merely prolonging the act of dying. What new powers do healthcare surrogates have? Previously, designating a healthcare surrogate allowed the surrogate to make healthcare decisions for a patient but did not allow for the surrogate to admit or request release of a patient from voluntary inpatient mental health treatment or to authorize the disclosure of mental health or substance abuse records of a patient. Changes in Tennessee law effective July 1, 2013, now allow a healthcare surrogate, both patient-designated and physician-designated, to • apply for admission to a public or private hospital or treatment facility for a patient to receive diagnosis, observation, and treatment of a mental illness or serious emotional disturbance (3); • request the release of the patient from voluntary inpatient treatment (4); • consent to the disclosure of confidential mental health and substance abuse treatment information concerning the patient (5). What does this mean for my practice? Careful attention should be paid to the documentation in a patient’s medical record when the patient lacks capacity and another person is making healthcare decisions for the patient. The medical record should

clearly document whether the patient designated the surrogate while the patient still had capacity. A copy of any written designation of healthcare surrogate should be kept in the patient’s medical record. If the healthcare provider determines that a patient lacks capacity and must designate a surrogate for the patient, the medical record should include documentation regarding: • the healthcare provider’s determination that the patient lacks capacity; • the relationship between the physician-designated surrogate and the patient; • whether the physician believes the surrogate can and will act in the best interests of the patient; • the surrogate’s demonstrated care and concern; and • the surrogate’s availability to visit the patient and engage in face-toface contact with healthcare providers

concerning the patient. Healthcare surrogates are a vital part of the care provided to patients who lack capacity to make their own healthcare decisions. Providers may rely on the decisions of a surrogate, but must ensure that sufficient documentation of the surrogate’s authority to act exists in the medical record. Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice. Jennifer Pearson Taylor is an attorney practicing at London & Amburn, P.C. Her practice focuses on health law, with concentrations in healthcare employment and board investigation matters, along with the defense of long term care and medical malpractice claims. For more information, you may contact Ms. Taylor by visiting www.londonamburn. com.

Notes 1. T.C.A. § 68-11-1806. 2. T.C.A. §68-11-1806(c)(3). 3. T.C.A. § 33-6-201. 4. T.C.A. § 33-6-206. 5. T.C.A. § 33-3-104.

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From the Editor:

Paddles Up for Community, Comradery, Cancer Care I’ve read about the Mountain States Dragon Boat Festival every year since I moved to Johnson City in 2006. Just completing its 8th year on September 7th, the Dragon Boat Race, hosted by the Mountain States Foundation, has become an event many people in the community look forward to participating in. I, on the other hand, have always been a bit leery, considering my lack of any athletic talent—until recently. I wanted to know what all the hype was about. I would hear many of my colleagues and friends go on and on about all the fun they had at the race. I couldn’t imagine that paddling a boat could be all that enjoyable. So, when the invitation was given, how could I turn it down? I’m inquisitive by nature. Good thing I’m a quick learner. The same week I accepted the invitation was the week I learned to paddle—the Dragon Boat way. I didn’t realize that paddling a canoe or kayak is different from paddling a Dragon Boat. Paddles should be up (vertical, not horizontal), and the speed comes from digging in deep and pulling back, using my abs (do I even have abs?) to power the motion, not my arms. And one more thing…you have to stay in-sync; otherwise, the paddler behind you gets out of rhythm, too, affecting the whole team. Our quick lessons paid off. Our team—the Yottabytes (a name

The Yottabyte Team, captained by Bill Steck, Corporate Director of the MSHA IT Customer Service Center, won the IPC, The Hospitalist Co., Challenge Cup only computer geeks could come up with)—was scheduled in the first race in the first heat. Our twenty-one member crew probably had some first race jitters, finishing second in our race with a time of 62.72 seconds, but with some helpful advice from our steersmen, our time in the second race in the next heat was much improved. We shaved off four seconds

and ended up among the top 18 teams who were placed in the Challenge Cup heats. Although none of our team members expected to be competitive in the race (almost all of us were first time paddlers), the thrill of moving on to a Cup Challenge had us riled up and prepared to win—and we did. We walked away winners of the IPC, The Hospitalist Co., Challenge Cup.

While winning the cup was definitely thrilling, what impressed me the most about the Dragon Boat Festival was the sense of community and comradery fostered by the event. Local healthcare providers, businesses, and organizations, even the Science Hill High School Marching Band, came out to work together for a common cause. This year, the annual fundraiser benefited Mountain States Health Alliance Oncology Services, and at the opening remarks, area cancer patients addressed the crowd, expressing gratitude for the paddlers’ fundraising efforts. Remarkably, every face in the crowd appeared to have a smile, with the realization that so many lives would be touched with the dollars earned—as of this writing, $152,909.17. I am so grateful I had the opportunity to participate, so let me say thank you to the Mountain States IT Department for allowing me to paddle with them as a Yottabyte. For more information or to see photos from this year’s festival, visit http://www.mshafoundation.org/. All the best, Bridget Garland Editor, East Tennessee Medical News

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Enjoying East Tennessee Cades Cove

By LEIGH ANNE W. HOOVER

As legend goes, the picturesque cove, which is part of the Great Smoky Mountains National Park, was once call “Kate’s Cove” and named for the wife of an Indian chief. Some say it was named after Chief “Kade” or “Cade” or possibly even the Cades Family. Others even say it was originally called “Caged Cove” because settlers felt “caged in.” Regardless, today, Cades Cove still posses the peacefulness and tranquility of wildlife and natural beauty on a landscape canvas created by God. The Great Smokey Mountains National Park is over 500,000 acres of land, and Cades Cove is within this acreage. When the area was turned into a national park, the open fields were maintained, offering views for great distances and prolific wildlife. “It isn’t a traditional forest area like much of the park,” said National Park Spokesperson, Molly Schroer. “So, you can see a great distance, and there are no trees obstructing your view of wildlife in the open fields where they roam.” According to Schroer, black bears are a popular sight in the fall, and they are usually out eating acorns and nuts around the

trees. “We ask people not to feed the bears,” explained Schroer. “People need to keep a safe distance of 50 yards…, and if you find a bear is getting closer, make a lot of noise and be loud to scare it off. Don’t give them food or a reason to want to approach you.” Visitors can glimpse breathtaking vistas ripe with all of the glorious colors of the season. Whether it’s from the car enjoying the

