The Stethoscope Newsletter, June 2020, Erie County Medical Society

the Stethoscope the Stethoscope

September 2019 Issue

Quarterly Newsletter of the Erie County Medical Society

Quarterly Newsletter of the Erie County Medical Society • June 2020 Issue

A Message From Your President

A Paean to Physicians

by Jeffrey McGovern, MD, FCCP, FAASM, President, ECMS

Jeffrey McGovern, MD, FCCP, FAASM, President, ECMS Rebecca Doctrow Association Executive rdoctrow@pamedsoc.org Phone: 814-866-6820 1438 West 38th Street Erie, PA 16508 Administrative Office/ Mailing Address: 777 East Park Drive Harrisburg, PA 17111 eriecountymedicalsociety.org

The opinions expressed in this publication are for general information only and are not intended to provide specific medical, legal or other advice for any individuals. The placement of editorial content, opinions, and paid advertising does not imply endorsement by the Erie County Medical Society.

All of us are inundated and when has it been any different? Recall when the topic du jour was physician wellness with calls to restore a sense of normalcy and prevent the downward spiral of physicians in particular and medicine in general. COVID19 has put any of those restorative proposals and others on the back burner. These troublesome patterns are not at all resolved but are rather simmering under the surface as if some superhuman power is repressing their expression. That power is the resilience and compassion of the physician. It is worthwhile to explore that superhuman power of the physician further through a Kubler-Ross-esque process.

Recall the five stages of grief? As college students we could easily spout off denial, anger, bargaining, depression and acceptance. These therapeutic gems can still enlighten us today.

When word of a deadly virus allegedly originating from a wet market in Wuhan began to circulate on the many sites popping up on our smart phones, we certainly registered alarm. Was there one among us who thought the virus would travel beyond its make-believe borders and makes its footprint worldwide? I would venture to say that policy makers and public health officials took note. Dr. Jung Eun-Kyeong of South Korea, Dr. Jenny Harris of the United Kingdom and Dr. Anthony Fauci of the United States voiced their concerns and courageously recommended social distance techniques and other widespread health measures. They are trained physicians who followed a different path in medicine but are cognizant of the patient coming first. The rest of us, though concerned, knew that our patients deserved our full attention. Our denial of the reach of this virus was fueled by the daily needs of our sick patients.

We told them as always to wash their hands, get their flu vaccine and avoid sick contacts.

The virus invades northern Italy after a devastating show at its originating city of Wuhan. We learn its name and its genetic structure. We learn of its powerful effect on the immune system and the deadly cytokine storm. We start to hear about foreknowledge of the virus and the alleged unleashing of coronavirus.

We hear daily accounts of our elected officials trying to respond with starts and Continued on page 2

A Paean to Physicians Continued from page 1

fits and subjected to the angry gesticulations of other elected officials and the populace. As physicians we too feel the anger, but the anger revolves around our patients: What don’t I know to protect my patients and the system that is their safety net? Where is the PPE to protect my family and patients? Where is the vaccine?

Our anger drives us to push against social isolation and be present on the front line with other members of the health team. It is an anger directed at productivity.

We accept that the work of a physician is arduous and often superhuman, but this is exactly what the majority of us signed up for. We agree that our positions can feel lonely but we must realize daily that we are consistently a part of a vital team of nurses, medical assistants, secretaries and custodians.

We accept now that the aftermath of COVID19 will linger and the presence of face masks and social distance will be as common as a stethoscope. Most importantly, we accept that the patients to whom we have pledged our intellect still need our care in the form of intervention or assurance. We accept too the words we uttered upon receiving our medical degrees: With purity and holiness I will pass my life and practice my Art (Hippocratic Oath).

Next, we turn to bargaining. Whether or not we have a faith to buttress our lives we still cry out for more time in the day, more strength to weather the frustrations in order to focus our attentions on our patients, even for warmer weather if indeed this will abate the growth of COVID19. At the end of the day we may take on the persona of a day trader riding the peaks and valleys of the markets, asking for more time with our patients to prevent their chronic diseases from complicating an already precarious health care system.

