THE BULLETIN

A PUBLICATION OF THE MUSCOGEE COUNTY MEDICAL SOCIETY

ERUDIRE ET DELECTARE

V O L U M E 5 8 • N U M B E R 6

JUNE 2013

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THE BULLETINSociety Office: 2300 Manchester Expressway, Suite F-7 • Columbus, GA 31904

706-322-1254 • FAX 706-327-7480 • www.muscogeemedical.org

C o n t e n t sPresident’s Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Hospital News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10, 14

Editor: David H. Levine, M.D. • Associate Editor: Casey Geringer, D.O.Managing Editor: Lisa Venable

Officers 2013:

President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Glenn E. Fussell, M.D.

President-Elect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Past President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ashish K. Jain, M.D.

Secretary-Treasurer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . William Frank Willett, III, M.D.

Director to MAG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fred Flandry, M.D.

Alternate Director to MAG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . James D. Majors, M.D.

Executive Committee: Glenn E. Fussell, Ashish K. Jain, David H. Levine, Raj Alappan, FrederickFlandry, Larry E. Brightwell, Edmund M. Molnar, Jr., William Frank Willett, III, James D. Majors,Joseph R. Zanga, Ryan Geringer, Kurt Jacobson

Delegates: Benjamin Cheek, MD, Frederick Flandry, MD, Glenn E. Fussell, MD, Ryan Geringer, DO,A.J. Jain, MD, James Majors, MD, Edmund M. Molnar, Jr., MD, William Frank Willett, III, MD,Kenneth Smith, M.D. and Joseph R. Zanga, M.D.

Alternate Delegates: Larry E. Brightwell, MD, Marvyn Cohen, MD, Thomas Ellison, MD, JamesJohnson, MD and John D. Watson, Jr., MD

Ad position is at the sole discretion of the Editorial Board.

Members are urged to submit articles for publication in The Bulletin. Deadline for copy is the 11th of the month preceding date of issue.The Bulletin of the Muscogee County Medical Society is the official monthly publication of the Muscogee County Medical Society, 2300Manchester Expressway, Suite F-7, Columbus, GA 31904. All material for publication should be sent to the Managing Editor not laterthan the 11th of the month. Advertising requirements and rates upon request. Opinions expressed in The Bulletin, including editorials,are those of the individual authors and do not necessarily reflect policies of the Society unless stated. Advertisements in this magazinedo not necessarily represent endorsement or support by the Muscogee County Medical Society.

President’s Message

It has been two years since I timidly agreed to become thePresident of the Muscogee County Medical Society. One of thefirst things that I did as new President was to develop abusiness plan. Part of the business plan was to identify thepracticing physicians in Muscogee County. At that time therewere 495 physicians. So we developed a goal of capturing halfas members to the Muscogee County Medical Society. Two

years ago we had 175 members. Currently we have 249 active members. Duringthat two years, I have seen more enthusiastic participation, resulting in a strongerorganization. The committees have worked hard and have done a yeoman's job insupporting and strengthening our society.

Last year, we developed a Preceptor Development Course that was presented toprospective clinical preceptors of Mercer University School of Medicine andPhiladelphia College Of Osteopathic Medicine, Georgia Campus. That was asuccessful program and we will repeat it this year. This time we will direct somefocus to the fourth-year curriculum. However it is still very applicable for thosewho teach third-year curriculum. This course will be for 3 hours of CME. It ishosted by St. Francis Hospital. The location will be at the auditorium at PastoralInstitute. This will be the morning of June 29, commencing at 9 am.

Our summer meeting will be on Monday, July 15. This event will be at the RiverMill Event Center. Our guest speaker will be Congressman Phil Gingrey, M.D. Heis the Congressman from the 11th district. He is one of three Georgia physicianswho are in the US House of Representatives. He has announced his intention torun for the upcoming vacant seat of US Senator Saxby Chambliss. This will be ourpolitical event for the year. Last year’s political event was a lively debate betweenUS Congressman Sanford Bishop and his opponent, Col. John House.

Nominations have been returned from the nominating committee. Elections willbe held at the summer meeting on Monday, July 15. The executive officers willassume their new roles in January 2014.

James Majors, M.D. has been nominated as the upcoming President. He hasserved as the Audit Committee Chairman and as Alternate Director to MAG.

Frank Willett, M.D. has been nominated as the President-elect. He has served forsix years as the Treasurer.