11-mile loop around the Cades Cove, hiking to Abram Falls, or enjoying a picnic, Cades Cove is truly a treasure—especially in October. “Cades Cove is located in the western part of the park near the Townsend entrance,” explained Schroer. “It’s a great place to see wildlife, historic cabins, and the fall views.” In fact, Cades Cove has been referred to as “the largest open air museum in the

entire Great Smoky Mountains National Park.” Structural remains are reminiscent of life dating back to the 1800s. “Cades Cove is such a particularly beautiful area of the park because you’ve got these great views, where you can see the mountains from a distance, but you can also see this historic past with the cabins, mill, churches and barns…,” said Schroer. “It’s a great place to explore and see what it was like for the people who settled and lived in the park many years ago.” Some structures are visible from the loop and just short walks from the paved parking pullover areas. Often, park rangers assist visitors by answering questions and conducting programs. Topics and times vary, and these can be referenced on the park website. There is also a Cades Cove tour/map book with some history about each. The oldest structure in Cades Cove, John Oliver Cabin, is a favorite for Schroer because she enjoyed walking to it and sharing this piece of history with her mother. Such structures are connections to the past and reminders of life in a “simple time” without the stress of life today. Although the loop is closed occasionally to motor traffic in the summer, the loop is open daily during the fall from sunup to (CONTINUED ON PAGE 8)

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Enjoying East Tennessee, continued from page 7

sundown. Due to the park’s popularity, Schroer suggests visiting on a weekday when possible or beginning early in the morning. Also, make sure that you have a full tank of gas, snacks, and plenty of water. “Be prepared to spend the day. It can take three to four hours just to get around the 11 mile loop,” said Schroer. “Just be patient and come out and enjoy it. People love this, and they come back every year.” The head of the loop offers picnic areas and restrooms. There is a small campground store to rent bicycles, and there are also riding stables. Halfway around the loop at the Cable Mill historic area, you will also find a visitor’s center and restrooms. Beautiful water areas and creeks are also throughout Cades Cove. If you are adventurous, you can pack hiking shoes and explore Abram Falls. Named for a Cherokee chief, Abram Falls has its own trail leading to it. However, it is important to plan for this hike and bring appropriate gear. “Many people go out in the Cades Cove loop not quite knowing what to expect,” explained Schroer. “But after driving through a tunnel of trees in the park in order to get there and then coming up on this beautiful, open area—running an 11 mile loop—it’s such a great part of history and the perfect place for wildlife.” For additional information, visit www. nps.gov/grsm or http://www.nps.gov/ grsm/planyourvisit/cadescove.htm for the specific site on Cades Cove. Leigh Anne W. Hoover is a native of South Carolina and a graduate of Clemson University. She has worked for over 25 years in the media with published articles encompassing personality and home profiles, arts and entertainment reviews, medical topics, and weekend escape pieces. Hoover currently serves as immediate president of the Literacy Council of Kingsport. Contact her at hoover@chartertn.net.

A Butterfly Called Hope As a gifted storyteller, New York Times bestselling author Mary Alice Monroe beautifully parallels human relationships with nature. Now, “Monroe’s Monarch,” better-known as A Butterfly Called Hope, arrives, as the monarch butterfly population is declining, to entrance, educate, and capture future conservationists. Once this little book becomes part of your home or classroom collection, you will also want to be on the lookout for milkweed and caterpillars to house and watch your own monarch arrive from its chrysalis, and Monroe tells you how. Just as she beautifully writes, while also teaching in her adult novel The Butterfly’s Daughter, Monroe emerges with the same inner spirit and passion in her latest children’s book, A Butterfly Called Hope from Sylvan Dell Publishing. Teaming with award-winning photographer Barbara Bergwerf and co-author Linda Love, Monroe’s second children’s book displays the miracle of transformation in a book that can be shared with children and adults alike—milkweed required! From actively raising her own monarch butterflies, researching, and following them to their wintering sanctuaries in the mountains of Mexico, Monroe shares additional, educational details “for the creative minds” in the back of the book for more indepth study. Even vocabulary words from the life cycle are included. “My adult reading student, Ralph, from Reading with Ralph—A Journey in Christian Compassion, Jan-Carol Publishing, Inc., learned all about the loggerhead sea turtle

in Monroe’s first children’s book, Turtle Summer which is the comSummer, panion to her adult novels Swimming Lessons and The Beach House,” said author Leigh Anne W. Hoover. “I know A Butterfly Called Hope will also provide shared lessons on the monarch to read, enjoy, and to treasure.” The monarch butterfly actually travels through Tennessee during October winging its way to Mexico for the winter. In addition to this new book, readers can experience the grandeur through the IMAX Theater’s Flight of the Butterflies 3D at the Tennessee Aquarium in Chattanooga.

Reading with Ralph— A Journey in Christian Compassion Medical News columnist Leigh Anne W. Hoover is author of the well-known children’s book The Santa Train Tradition and awardwinning Festus and His Fun Fest Favorites. Recently, Hoover has ventured into a new genre publishing her first adult, non-fiction novel Reading with Ralph— A Journey in Christian Compassion with JanCarol Publishing, Inc. “Ralph is my adult reading student at the Literacy Council of Kingsport, Inc.,” said Hoover. “We are in our

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“Obviously, this is a great time to see the film as the “Supergeneration” of monarchs will be migrating through our region in late September and October,” explained Thom Benson, senior marketing and communications manager for the Tennessee Aquarium & IMAX Theater. “Last year we had quite a few stop by the butterfly garden between River Journey and Ocean Journey and in the IMAX garden.” Flight of the Butterflies 3D will be showing at IMAX Theater at the Tennessee Aquarium in Chattanooga through Thanksgiving. The film description can be found at: http://tnaqua.org/IMAX/ IMAX.aspx To learn more about this great flight, be sure to visit! Both A Butterfly Called Hope and Reading with Ralph—A Journey in Christian Compassion are available from major book sellers.