Let us carry on with confidence in our skills and renewed passion with the patient in mind. Be safe and renewed!

Depression shows its ugly self in the form of inexhaustible data and disease models. Even the public policy champions seem to drone on with the same depressing details of sickness and death. If we are not vigilant about our own health and sleep, that same depression seeps insidiously into our very being.

Like physician “unwellness” it serves only to frustrate patient care and decision making. What do we do with the depression? We answer patients’ anxieties with assurance. When we can offer nothing but assurance via the limitations of telehealth, we do so readily and enthusiastically. As physicians we don’t falsely sweeten but tell our charges that we are present for them. We won’t sneak away into our undisclosed silos until the “all clear” sign. We instinctively and devotedly see the next patient in whatever forum our state in life brings us. Simply put, we answer adversity and the unknown as our forebears in medicine did: head on.

The last stage outlined by Drs. Kubler-Ross and Kessler is acceptance. I have always understood this stage by the phrase: “OK, I get it but…” We accept that COVID19 has devastated worldwide health, killed many in their prime years by at least a decade but generations of physicians have faced in their lifetimes war and pestilence and have conquered insurmountable obstacles with ingenuity and grit.

2

Dr. Jeffrey McGovern, President of ECMS, delivers contributions to Second Harvest from recent drive to support the Erie community.

Anyone who missed the opportunity to donate goods to our collection can still contribute. Visit https://nwpafoodbank.networkforgood.com/ to contribute, and be sure to note in a donor scroll that you are making a contribution as a physician of the Erie Community.

3

Member News New

Reinstated

David Ricardo Almeida, MD Kimberly Arndt Sarah Bilski, DO Susannah Boulet, DO Kristen Bublitz, MD Mihir Buch, DO Niranjani Buch, MD Jacob Cauvel, DO Jenna X Cheng, DO Shelby Rose Curren, MD Brendan Dempsey, MD Michael Driscoll, DO Laura Faye Gephart, MD Alec David Grossman, DO Rakesh Guha, DO

Christopher Francis Hietanen, DO Darshan Hullon , DO Paul Jimenez Stuart, DO

Gary Michael Ritten, MD George Raymond Rollins, DO Anjali Singh, DO

Dillon Chandler Kolacz, MD Aditya Harendra Mehta , MD Vincent Viet Ngo, MD Jeffrey Reynolds, DO Jeffrey Reynolds, DO Rachel Rivell Micah Schmal, DO Clinton Van Hoff Richard John Wagner Jr. Barry A Warshaw, DO Leonardo Zingg , MD Monica Zipple, MD Andrew Zweig, DO

Financial Wellness Event Has Been Postponed

!

D E N O P T S O P At this time, we are going to postpone the Financial Wellness event until a time when we are more comfortable with in person events. ECMS feels that this event will be most rewarding only if it can be held in an atmosphere of networking and social interaction.

Please continue to stay safe and healthy. We will send additional communication when a new date has been decided for the Financial Wellness event.

If you have any questions regarding the postponement of the Financial Wellness event, please email ErieCMS@pamedsoc.org.

4

The Big Picture John C. Reilly, MD I came to know her over two years: first as a physician and then as a friend. I had been asked to see her on the Oncology floor at Saint Vincent. I knew I was in for a challenging experience when, upon entering her room, I was greeted by a crescendo of randomly directed, F-laden outbursts. I quickly realized these to be the raw primal screams of a sick 25 year old in pain and on chemotherapy for leukemia. I took care of her minor surgical problem but the fury continued.

During a hospital visit in late August 2005 I sensed a change in her mood. That afternoon, I found her sobbing as if defeated - a new dimension to the agony she seemed to have previously covered with anger. I asked her what was going on. She pointed to the TV on the wall of her hospital room and, between sobs, cried out: “How can anyone care about me when this is going on?” Turning around I saw that she was referring to CNN’s 24/7 coverage of the ravages and human cost of Hurricane Katrina.