P R E S I D E N T ’ S M E S S A G EGlenn E. Fussell, M.D.

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Glenn E. Fussell, M.D. has been nominated as the Treasurer.

Fred Flandry, M.D. and Frank Willett, III, M.D. are nominated as Director andAlternate Director to MAG.

MAG House of Delegate will meet in October and these delegates are nominatedfor service in 2013.

Nominations for Delegates to MAG are Glenn Fussell, M.D., Frank Willett, M.D.,James Majors, M.D., Timothy Villegas, M.D., Joseph Zanga, M.D., Ryan Geringer,D.O., Vince Naman, M.D., Fred Flandry, M.D., Benjamin Cheek, M.D., FolarinOlubuwale, M.D., and Jim Hagler, M.D.

Nominations for Alternate Delegates to MAG are Mike Borkat, M.D., CaseyGeringer, D.O., Norman Luton, D.O., Larry Brightwell, M.D, Henry Ngo, M.D., andMac Molnar, M.D.

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A R T I C L E O F I N T E R E S T

Decompressive Craniectomy: A Life Saving Surgery for Cerebral Infarction

A 42-years-old obese lady uncharacteristically did notshow up for her night shift. The following morning her co-workers went to her apartment and found her lyingunconscious outside her shower. She was brought to St.Francis hospital ER by EMS. The patient had severe righthemiperesis with hemisensory neglect, and was unable tophonate. Her eyes and head were initially severelydeviated to the right. Computed tomography scanshowed a completed stroke in the distribution of leftinternal carotid artery (ICA) territory (Fig. 1). A largecraniectomy was performed emergently and the elevatedbone flap stored in her anterior abdominal wall. The craniectomy uncoveredalmost the entire brain surface involved in stroke and extended down to the floorof the temporal fossa. The dura was opened for further decompression and duralsubstitute placed in onlay fashion to create further room for brain expansion.Postoperatively, the patient was aggressively managed in the ICU where her gazewas noted to be persistently deviated to the left. Over the next few days the gazedeviation resolved entirely. Concurrent stroke workupdemonstrated a patent cardiac foramen ovale that hadresulted in paradoxical embolism. Of great concern was alarge, pedunculated, highly mobile mass in the rightatrium consistent with a thrombus, detected ontransthoracic echocardiography. It compelled theinitiation of intravenous heparin on POD 3 (goal PTT in50s) , despite the significant associated risk due to therecent stroke and surgery. The patient’s care was alsocompounded by acute pancreatitis, discovered duringevaluation of persistent fever spikes and high WBC since admission. She wassuccessfully bridged over to coumadin after POD 8. Neurologically, the patientcontinued to make a remarkable recovery such that by the time of discharge to arehabilitation facility on POD 30, she was completely interactive with her familymembers and staff as well as, on the phone. She was able to weight bear and takea few steps. She phonated frequently and was able to utter simple meaningfulwords and appropriate sounds.

This case highlights the importance of early and aggressive decompression alongwith meticulous multi-specialty care that resulted in a favorable outcome in anextensive, dominant hemisphere stroke.

by Shah-Naz Hayat Khan, BSc, MD, FRCS(C), FAANS, Director of Neurosurgery, Director of Endovascular Neurosurgery & Stroke Intervention, St. Francis Hospital

(Fig. 1)

(Fig. 2)

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Malignant cerebral infarction that occurs from occlusion of distal internal carotidor proximal middle cerebral arteries is known to have mortality upto 80% withconservative management alone, or if surgery is delayed until there isdeterioration in the patient’s neurological condition. The patient’s level ofconsciousness declines within the first 2-3 days and deaths usually occur withinthe first five days, consequent to transtentorial herniation. The predictors ofmalignant cerebral ischemia include a stroke volume greater than 145cm3 within14 hours of onset of stroke symptoms, involvement of more than 50% of middlecerebral artery (MCA) territory in stroke, leukocytosis, additional involvement ofanterior cerebral artery (ACA) or posterior cerebral artery (PCA) territory andsystolic pressures higher than 180 mmHG within 12 hours of stroke onset. Ourpatient had all the above-mentioned indicators.