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seventh year working together weekly, and Ralph is also a member of our church and Sunday school class at First Broad Street United Methodist Church in Kingsport. Without a doubt, I believe that Ralph was put in my path. In fact, when Ralph learned that I was writing a book about him, he replied, ‘This book is not about me. It’s about God.’” While the story of Ralph shows God’s strength and His prevailing love and grace, it also sheds a light on illiteracy, a cause near and dear to Hoover. When Ralph came to the Literacy Council of Kingsport, he was at a first grade reading level. Today, with the help of tutors, he is now above a sixth grade level and continues to improve. Over the past seven years, Ralph has gained a sense of freedom, independence, and confidence. Hoover is a native of South Carolina and graduate of Clemson University. Reading with Ralph— A Journey of Christian Compassion is endorsed by the President of Clemson University James F. Barker and Clemson Head Football Coach Dabo Swinney. Additional endorsements include New York Times bestselling authors Mary Alice Monroe and Patti Callahan Henry, former (CONTINUED ON PAGE 10)

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theLiteraryExaminer BY TERRI SCHLICHENMEYER

Five Days at Memorial: Life and Death in a StormRavaged Hospital by Sheri Fink; c.2013, Crown; $27.00 / $32.00 Canada 558 pages You know what you’d do in a crisis – or do you? Could you ignore your inner voice and do something wrongly right? That’s what allegedly happens in the new book Five Days at Memorial by Sheri Fink: one of our country’s worst disasters may’ve led to one of medicine’s most questionable acts. When Southern Baptist Hospital opened in New Orleans in 1926, its founders hoped it would be “the greatest hospital in all the Southland.” Indeed, it had the sturdiest of buildings: when Hurricane Betsy hit in 1965, the campus barely blinked. There was no reason, therefore, to believe that the hospital (renamed Memorial Medical Center the mid-1990s) couldn’t withstand Hurricane Katrina. As Katrina approached land on August 28, 2005, there were as many as 2,000 people at Memorial, including staff and families, 183 Memorial patients, and 55 patients belonging to LifeCare, a “hospital within a hospital” that rented facilities at Memorial. There were also hundreds of staff-owned pets inside, for safety’s sake. At first, the atmosphere was lighthearted. It was obvious by the “little shimmy shake” of the floor-to-ceiling windows and the devastation outside that the storm was dangerous, but staff was optimistic. And then the levee broke. Water poured into the building, the hospital’s generators became waterlogged, air conditioning failed, and the temperature skyrocketed inside. Plumbing shut down, and fetid odors wafted through each floor. Evacuations were denied (or sporadic), whispers of “martial law” circulated, and optimism waned as the sickest patients became dehydrated, overheated, delirious. Nurses scrambled to keep people alive in conditions that deteriorated almost by the minute. When it became obvious that pets mightn’t be evacuated, some staff tearfully requested that beloved companions be euthanized. A few nurses wondered if they would ever leave Memorial alive. And then someone asked a quiet question: “Why should we treat the dogs better than we treat the people?” Inflammatory? You bet. And the subject of a months-long, post-Katrina investigation, all of which author and Pulitzer Prize-winning author Sheri Fink details in this huge, totally absorbing book. Five Days at Memorial begins with tip-of-a-shark-fin anxiety and quickly de-

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scends into chaos, which perfectly displays a mere taste of what happened to the survivors you’ll meet here. That’s the first half of this book, before Fink’s story turns into something conversation-worthy, something that (admit it) everyone’s reluctantly thought about. From there, and during the legalities that Fink recounts, readers have a front-seat view of finger-pointing, trackscovering and fact-finding that also became policy-changing. Once you start it, it’s hard to let go of a book like this because the memory of what happened is still awfully fresh.

High Price: A Neuroscientist’s Journey of SelfDiscovery That Challenges Everything You Know About Drugs and Society by Dr. Carl Hart; c.2013, HarperCollins; $26.99 / $28.99 Canada, 340 pages In the new book High Price by Dr. Carl Hart, you’ll be surprised at recent revelations about drugs, and the causes of addiction. Growing up on “one of the roughest neighborhoods of Miami,” Carl Hart had all kinds of temptations at his fingertips. Still, he managed to resist many of them. That doesn’t mean, however, that Hart was a complete angel. Guns were easy to get where he lived, and there was once a time when he wanted one for revenge-making. He and his friends shoplifted, dine-and-dashed, and once held a gun on a white man for fun. And he experimented with drugs – marijuana, cocaine, tobacco, and alcohol - even though he knew that those substances would poorly affect the basketball career he badly wanted. When he didn’t get a basketball scholarship, Hart knew that his best option was to join the military, so he entered the Air Force and discovered that basic training was easy for an athlete from Miami who was used to hot-weather activity. He used that ease to challenge his fellow airmen, and he found his leadership abilities. And because he was trying to stay out of trouble – which meant avoiding the brothers who wanted to smoke marijuana – he took his first college class. Today, Hart’s career lies in the study of the effects of drugs on behavior, and because of his research, he has learned some surprising things about addiction; for instance, the vast majority of cocaine use is outside the black community, and 80-90 percent of cocaine users “do not develop problems with the drug.” Furthermore, Hart believes that the solution to the drug problem – and, by extension,

many of the other societal ills that befall inner cities – isn’t through a racially-motivated “war on drugs.” What’s needed, he says, is for people – especially young adults - to have a “stake in our society.” Though it tends to take a while to get to the point, High Price isn’t bad. Author and neuropsychopharmacologist Dr. Carl Hart uses his own life experiences and plenty of up-front truth to show how general perceptions of drug use and abuse is wrong, particularly when it comes to drugs and the Black community. This mixing of personal story and hard research is interesting and appealing, in part because Hart isn’t preachy and partly due to his unique history as someone who actually lived that which he’s trying to help others avoid. It took some effort for me to stay with this book at first, but I was ultimately glad I stuck around. And if you’re a reader who questions assumptions, is tired of “experts” who don’t walk the walk, and you love a good biography, then High Price is a book I believe you’ll like, too. Terri Schlichenmeyer has been reading since she was 3 years old, and she never goes anywhere without a book. She lives on a hill in Wisconsin with two dogs and 11,000 books.

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...Welcomes Jennifer Oakley, MD. She is a glaucoma specialist (our third) and a Bristol native, attended UT and ETSU’s Quillen College of Medicine, completed an Ophthalmology Residency at University of MS Medical Center and a Glaucoma Fellowship at the University of South Florida.

Accepting new patients!