It seems that our flag is almost perpetually found to be at half-staff. The lowered flag has been stripped of meaning and its subsequent raising no longer announces the end of bereavement and a return to normal life after loss. The flag was meant to commemorate a life or lives of service. It now serves as an unfocused emotional backdrop to the culture of perpetual mourning.

Beginning with the Kennedy assassination, television offered the ability to communicate and cultivate a national and even world-wide sense of shared experience. This has been especially true of tragedy. Today, media packaging forges deep emotional connections to tragedies that few, in actual fact, have personally experienced. We are in the streets of New York City on 9/11.

We are at the scenes of mass shootings. We see the faces and hear the life stories of those lost to senseless violence. We are connected to the tragedy yet truly remote from one another in that experience. We are powerless to help but we can mourn.

In 2005, in that hospital room, in the flickering light of the TV, I was given a gift: that of understanding how the impact of media-forged “collective mourning” can make the suffering of an individual seem small or invalid when not a part of the “Big Picture”. It can make the fears and even the loss experienced by that individual’s family seem inconsequential in comparison to the professionally personalized stories of loss we witness almost every day.

Yet every day, in each room in the hospital a “Big Story” plays out. Every day, a patient and his or her family may experience the horror of their own 9/11. The suffering is no less intense because it is experienced privately, behind a closed hospital room door, and intimately, out of view of the cameras. The loss is no less worthy of a respectful lowering of the flag.

My friend lost her battle with leukemia later that year.

I came to learn that in the arms of her family and in the embrace of God, she experienced the consolation and peace that comes with the assurance of the preciousness of her life. That was the last sentence of the story of her life; it was the last frame of the visual memory of her brief worthy existence. Her life was celebrated and her loss mourned by those few to whom she really mattered.

5

These are unprecedented times that call for heroism. We are seeing the physicians of the Pennsylvania Medical Society step up to care for their patients through uncharted, daunting territory — although they tell us “I’m just doing my job.” Let’s honor their dedication as they continue to provide exemplary care throughout the COVID-19 pandemic.

Please nominate a physician you feel exemplifies an Everyday Hero by completing the brief form at www.pamedsoc.org/everydayhero.

(855) PAMED4U (855-726-3348) • www.pamedsoc.org • KnowledgeCenter@pamedsoc.org 20/879

6

Congratulations to our members who were included on PAMED’s Top Physicians Under 40 for 2020!

Amrita Chakraborty, MD, Erie

Dr. Chakraborty is a palliative care physician affiliated with Saint Vincent Hospital.

Her colleagues note the dedicated care she provides to patients who are managing end-of-life issues. She is also involved with the Saint Vincent Family Practice Residency Program. Her enthusiasm for resident education will ensure that the skills and support she offers to patients are passed down to the next generation of physicians.

Joshua D. Czerwinski, DO, Girard

Dr. Czerwinski is a family medicine physician with Elk Valley Family Medical Center, part of Allegheny Health Network. He is dedicated to offering patient-centered care to rural patients in his community. He is a faculty member at a family medicine residency. Dr. Czerwinski has developed a rapport with his trainees and is passing on the skills to be a successful primary care physician to the next generation of Pennsylvania doctors.

Stephanie A. Larson, DO, Erie

Dr. Larson is an emergency medicine physician affiliated with Saint Vincent Hospital.

She is an advocate for patients in her community who are suffering from opioid use disorder and other substance use disorders. She has worked to streamline the “warm hand-off” process to help patients find addiction treatment opportunities.

Anand Popuri, DO, Erie

A pulmonary and critical care physician with LECOM Health, Dr. Popuri specializes in advanced bronchoscopy and the treatment of breathing disorders such as asthma and COPD. He works to advance pulmonary diagnostics and treatments in order to increase access to care for patients in the Erie region. Dr. Popuri is devoted to educating students and residents in current pulmonary practices to help shape the lives of future physicians.