Literature increasingly indicates that early decompressive surgery limitsexpansion of the infarcted area, immediately attenuates ICP and preventsherniation, as the cranial vault is effectively enlarged and allows infarcted braintissue to move away from midline. The removal of bone drastically reduces theICP and opening the dura causes further reduction e.g., in one case it declinedfrom 54.8 mmHg to 35.5 to 4.4 mm Hg. The reduction in ICP results in improvedcerebral perfusion pressure. The literature indicates that perhaps those ≤ 60 yearsdo better than older patients. Exclusion criteria for craniectomy include bilateralfixed dilated pupils, GCS <6, prestroke mRS ≥2, hemorrhagic transformation ofstroke, coagulopathies or systemic bleeding disorders.

ReferencesHacke W, Schwab S, Horn M, et al. Malignant middle cerebral artery territory infarction: clinical courseand prognostic signs. Arch Neurol 1996, 53: 309-315 Kasner SE, Demchuk AM, Berrouschot J, et al. Predictors of fatal brain ischemia in massivehemispheric ischemic stroke. Stroke 2001, 32:2117-2123Musabelliu E, Kato Y, Imizu S, Oda J and Sano H (2012). Surgical treatment of Patients with ischemicStroke decompressive craniectomy. In: Rodriguez JCG (Ed) Acute Ischemic stroke. pp 165-186. ISBN:987-953-397-983-7. http://www.intechopen.com/books/acute-ischemic-stroke/surgical-treatment-of-patients-with-ischemic-stroke-decompressive-craniectomy.

LegendsFig. 1. CT head demonstrating a completed stroke involving the MCA and ACA ditributions. The masseffect has resulted in effacement of the frontal horn of left lateral ventricle. The enlargement of theposterior horn of the right lateral ventricle is also appreciated (arrow, a), indicating that it is trapped.The territory supplied by posterior cerebral artery is spared (arrow, b).

Fig. 2. Repeat CT scan a day after decompressive craniectomy. Note the attenuated size of the rightposterior horn (b, black arrow. Compare to 1a), indicating the ventricle is no longer trappped. Thecraneictomy defect exposes almost the entire surface involved in stroke. The swollen infarcted braintissue (white arrows, a and b), now sharply demarcated from the non-injured brain, has shifted awayfrom the midline and is extending beyond the outer table of skull. If a decompressive craniectomyhad not been performed, the swollen tissue could only compress and displace normal brain tissue,causing expansion of infarction and brain herniation leading to death.

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Patient Satisfaction Scores Soar throughout Columbus Regional Healthcare SystemPatient satisfaction scores throughout Columbus Regional Healthcare Systemhave seen a major increase in one year’s time. Measured by Press Ganey as anindependent third party submitting results based on the HCAHPS (HospitalConsumer Assessment of Healthcare Providers and Systems) Survey to CMS forColumbus Regional’s hospitals, the scores shared below compare publicperception from survey results in April 2012 and in March 2013. At The MedicalCenter, to the question “Rate the hospital from 0-10,” the patients’ scoreincreased from a 6th percentile ranking to the 89th percentile in the Press Ganeydatabase of over 1,700 facilities. Many additional areas showed comparativeimprovements, including responses to the question about the likelihood ofrecommending the hospital increased from the 16th to 98th percentile;communication with nurses increased from the 11th to 99th percentile;responsiveness of staff increased from the 83rd to 99th percentile;communication about medications increased from the 8th to 99th percentile; andrating of discharge information increased from the 35th to 83rd percentileranking.

At Doctors Hospital, significant increases were seen in the response to thelikelihood of recommending the hospital, which increased from the 81stpercentile ranking to the 99th percentile in the Press Ganey database of over1,700 facilities. Many additional areas showed comparative improvements,including communication with nurses increased from the 42nd to 97thpercentile; responsiveness of staff increased from the 69th to 99th percentile;communication with doctors increased from the 37th to 99th percentile;hospital environment rating increased from the 86th to 99th percentile;communication about medications increased from the 63rd to 98th percentile;and rating of discharge information increased from the 60th to 99th percentileranking. At Hughston Hospital, which is consistently ranked nationally for patientsatisfaction and core measure performance, the HCAHPS scores remained at the99th percentile ranking for questions related to overall hospital rating, likelihoodof recommending the hospital, communication with nurses and doctors,communication about medications, responsiveness of staff, hospitalenvironment, pain management and the quietness of the hospital. HCAHPS is anational, standardized, publicly reported survey of patients’ perspectives ofhospital care.