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Happy, Safe Workforce Prerequisite for Patient Safety, continued from page 1 to make errors and less likely to follow institutional protocols. Julianne Morath, RN, MS, president and CEO of the Hospital Quality Institute based in Sacramento, Calif., co-led the roundtables with former U.S. Treasury Secretary Paul O’Neill, now CEO of Alcoa. A founding member of the Lucian Leape Institute, Morath was the inaugural recipient of the John M. Eisenberg Award for Lifetime Achievement in Patient Safety from NPSF and is a noted author and speaker on the topic of safety and workforce improvement. Going into the roundtables, Morath said the working hypothesis was, “A workforce, no matter how committed and skilled, cannot create a culture of safety unless they themselves are free from harm and disrespect.” This hypothesis was borne out during the discussions that included the experiences and opinions of frontline practitioners, leaders of healthcare organizations, scholars, and representatives of government agencies and healthcare professional societies. Morath said, “It became very evident through the course of the roundtables that we have a long way to go in healthcare workforce safety.” When workers live in a constant state of risk, they become blind to that risk and resigned to their situation, Morath said. “It’s a dangerous place to be if you think this is as good as it’s going to get no matter what you do,” she noted. When a workforce reaches this state, Morath continued, the workers won’t speak up or speak out. Yet, the evidence clearly shows having a culture that allows for effective assertion … or a ‘stop-the-line conversation’ … is a prerequisite for patient safety. Morath, who served as chief quality and patient safety officer at Vanderbilt University Medical Center at the time of the roundtables, said her co-leader O’Neill has often made the statement that every person in a workforce should be able to answer affirmatively to three essential questions: 1. Am I treated with respect and dignity by everyone? 2. Do I have the support and training tools to do my job? 3. Am I recognized and thanked for my contributions? Unfortunately, ‘no’ is too often the answer to those questions. “It was jarring to

find not only was there a lack of respect … but even worse, there was a culture of disrespect in many of our healthcare organizations that was tolerated,” she said of the group’s findings. “We have a somewhat historic and toxic culture where the hierarchy has to do with positional titles and the number of degrees,” Morath added. Vulnerabilities in the system include accepting emotional abuse, bullying and learning by humiliation as ‘normal,’ performing demanding tasks under severe time constraints due to the production and cost pressures that dominate today’s healthcare landscape, and having a higher rate of physical harm than such high-risk industries as mining, manufacturing and construction. This culture of fear and intimidation takes away the joy and meaning from work that most healthcare employees chose for the very purpose of helping others and making a difference. “While this report is concerning, it’s also hopeful,” said Morath, noting there were also examples of healthcare workplaces that are getting it right … at least most of the time. New healthcare models that rely heavily on teamwork are also helping make cooperation part of the landscape. “It really requires an appreciation and respect for everyone’s contribution in a team to deliver high quality, safe care in this complex environment in which we work today,” she noted. The report asserts joy and meaning are created when the workforce feels valued, safe from harm and part of the solutions for change. The Mayo Clinic and Virginia Mason Medical Center are two examples that Morath said stood out for their culture of respect. She also said Hospital Corporation of America (HCA) has an exemplary employee safety and security initiative. To create safe, supportive work environments, healthcare facilities must become high-reliability organizations with a fundamental precondition that employees are their most valuable assets and that the health and well being of those employees is a non-negotiable priority. The report outlined seven strategies to move the needle toward becoming this type of an effective organization. 1. Develop and embody shared core values of mutual respect and civility; transparency and truth telling; safety of all

Reading with Ralph, continued from page 8 Clemson and NFL Titans Football player Coty Sensabaugh, and several others. Reading with Ralph— A Journey of Christian Compassion contains a foreword written by Dr. Robert Laubach. Laubach is well into his 90s, and his father, Dr. Frank Laubach, created the “Laubach Way to Reading” when he was a missionary in the Philippines. Dr. Frank Laubach was referred to as the “Apostle to the Illiterates,” and he coined the phrase “Each One Teach One.” Literacy organizations throughout 10

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the country utilize the Laubach Way to Reading. A portion of the proceeds from Reading with Ralph— A Journey of Christian Compassion will go towards the Literacy Council of Kingsport, Inc. located in Kingsport, Tennessee. The book is available on Amazon and Barnes & Noble, as well as other major outlets, and it is also in ebook format. Visit Leigh Anne W. Hoover on Facebook or www.thesantatraintradition.com.

workers and patients; and alignment and accountability from the boardroom through the front lines. 2. Adopt the explicit aim to eliminate harm to the workforce and to patients. 3. Commit to creating a high-reliability organization and demonstrate the discipline to achieve highly reliable performance. 4. Create a learning and improvement system. 5. Establish data capture, database and performance metrics for accountability and improvement. 6. Recognize and celebrate the work and accomplishments of the workforce regularly and with high visibility. 7. Support industry-wide research to design and conduct studies that will explore issues and conditions in healthcare that are harming the workforce and patients.

“It sounds deceptively simple, but it’s about and individual and collective commitment to continual learning, continual improvement, and continual engagement,” said Morath. “When you start, you’re never finished. This is a commitment … a long term commitment.”

Through the Eyes of the Workforce To download the full report and related materials, go online to www. npsf.org. Click on “About Us” and select the Lucian Leape Institute at NPSF. From there, choose the LLI Reports and Statements link under “Related Pages.”

Research Uncovers Clues, continued from page 1 and Harvard, and the Mount Sinai School of Medicine in New York. “We discovered there were 22 places in the genome, 13 of which to our knowledge had never been described before, and each is a clue about the cause of schizophrenia,” Sullivan said of identifying nearly two dozen locations in the human genome that are involved in the disorder, including one that has previously been implicated in bipolar disorder. Dr. Patrick “If finding the causes Sullivan of schizophrenia is like solving a jigsaw puzzle, then these new results give us the corners and some of the pieces on the edges,” he stated, adding the number of genetic variants probably numbers in the thousands. “These 22 are the tip of the iceberg.” The study was based on a multi-stage analysis that began with a Swedish national sample of 5,000 schizophrenia cases and 6,200 controls followed by a meta analysis of previous GWAS studies and then a replication of single nucleotide polymorphisms (SNPs) in 168 genomic regions in independent samples for a total of more than 59,000 people included in the research. The results underscored two takeaways for Sullivan. The first, “We need to do more studies urgently. We’re actually quite encouraged and believe larger studies of this type will lead to more knowledge,” he said. The second, “The early results we have here certainly indicate two different biological processes are involved.” The research uncovered two distinct pathways that might be associated with the disorder — a calcium channel and microRNA 137. Calling the calcium channel, which includes the genes CACNA1C and CACNB2, the ‘queen of the channels,’ Sullivan explained there are a number of FDAapproved calcium channel blockers on the market today that are used for a variety of conditions ranging from hypertension and angina to migraines. Stressing that it was much too early to draw conclusions, Sullivan said the findings