Ingrid Renberg, MD, MPH, Erie

A forensic psychiatrist, Dr. Renberg works with the Pennsylvania Department of Corrections as the regional chief of psychiatry for Northwest Pennsylvania. In her role, she oversees six institutions with a diverse patient population of male and female inmates, provides direction to psychiatrists and psychiatric nurse practitioners, and offers direct patient care. Dr. Renberg also serves as a district representative for PAMED’s Women Physicians Section.

7

Erie County Medical Society will be hosting the 11th Annual Health Expo on the Macy’s Concourse at the Millcreek Mall on Saturday, October 10. The event will be held from 11:00 AM – 2:00 PM. For the past 10 years, the Erie County Medical Society has hosted a health fair to provide health screenings and education to our community in an effort to promote healthier living. Several local establishments will be onsite to offer services and education to the Erie Community. We hope you are able to join us!

Display Opportunities Screening/Education Table ($70 Non-Profit/$200 Regular) Company name listed on sign at ECMS table and on vendor list provided to attendees, (1) table with (2) chairs.

Event Sponsor ($2000) Logo included in all marketing materials (social media, posters, event banner, etc.), up to (4) tables with (2) chairs at each, Company name listed on sign at ECMS table and on vendor list provided to attendees.

Click here to register as an exhibitor or sponsor.

All sponsors must be received by August 15 in order to be included in marketing for the event.

8

Legislative Update As we reach the midway point of the calendar year, the Pennsylvania General Assembly heads for the home stretch of the 2019-2020 regular session. To say that this current session has been unique and challenging would be a gross understatement. The current pandemic the world is facing has had a significant impact on everyday life in Pennsylvania and the General Assembly is no exception. Adding to this is the civil unrest and justice reform movements that our nation is experiencing collectively. The unfortunate result on the way business is being conducted in Harrisburg is that all of these things together have only deepened the divide between political parties and those sitting on opposite sides of the aisle.

While June is typically a very busy month in Pennsylvania politics as legislators and the Governor seek to reach compromise on a budget for the next fiscal year, this has not been the case as elected officials worked to pass an interim budget ahead of the usual June 30 deadline. To this end, a 5-month budget was passed to allow the Commonwealth to continue moving forward in the face of these uncertain times. The budget was based on the previous fiscal year numbers and the most notable highlight was the inclusion of full year school funding, while the rest of the budget will only take the Commonwealth through November 30, the date in which the current legislative session will end and legislators’ terms will expire (all members of the House and half of the Senate).

Additionally, Pennsylvania saw its primary election postponed until the first week of June, being held on June 2. The entire state House of Representatives and half of the state Senate are up for reelection. Prior to the primary election, two state senators announced their retirements, most notably Senate President Pro Tempore Joe Scarnati (R-25). Over in the House of Representatives, sixteen members made the decision to not seek reelection, most notably Speaker of the House, Mike Turzai (R-28). The House also saw Representative Chris Dush take aim at replacing Senator Scarnati in the 25th State Senate District. Representative Dush emerged victorious in the primary and likely will be moving to the Senate come November. The primary election saw a surge in the use of mail-in ballots, significant challenges with new voting machines in various counties and long delays in finalizing election results (some are not yet final as of this writing). While there will not be as many new faces at the beginning of the 2021-22 legislative session as this current session, there will be changes in leadership in both legislative chambers. As mentioned above, the top two members in each chamber are moving on and as jockeying plays out to replace those leadership posts other dominos will fall into place to form the new leadership teams.

Continued on page 10

9

Legislative Update Continued from page 9

involving federal funding. This legislation is redundant as the Federal government currently provides for these remedies and grants unprecedented investigative powers and authority to the state Attorney General.

Lastly and ending on a positive note, HB1947, which seeks to modernize the process by which graduates of international medical schools become licensed, advanced to the Senate after final passage by the House with a vote of 202-0. The legislation reduces the number of residency years, from 3 to 2, that IMG’s must complete prior to applying for a Pennsylvania medical license. We anticipate this measure to win Senate approval in the fall.