“Great Place to Work” Survey Scores Reflect New Culture The culture shift at Columbus Regional, to become an employer that values andis inspired by its employees, has recently received validation. Not only are theemployees expressing greater satisfaction and engagement levels but, equallyimportant, the patients served by our employees are expressing greater

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C O L U M B U S R E G I O N A L H E A L T H C A R E S Y S T E M N E W S

satisfaction as discussed in the article immediately preceding this one. ColumbusRegional, like many of the other large employers in our community, uses theGreat Place to Work survey administered by the independent research groupcalled the Great Place to Work Institute. The survey tool asks employees to ratetheir facility and the healthcare system overall on these dimensions: credibility,respect, fairness, pride and camaraderie. In every dimension System wide, scoresincreased. To the overarching statement, “Taking everything into account, Iwould say this is a great place to work,” these were the score improvements seen:

At The Medical Center, in 2012 66 percent of the employees answeredaffirmatively and in 2013 that increased to 82 percent;

At Doctors Hospital, in 2012 67 percent of the employees answered affirmativelyand in 2013 that increased to 79 percent;

At Hughston Hospital, in 2012 83 percent of the employees answeredaffirmatively and in 2013 that increased to 91 percent;

At John B. Amos Cancer Center, in 2012 71 percent of the employees answeredaffirmatively and in 2013 that increased to 79 percent; and

System wide, when rating the overall system direction and management in 201270 percent of the employees answered affirmatively and in 2013 that increased to 83 percent.

While Columbus Regional’s management has been told by Great Place to WorkInstitute representatives that the magnitude of these single year improvements israrely seen, we recognize we are on a journey and still have much more we intendto do as we pursue becoming the Healthcare Employer of Choice in ourcommunity and as we bring a new level of service to our community’s physiciansand their patients.

Columbus Regional Healthcare System, Clubview School Earn Top 10 Partnership AwardColumbus Regional Healthcare System and one of its Partners in Education (PIE),Clubview Elementary School, were recognized as a Top 10 Partnership of the Yearat the 2013 PIE Awards Banquet held on April 30 at the St. Luke Ministry Center.Columbus Regional is also partners with Allen Elementary School. PIE issponsored by the Greater Columbus Chamber of Commerce.

Celebrity Classic Events Benefit Expansion of John B. Amos Cancer CenterHundreds of people enjoyed tennis, golf, running and biking events at the 2012Celebrity Classic held at various locations the weekend of April 12-15 and April28. Hosted by the Columbus Regional Medical Foundation, proceeds from theevent, which were estimated at approximately $257,000, will go toward theexpansion of the John B. Amos Cancer Center. Synovus Financial Corp. was theCelebrity Classic’s presenting sponsor.

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THE MEDICAL CENTERPediatric Emergency Department to Open The Pediatric Emergency Department on The Medical Center campus is set toopen at 7 a.m. on Wednesday, June 12. An Open House will be held at 10:30 a.m.on Tuesday, June 11. The Pediatric ED is the first emergency department in thisarea strictly devoted to children. The 5,080 square foot department will includeseven treatment rooms, one medical screening exam room, and a separate entryand waiting room. The Pediatric ED will be adjacent to the Emergency and TraumaCenter (ETC) with a back corridor connecting the ETC’s imaging, trauma servicesand ambulance entrance for immediate access. The new ED will be staffed by aboard-certified pediatric ER physician, something only one in five emergencyrooms in the United States have available.

The Pediatric Emergency Department is the first of many enhancements in a $35million renovation and expansion project for The Children’s Hospital at TheMedical Center. The Medical Center is one of the top birth centers in Georgia andone of only six regional perinatal centers in the state. In an effort to create anational standard for pediatric and neonatal care, future plans include thecentralization of specialized pediatric services, including a pediatric intensive careunit, at The Medical Center with labor, delivery and a neonatal intensive care unitrelocated to Hughston Hospital in north Columbus.

Stamey Lecture Focuses on Weight Loss SurgeryPhysicians, nurses, clinical staff and the general public heard about “CurrentTopics in Weight Loss Surgery” from Richard Stahl, M.D., on April 9 at The MedicalCenter. Dr. Stahl is medical director of Bariatric Surgery at the University ofAlabama at Birmingham. This educational program was presented by theColumbus Regional Medical Foundation through the Stamey Lectureship Series,which is named in honor of retired OB/GYN Charles Stamey, M.D.