at least indicate the calcium channel might be an area that deserves further attention from those studying schizophrenia. Hypothetically, he continued, calcium channel blockers might be found to have unexpected efficacy in schizophrenics. “That’s something that needs to be evaluated in a careful, rigorous way,” he said, again cautioning against jumping too far ahead. The second pathway includes its namesake gene MIR137, which is a known regulator of neuronal development. Sullivan noted more than a dozen other genes are also known to be regulated by MIR137, as well. Schizophrenia has long been known to have a strong genetic component. While it occurs in about 1 percent of the general population, the disorder is found in about 10 percent of people with a first-degree relative diagnosed with schizophrenia. The National Institute of Mental Health notes the highest risk for developing the illness — 40 to 65 percent — occurs in an identical twin of an individual with schizophrenia. Yet, most scientists believe genetics is only one component in developing the disorder, which probably has environmental triggers, as well. While Sullivan said each different approach to solving the enigma of schizophrenia is important, he noted the genetic approach offers a strong foundation for discovery. “We can measure the DNA part of people particularly well these days,” he said. “Our study is a step forward in understanding the genetic basis of the disorder. This is really, truly nice progress.” He added the new findings provide “a couple of good strides forward” even though an endpoint isn’t yet in sight. “But for researchers and scientists, it shows us a bunch of things we’ve never seen before … and that’s pretty cool.” And Sullivan expects more information to be forthcoming. “What’s really exciting about this is that now we can use standard, off-the-shelf genomic technologies to help us fill in the missing pieces,” he said. “We now have a clear and obvious path to get a fairly complete understanding of the genetic part of schizophrenia. That wouldn’t have been possible five years ago.” easttnmedicalnews

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Wellmont Physician Connection

The best defense is a great offense. Especially when it comes to breast cancer. Thanks to remarkable strides in early detection, genetic testing and medical intervention, breast cancer fatality has seen a marked decline in recent years. And with the advanced breast imaging capabilities at the Wellmont Cancer Institute’s accredited breast centers, we can identify and start treating cancer almost as soon as it starts.

Finding invisible threats Most people can’t find a pea-sized lump in a breast on their own. But our advanced imaging services can find many that size – and even smaller.

Dr. James Phillips

Digital mammography

For younger women, or those with dense breast tissue, digital mammography can be particularly effective at detecting cancer. Just a 15-minute mammogram can be the impetus for early treatment or muchneeded peace of mind.

Digital mammography is available at the comprehensive breast centers of Holston Valley Medical Center and Bristol Regional Medical Center, as well as the Wellmont Breast Center in Johnson City. We also offer it in the radiology departments of Hawkins County Memorial Hospital in Rogersville, Lonesome Pine Hospital in Big Stone Gap, Va. and Takoma Regional Hospital in Greeneville. Breast MRI

For more advanced imaging options, the imaging services at Holston Valley and Bristol Regional also offer magnetic resonance imaging – mri – breast scans. Breast mris are more sensitive than mammograms and allow for better

early detection. The American Cancer Society’s new screening guidelines support what Wellmont’s been doing for several years – combining breast mris with annual mammograms for high-risk women. Breast-specific gamma imaging

Holston Valley was the first hospital in Tennessee to offer breast-specific gamma imaging – bsgi – which is also sometimes called molecular breast imaging. This is a procedure that helps show the metabolic activity of lesions in the breast, offering an important advantage to women with: • Dense breast tissue • Multiple suspicious lesions or clusters of microcalcifications • Lesions that can be felt but cannot be detected using other scans • Post-surgical or post-therapeutic densities • Implants • Hormone replacement therapy

Not only are we proficient with the most recent cancer-detecting technologies, but our breast centers were among the first in Tennessee to be accredited by the American College of Surgeons’ National Accrediting Program for Breast Centers. We’re currently the only two facilities in Northeast Tennessee to hold that distinction.

Fighting alongside our patients – every step of the way Receiving a breast cancer diagnosis can be one of the most overwhelming moments in a woman’s life. That’s why all of us with the cancer institute take extraordinary measures to guide our patients through treatment, giving them strength for today and hope for tomorrow.

helping patients find their way through visits, treatments and questions. Wellmont’ s breast centers, along with the Wellmont Cancer Institute, provide a complete range of services for the diagnosis and treatment of breast disorders and cancers, including: • High-risk clinic • Genetic testing and counseling • Clinical trials • Multidisciplinary care, including social workers and dietitians • Surgery, including treatment for breast conservation • Plastic surgery, including reconstructive breast surgery • Chemotherapy and targeted therapy • Radiation therapy, including breast brachytherapy • Support groups • Survivorship Our multidisciplinary team delivers holistic, compassionate care in a healing environment. And with locations in Kingsport, Johnson City, Bristol and Dr. Randall Barker Southwest Virginia, no matter where your patients live, you can rest assured they are getting the very best cancer care, close to home. Written by Dr. Randall Barker and Dr. James Phillips, diagnostic radiologists, Blue Ridge Radiology

From the moment a woman is diagnosed, she works with a nurse navigator who guides her through treatment and recovery. Our navigators are invaluable resources for

Learn more about our state-of-the-art breast imaging services – visit wellmont.org and click the Our Services tab. Patients may be referred by calling 1-855-878-8550.

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GrandRounds Bruce Joins Parkridge Medical Center Staff CHATTANOOGA – Sports medicine and orthopaedic specialist Jeremy Bruce, MD, has joined the medical staff of Parkridge Medical Center. Bruce earned a Bachelor of Science degree and a Master of Science in Physical Therapy from Dr. Jeremy Springfield College. Bruce He earned his medical degree from the Medical College of Georgia and completed a residency in orthopaedic surgery at the University of Tennessee College of Medicine Chattanooga. He also completed a sports medicine fellowship with Dr. James Andrews at The Andrews Institute in Gulf Breeze, Fla. Bruce is affiliated with the Chattanooga Bone and Joint Surgeons practice. 