It is also worth noting that, in a political rarity, two Philadelphia area incumbents likely were defeated in their primaries. Both Senator Larry Farnese (D-1) and Senator Daylin Leach (D-17) succumbed to challenges and these respective districts will welcome new State Senators in the fall. Another trend that we continue to see is extreme progressives knocking off more moderate members of both the Democratic and Republican parties, incumbents included.

Turning our attention to legislation, we remain focused on getting movement on PAMED’s top priority issues.

Due to the nature of the pandemic and most activities being conducted remotely, there was some optimism that telemedicine legislation could get done, however, the issue continues to be saddled with abortion concerns and a deep divide among pro-life legislators and the Governor’s office. PAMED continues to push for advancement of prior authorization reform legislation (HB1194) and while there are not many session days remaining, we will be advocating to get this finished in the fall as the General Assembly returns to Harrisburg.

We continue to monitor out of network-balance billing legislation (HB1862) and oppose in its current form. This is an important issue at both the state and federal level and while the issue needs to be addressed, the current bill falls short of removing the patient from the middle and is extremely pro-insurer. However, amendments have been drafted to address these issues and if they were to be included in the bill, PAMED would change our position to support the legislation. Also, worth mentioning is that PAMED opposes HB2352 seeking to provide state framework for addressing fraud in healthcare

Other legislation in which PAMED has been actively involved includes optometric (SB 391 & HB 2561) and CRNP (SB 25 & HB 100) scope of practice proposals both of which are not expected to move in the near term.

While PAMED’s legislative agenda is robust, we anticipate the legislature’s fall schedule to be light in advance of the November General Election. However, PAMED’s legislative affairs staff will continue advocating for the passage of legislation that improves patient care and preserves physician autonomy.

10

Letter to Governor Wolf

Dear Governor Wolf:

Thank you for your hard and diligent work to protect Pennsylvanians amidst the

COVID19 pandemic.

We offer our heartfelt support in your daily duties.

As a pulmonary physician on the front lines and president of the Erie County Medical

Society, I know firsthand the stressors that afflict our fellow citizens and physicians.

Physicians want always to do the best for patients and this mandate is surely echoed

during these very difficult times. I would ask on behalf of my fellow physicians that you

help to relieve the stress we are all experiencing by signing an order limiting liability of

physicians working on the front lines of this pandemic. Thinking about the stress of a

lawsuit when one is doing the best for fellow, ill Pennsylvanians is not productive or helpful

for the physician or patient. Your message would greatly support these hard-working

physicians and the citizens of this great state who dearly rely on their care. Thank you.

Jeffrey McGovern, MD, FCCP

The Quote

CORNER

It’s the best time ever to be a doctor because you can heal and treat conditions that were untreatable even a few years ago.

11

—Joseph Murray

IN MEMORIAM Erie County Medical Society is saddened by the passing of one of our members. Paul Newell, MD passed away in May at the age of 65. Our deepest condolences are with Paul’s family and friends during this time. More information can be found here. (https://www.legacy.com/ obituaries/erietimesnews/obituary.aspx?n=paul-m-newell&pid=196168080&fhid=9679)

2019–2021 ECMS Board of Directors Jeffrey P. McGovern, MD, FCCP, FAASM President

Timothy D. Pelkowski, MD At Large Member

Narendra Bhagwandien, MD Immediate Past President

Paul Malaspina, MD At Large Member

Kelli DeSanctis, DO President Elect

Kirk Steehler, DO At Large Member

Terence O. Lillis, MD Secretary/Treasurer

Amanda Marie Wincik, DO At Large Member

Peter S. Lund, MD, FACS AMA Representative

Justin Webber, MD Resident Representative

Kathleen Anne Costanzo, DO At Large Member

Michael Furey Student Representative

Thomas Falasca, DO, FACA, FACPM At Large Member