JOHN B. AMOS CANCER CENTERJohn B. Amos Cancer Center Receives National Achievement AwardThe John B. Amos Cancer Center is a recipient of the 2012 Commission on Cancer(CoC) Outstanding Achievement Award (OAA). The Cancer Center is one of onlythree accredited cancer programs in Georgia to receive the award and the state’sonly Community Hospital Comprehensive Cancer Center recognized for thisachievement. Seventy-nine cancer programs in the U.S. received this awarddesigned to recognize cancer programs that strive for excellence in providingquality care to cancer patients. Also receiving the award in Georgia were ColiseumMedical Center in Macon and Memorial Health in Savannah.

A facility receives the OAA following the on-site evaluation by a physician surveyorduring which the facility demonstrates a Commendation level of compliance withseven standards that represent the full scope of the cancer program and alsoreceives a compliance rating for the remaining 29 standards. The standards thatform the basis of the OAA criteria include cancer committee leadership, cancerdata management, clinical services, research, community outreach and quality

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improvement. The John B. Amos Cancer Center has been accredited by theAmerican College of Surgeons’ CoC since 1991.

John B. Amos Cancer Center Receives Radiation Oncology AccreditationThe John B. Amos Cancer Center has been re-certified by the American College ofRadiation Oncology (ACRO) following a comprehensive review of its radiationoncology practice. Accreditation is a voluntary process designed to promotequality of care and education and effective for three years. The RadiationOncology practice at John Amos Cancer Center is currently the only oneaccredited by ACRO in Georgia.

ACRO accreditation process includes thorough review of facilities, personnel,policies, equipment and treatment methods using quality indicators based oncurrent nationally accepted standards of care. Case reviews and a site visit byboard-certified radiation oncologists and board-certified medical physicists areincluded in the process. Radiation therapy is one of the most importantmodalities available for the treatment of cancer and is used as part of the initialtreatment in approximately one-third of newly diagnosed cancer cases, accordingto the American College of Surgeons. The ACRO re-accreditation reaffirms onceagain, the high quality of care given to patients receiving radiation treatment atthe John B. Amos Cancer Center.

One Hundred People Screened for Head and Neck Cancers More than 100 people took advantage of head and neck cancer screenings offeredat The Medical Center on April 19. Sponsored by the John B. Amos Cancer Center,this annual event was open to the public. Of those screened, two people werereferred for immediate consultation of a suspected neoplasm, 15 people werereferred for further head and neck evaluation, and 16 were referred for otherfollow up such as a dental evaluation.

HUGHSTON HOSPITALHughston Hospital in Columbus Places on Quality Honor RollHughston Hospital in Columbus has been named to the Georgia HospitalAssociation’s (GHA) Partnership for Health and Accountability (PHA) CoreMeasures Honor Roll. Hughston Hospital is one of 17 hospitals in Georgia to beplaced in the Chairman’s category, the highest on the list. The honor roll is basedon clinical data provided by the federal Centers for Medicaid & Medicare Services(CMS), which administers the nation’s Medicare and Medicaid programs. Thedata was collected from October 2011 to September 2012.

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Dr. Cheryl Clark Joins St. Francis’ Critical Care TeamCheryl Clark, MD, an intensivist, will join St. Francis’ critical care team in June.Dr. Clark comes to St. Francis via Memorial Regional Hospital in Hollywood, Fla.,where she was vice chief of Critical Care. Dr. Clark earned her medical degreefrom the University of North Carolina School of Medicine in Chapel Hill, NC. Shecompleted an internal medicine internship and residency at Vanderbilt UniversityMedical Center in Nashville, Tenn. and a pulmonary and critical care fellowshipat the University of Florida in Gainesville, Fla. She is board-certified in internalmedicine by the American Board of Internal Medicine; board-certified in internalmedicine and pulmonary disease by the American Board of Internal Medicine andPulmonary Disease; and board-certified in internal medicine and critical care bythe American Board of Internal Medicine and Critical Care. She is a fellow of theAmerican College of Chest Physicians.

American Heart Association Honors Belk Brooks, MDDr. Belk Brooks, a cardiovascular surgeon, was honored at the American HeartAssociation’s (AHA) annual gala April 12 for his many years of outstanding serviceto heart patients and his support of AHA initiatives to fight heart disease. SamWellborn presented the award to Dr. Brooks, thanking him for the outstandingcare he has provided to patients in Columbus and the surrounding region.Dr. Brooks, cardiovascular chair on St. Francis Medical Executive Committee,leads St. Francis’ heart program; 2012 outcomes showed improvement as a resultof his leadership.