Parkridge Medical Group – Hamilton Family Medicine Welcomes New Physician Assistant CHATTANOOGA – Parkridge Medical Group – Hamilton Family Medicine is pleased to welcome physician assistant Ginger Mullins, PA-C, to the practice. Mullins joins Synthia Beeler, MD, at the Shallowford Road location, where she will provide Ginger Mullins primary care for teens and adults. Her services include well visits and sports physicals as well as the maintenance of chronic conditions such as diabetes and hypertension. Mullins earned a Bachelor of Science degree from the University of Tennessee at Chattanooga. She holds

a Master of Science degree in Physician Assistant Studies from Bethel College, with concentrations in emergency medicine and family medicine. Mullins is certified by the National Commission on Certification of Physician Assistants. She is a member of the American Academy of Physician Assistants, the Tennessee Academy of Physician Assistants, and Beta Beta Beta Biological Honor Society.

Cumberland Heights Opens New Intensive Outpatient Center in Chattanooga

Adult programs, local assessment and focus on family participation make new center a notable regional addition NASHVILLE –Cumberland Heights (www.cumberlandheights.org) has opened the doors to its latest Intensive Outpatient (IOP) treatment facility in Chattanooga, Tenn., thus expanding its reach to include parts of eastern Tennessee and surrounding states. The nationally recognized alcohol and drug treatment center anticipates that Cumberland Heights Chattanooga, which began assessing patients for its Adult Program morning sessions on August 19, will impact a 50-mile radius around the city, including parts of Alabama and Georgia. The 3,000-square-foot facility features three group rooms that will accommodate activities and therapy sessions for 20 patients and their families simultaneously. The well respected Adult Program will be comprised of four weekly sessions beginning with daytime hours from 9 a.m. to 12 p.m. and soon expanding to include evening hours from 6 to 9 p.m. Cumberland Heights Chattanooga officials also plan to offer youth programs in the future. While there are already a number of

respected treatment options in Chattanooga, Cumberland Heights leadership saw a need for more care alternatives in the region. According to Tennessee Department of Health and the Centers for Disease Control, in 2011, 1,069 people died of prescription drug overdoses in Tennessee, and unintentional drug overdose is now the leading cause of death in the state, exceeding death rates for motor vehicle crashes, homicides and suicides. Furthermore, in 2010, there were 11,717 people admitted for drug and alcohol treatment. As an added benefit, the staff at Cumberland Heights Chattanooga can assess and pre-certify local patients, which helps eliminate extended waiting periods and gets patients into treatment faster. Cumberland Heights Chattanooga IOP is located at Executive Hills Professional Center, 6650 East Brainerd Road, Suite 102, 423-308-0689. Cumberland Heights also offers rehabilitation services in Nashville, Jackson, Murfreesboro, Hermitage and Smyrna. 

Nation’s First Statewide Residential Recovery Court Set to Open in East Tennessee

Residents in Need of Treatment will be Diverted from Prison to Program NASHVILLE – The Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) and the Tennessee Department of Correction (TDOC) has opened the first statewide residential Recovery Court in the nation, effective August 1, 2013. The court is located in the Morgan County city of Wartburg, which is about 45 miles west of Knoxville. A special Ribbon-Cutting Ceremony was held July 30. The 100-bed program

Mark Your Calendar

Your local Medical Group Managers Association is Connecting Members and Building Partnerships. All area Healthcare Managers are invited to attend.

3RD THURSDAY Knoxville MGMA Monthly Meeting Date: 3rd Thursday of each month Time: 11:30 AM until 1:00 PM Location: Bearden Banquet Hall, 5806 Kingston Pike, Knoxville, TN 37919 Lunch is $10 for regular members. Come learn and network with peers at our monthly meetings. Topics are available on the website. Registration is required. Visit www.kamgma.com.

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2ND WEDNESDAY Chattanooga MGMA Monthly Meeting Date: 2nd Wednesday of each month Time: 11:30 AM Location: The monthly meetings are held in Meeting Room A of the Diagnostic Center building, Parkridge Medical Center, 2205 McCallie Avenue, Chattanooga, TN 37404 Lunch is provided at no cost for members, and there is currently no cost to a visitor who is the guest of a current member. Each member is limited to one unpaid guest per meeting, additional guests will be $20 per guest. All guests must be confirmed on the Friday prior to the meeting. RSVP to Irene Gruter, e-mail: irene@chattmedsoc.org or call 622.2872. For more information, visit www.cmgma.net.

has been established to allow the state to divert people in need of substance abuse treatment or mental health services from hard prison beds to effective treatment programs that are evidencebased and proven to have a larger impact on reducing recidivism. It will also allow for prison beds to be reserved for those violent offenders who are in most need of them. This Recovery Court is different from the other Drug Courts and Recovery Courts currently in operation in that this one is more intensive than the current program and offers services on a 24-hour-a-day, 7-day-a-week basis. It will be operated by the Davidson County Drug Court Support Foundation, a private foundation. The Recovery Court will cost much less per person than an average prison: While prison costs an average of $65 per prisoner per day, the Recovery Court will cost an average of $35 per person per day. TDMHSAS and TDOC are working on this project in partnership with the Tennessee Department of Safety and Homeland Security, the Tennessee Department of Health, and the Davidson County Drug Court.

Ramsey and Physicians Regional Medical Center Named Observation Site for Robotic Prostatectomies Surgical team can introduce other physicians to robotic technology developed by Intuitive Surgical

KNOXVILLE – Chris Ramsey, MD, urologist with Physicians Regional Medical Center (PRMC), has been named a National Observation Site by Intuitive Surgical for robotic-assisted prostate surgery. National Observation Site designation recognizes a surgeon who consistently demonstrates good outcomes in high numbers of patients. Intuitive Surgical sends physicians who are interested in learning more about roboticassisted surgery to National Observation Sites, where they can observe successful programs first-hand. Ramsey has performed close to 2,000 roboticassisted surgeries with the PRMC surgical team. Established in 2006, the robotic prostate surgery team at PRMC performs the most prostatectomy procedures in the metro region. “Being named a National Observation Site by Intuitive Surgical recognizes the skill and dedication of our robotic surgical team,” said Karen Metz, CEO of Physicians Regional Medical Center.

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GrandRounds Erlanger East and Baroness Campuses Recognized for IBCLC Care Award CHATTANOOGA – The International Board of Lactation Consultant Examiners® (IBLCE®) and International Lactation Consultant Association® (ILCA®) have recognized Erlanger East and Baroness Campuses for excellence in lactation care. The Erlanger Women’s Services Departments have received the IBCLC Care Award in recognition for staffing professionals who hold the prestigious International Board Certified Lactation Consultant® certification (IBCLC®) and providing a lactation program that is available 5-7 days a week for breastfeeding families. In addition, the facilities demonstrated that they have provided recent breastfeeding training for medical staff that care for new families, and have recently completed activities that help protect, promote, and support breastfeeding.  As allied health care professionals with the only internationally-recognized certification for professional lactation services, IBCLC professionals work in hospitals, clinics, public health agencies, private practice, community settings, government agencies, and in research. There are currently more than 26,000 such professionals in 94 countries worldwide that are certified by the International Board of Lactation Consultant Examiners® (www.iblce.org), a program accredited by the National Commission for Certifying Agencies (NCCA).  NCCA accreditation represents a mark of quality for certification programs.  In addition to finding IBCLC professionals at Erlanger East or Erlanger Baroness, mothers can also find an IBCLC near them by visiting the ILCA website at www.ilca.org. Follow the “Find a Lactation Consultant” link and search for an IBCLC by postal code, city and state, or country.   

Decosimo Advisory Services Practice Growth Leads To Specialized Management Appointments Shannon Farr named director of valuation services and Sharon Hamrick named director of litigation support services.

CHATTANOOGA – Decosimo, a top 100 regional accounting and business advisory firm, continues to experience significant growth within its Decosimo Advisory Services practice prompting the addition of director roles for the firm’s specialized valuation and litigation Shannon Farr support service lines. Appointed to director of valuation services is Shannon Farr, who formerly served as director of healthcare valuation, and the new director of litigation support is Sharon Hamrick, who formerly served as

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senior manager. In their director roles, Shannon Farr and Sharon Hamrick will be responsible for the overall management of their respective Decosimo valuation services and litigation services teams. Sharon Hamrick Decosimo Advisory Services is also pleased to announce that Senior Manager Pamela Mantone, a published author and accomplished forensic accounting and financial fraud detection expert, is focusing her talents in the litigation support services area under Sharon Hamrick’s leadership. Farr joined Decosimo in May 2007 and attained advanced credentials including the Accredited in Business Valuation (ABV) and Certified in Financial Forensics (CFF) designations during her tenure with the Tennessee-based firm. She specializes in business valuation and litigation support for cases involving valuation issues. In addition to valuations for estate and gift tax purposes, ownership transactions and strategic transition planning, Ms. Farr has specialized expertise in healthcare valuation and is a member of the American Health Lawyers Association. She also performs fair value for financial reporting valuations to be used in purchase price allocations and goodwill impairment testing. Her valuations for litigation support and expert witness testimony have been used in numerous marital dissolution cases, as well as shareholder disputes. Ms. Farr is a member of the Tennessee Society of Certified Public Accountants (TSCPA) and the American Institute of Certified Public Accountants (AICPA). A graduate of the University of Tennessee’s College of Business, Farr frequently lectures on valuation topics such as fair market value determinations in healthcare and personal and enterprise goodwill in marital dissolution. Hamrick, a certified fraud examiner with CFF credentials, has extensive experience in financial analysis and preparation of expert reports for state and federal courts, especially related to litigation involving embezzlement, contract disputes, breach of contract, manufacturing and supply disputes, wrongful termination, personal injury and wrongful death. She has provided litigation consultation services to both plaintiff and defendant attorneys. Hamrick earned a Bachelor of Science degree in Business Administration from Middle Tennessee State University. She is a member of the AICPA and its Forensic and Valuation Services Section, the Association of Certified Fraud Examiners and the TSCPA. Hamrick has made presentations on fraud prevention and risk assessment and has written articles for various publications. 

Decosimo’s Pam Mantone Authors Fraud Detection Book CHATTANOOGA – Pamela Mantone, a senior manager and forensic specialist with the Decosimo Advisory Services practice of the regional accounting firm Decosimo, has authored a technical book on forensic accounting. The book, titled Pamela Using Analytics to Detect Mantone Possible Fraud: Tools and Techniques, is a practical overview of forensic accounting, providing a common source of analytical techniques used for both efficiency and effectiveness in forensic accounting investigations. The official in-store release date was Sept. 3 and the book is available for order through several online book stores including Amazon and has already began to ship to buyers in the U.S.   

Hutcheson Announces New Hospitalist Program FORT OGLETHORPE, Ga. – Hutcheson Medical Center has announced the formation of its new hospitalist medicine program, led by Larry Rigsby, MD, FACP, FHM. The program is comprised of six physicians who will provide round-the-clock medical care to hospitalized patients. The new hospitalist team is comprised of Larry Rigsby, MD, FACP, FHM; Sylvanus Fiakapornoo, MD; Tricia Scheuneman, MD;  Seth Wagner, DO; and Sunny Onuigbo, MD. Larry Rigsby, M.D., FACP, FHM com-

pleted his undergraduate and medical degree at University of Alabama in Birmingham and completed his Internal Medicine residency at Duke University. He was most recently with Memorial Health System in Chattanooga prior to joining Hutcheson as the hospital’s Medical Director of Hospitalist Medicine.  Rigsby is a Fellow in the Society of Hospital Medicine. Sylvanus Fiakapornoo, MD, is a graduate of The University of Ghana Medical School and completed his internal medicine residency at Interfaith Medical Center in Brooklyn, NY. Dr. Fiakapornoo has served as a hospitalist with St. Michael’s Hospital in Wisconsin and at Redmond Regional Medical Center in Rome, GA. Tricia Scheuneman, MD, is a graduate of the Loma Linda University School of Medicine.  She completed her residency at Kaiser Permanente in California and received her undergraduate from Andrews University in Michigan.  Scheuneman has served as a hospitalist with ParkRidge Medical Center and most recently at Hamilton Medical Center.  Seth Wagner, DO, received his undergraduate degree from The University of Tennessee in Knoxville and his medical degree from the Virginia College of Osteopathic Medicine.  He completed both his internal medicine internship and residency at UTCOM, Chattanooga. Sunny Onuigbo, MD, received both his Bachelors of Science in Nursing and premedical certification from the University of Massachusetts.  He obtained his Doctorate in Internal Medicine at the Ross University of Medicine and completed his residency at Stanford Hospital/Columbia College of Medicine.   

KenJo Markets Raises $43,000 for East Tennessee Kidney Foundation KNOXVILLE – The East Tennessee Kidney Foundation is the recipient of a $43,000 donation, thanks to benefit coupon books purchased by KenJo Markets customers. The funds will be used to enhance the lives of East Tennesseans with, at risk for or affected by kidney disease. “We are very appreciative of our customers and employees who helped raise the money through the KenJo coupon book campaign,” said Charles W. “Wes” Carruthers Jr., president of KenJo Markets. “The East Tennessee Kidney Foundation is a fantastic organization, and the money stays right here in the region to help pa- East Tennessee Kidney Foundation Executive Director Katie tients with kidney dis- Caldwell recently accepted a $43,000 donation from Charles “Wes” Carruthers Jr., president of KenJo Markets. The funds were raised ease.” through the sale of benefit coupon books at area KenJo Markets The East Tennessee locations. For more information about the East Tennessee Kidney Kidney Foundation cur- Foundation, visit http://www.etkidney.org. rently serves approximately 200 low-income patients in 15 counties. The organization focuses on patient services, including helping patients with transportation to and from dialysis treatments and providing assistance and resources for dental care and also nutritional supplements. Tax-deductible donations are accepted online at http://www.etkidney.org. OCTOBER 2013

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GrandRounds Michael D. Underwood, MD, Interventional Cardiologist, Joins Tennova Healthcare KNOXVILLE —Tennova Healthcare welcomes Michael D. Underwood, MD, Interventional Cardiologist, to the medical staff at Turkey Creek Medical Center. Dr. Underwood’s office, West Knoxville Heart at Tennova, will be located in Physicians Dr. Michael D. Underwood Plaza 1 at 10820 Parkside Drive, Suite 201. Underwood is an East Tennessee native. He received his medical degree from the University of Tennessee and is fellowship trained in cardiology from the University of Michigan, Ann Arbor. He specializes in interventional cardiology. Underwood has practiced in Knox-

ville for 33 years and is now accepting patients at his new location at Turkey Creek Medical Center.

Christopher Kulisek, MD, Gastroenterologist, Joins Tennova Healthcare KNOXVILLE —Tennova Healthcare welcomes Christopher Kulisek, M.D., Gastroenterology and Hepatology, to the medical staff at Turkey Creek Medical Center. Dr. Kulisek will be located in the Physicians Plaza at the hospital, 10810 Parkside Dr. Christopher Drive, Suite G-15. Kulisek Kulisek is board certified in internal medicine and offers gastroenterology and hepatology services. His advanced training includes a pro-

Dr. Robert F. Thomas Foundation Supporter Surprises Dolly Parton with $50,000 Check PIGEON FORGE—While on the Dollywood set of her new Lifetime Christmas movie, entertainment legend Dolly Parton was gifted with a $50,000 check for the Dr. Robert F. Thomas Foundation from Michael Cooper, CEO, and President of GlobalDoc, Inc. Parton is the foundation’s honorary chairperson. A portion of Cooper’s donation to the Dr. Thomas (left to right): Linda Ogle (Dr. Robert F. Thomas Foundation Foundation was earmarked for Board Member), Ellen Wilhoit (CAO, LeConte Medical the Sevier County Boys & Girls Center), Debbie Dowling (Executive Director, Dr. Robert Thomas Foundation), Dolly Parton, Mike Cooper Club to aid in the organization’s F. (CEO GlobalDoc), and Julio Pujols (Executive Assistant, anti-bullying awareness efforts. GlobalDoc). Debbie Dowling, Executive Director of the Dr. Thomas Foundation; Ellen Wilhoit, Chief Administrative Officer of LeConte Medical Center; and Linda Ogle, Dr. Thomas Foundation board member, were all on hand for the presentation.

ACCEPTING NEW PATIENTS East Tennessee Children’s Hospital Gastroenterology and Nutrition Services is East Tennessee’s premier pediatric gastroenterology group. We are staffed with four of the area’s finest board certified pediatric gastroenterologists, in addition to three nurse practitioners, two behavior health clinicians, three registered dieticians, one physicians assistant, and a research coordinator. We serve all of east Tennessee and the surrounding areas. 2100 Clinch Avenue, Suite 510 | Children's Hospital Medical Office Building | Knoxville, TN 37916

www.giforkids.com

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cedure used to identify stones, tumors and other problems of the digestive system. Dr. Kulisek specializes in colonoscopy screenings and early detection of colon cancer. Dr. Kulisek is accepting new patients.

UT Nursing Professors Aim to Prepare Appalachian Region for the Worst KNOXVILLE—In Clay County, Kentucky, flooding or ice frequently blocks access to emergency services. Nursing professors in the Global Disaster Nursing program are working with architecture and environmental engineering professors, law enforcement professionals, graduate students, and Clay County community partners to improve the area’s community wellness and disaster preparedness. The project is made possible through a $1.5 million grant over three years from the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA).   Through a constant flow of communication between the project group and community members, the group will identify, evaluate, and address the health and disaster readiness needs of Clay County. Participants include nursing professors Susan Speraw, Moriah McArthur and Mary Nypaver; architecture and design professors John McRae and J. David Matthews; John Schwartz, environmental engineering professor; Don Green from the UT Law Enforcement Innovation Center; graduate students; the UT Institute for Assessment and Evaluation; and two Clay County community partners, Red Bird Mission and Clay County Emergency Management. 

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Bee Fit 4 Kids is a family oriented pediatric weight management program using evidenced based research to help overweight children & their families. We are now accepting insurance. KidsFACT is a nonprofit support group created by GI for Kids, PLLC for those diagnosed with pediatric Inflammatory Bowel Disease (IBD) & their family members. Our behavior clinicians are experienced in helping a variety of disorders. Support group helping the Knoxville region with celiac disease & gluten intolerance. www.celi-act.com

or e-mailed to: subscriptions@southcomm.com Subscriptions: Become a fan on Facebook, One year • Two and$48 Follow us years on $78 Twitter@EastTNMedNews SOUTHCOMM Chief Executive Officer Chris Ferrell Chief Financial Officer Patrick Min Chief Marketing Officer Susan Torregrossa Chief Technology Officer Matt Locke Business Manager Eric Norwood Director of Digital Sales & Marketing David Walker Controller Todd Patton Creative Director Heather Pierce Director of Content / Online Development Patrick Rains East Tennessee Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2013 Medical News Communications.All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials.        All letters sent to Medical News will be considered Medical News property and therefore unconditionally assigned to Medical News for publication and copyright purposes.

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