Dr. Robert Lewis Graduates from the Georgia Physicians Leadership AcademyDr. Robert “Bo” Lewis graduated from the Georgia Physicians LeadershipAcademy (GPLA) on April 20. The GPLA was established to develop physicianleaders to improve health care delivery for their patients, communities and themedical profession. The year-long program includes classes that cover leadershipdevelopment, conflict resolution, media relations, and advocacy. Participantsmust design and complete a leadership project during the year.

Dr. Lewis’ leadership project, “Operating Room Efficiency Initiative,” was basedon the “Lean” process, a well-known manufacturing design created by TaiichiOhno, who is credited as being the father of the Toyota Production System. Thegoal of Dr. Lewis’ project was to improve the efficiency of peri-operative servicesand render cost savings by eliminating waste and wasteful processes that are notdirectly related to the ultimate goal of creating value for the patient, i.e., patientsatisfaction and quality of care. The GPLA is a MAG Foundation program that wasdesigned by the Medical Association of Georgia. The mission of the MedicalAssociation of Georgia Foundation is to enable physicians to support projects thataffect scientific medicine and public health.

S T. F R A N C I S H O S P I T A L N E W S

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St. Francis Host Retirement Party Honoring Dr. Bruce Carr More than 100 physicians, nurses and hospital administrators came out to honorJ. Bruce Carr, MD, an intensivist, who served as both chief of critical care andmedical director of critical care at St. Francis from 2004-2013. Dr. Carr also servedon the hospital’s Ethics Committee. As Columbus’ first nephrologist, Dr. Carrbrought dialysis to the area in the early 1970s and was a strong advocate for its usebefore it became a health care standard. In July 2011, Dr. Carr was recognized bythe Dialysis Clinic with the organization’s Pioneer Award for bringing dialysis toour area.

During his service at St. Francis, he showed a keen ability to assess all aspects of apatient’s condition and establish a deep level of trust and rapport with familymembers, aiding them in making end of life decisions for their loved ones’ care.

Dr. Carr was also instrumental in ensuring the education of the Critical Care staffat St. Francis. He personally invested countless hours educating nurses and otherclinical staff both at bedside and in the classroom. St. Francis’ Critical Care staffhonored Dr. Carr by establishing the J. Bruce Carr MD Critical Care EducationScholarship. The funds will be used to assist critical care staff in furthering theireducation by returning to college or obtaining by studying for the certificationexam.

June Educational OpportunitiesSt. Francis will offer these educational opportunities in June:Breast Cancer Conference: Friday, June 7, 7-8 a.m., St. Francis HospitalBoardroom (first floor). Breakfast will be provided. A reservation is not required.For more information, contact Ruby Gladney at 706-660-6096 orgladneyr@sfhga.com.Cancer Conference: Wednesday, June 19, 12:30-1:30 p.m., St. Francis HospitalBoardroom (first floor). Lunch will be provided. A reservation is not required. Formore information, contact Ruby Gladney at 706-660-6096 or gladneyr@sfhga.com.

St. Francis Hospital is accredited by the Medical Association of Georgia to providecontinuing medical education for physicians. St. Francis Hospital designates thislive activity for a maximum number of 1 AMA PRA Category 1 Credit™. Physiciansshould claim only the credit commensurate with the extent of their participationin the activity.

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M U S C O G E E C O U N T Y M E D I C A L S O C I E T Y N E W S

Muscogee County Medical Society 2013 Candidates for Election

EXECUTIVE OFFICERS:President: James D. Majors, M.D.

President-Elect: W. Frank Willett, III, M.D.Treasurer: Glenn Fussell, M.D.

Director to MAG: Frederick Flandry, M.D.Alternate Director to MAG: W. Frank Willett, III, M.D.

Delegates to MAG:Benjamin Cheek, M.D.Frederick Flandry, M.D.Glenn E. Fussell, M.D.Ryan Geringer, D.O.James Hagler, M.D.

James D. Majors, M.D.Vincent Naman, M.D.

Folarin Olubowale, M.D.Timothy Villegas, M.D.W. Frank Willett, M.D.Joseph Zanga, M.D.

Alternate Delegates to MAG:Michael Borkat, M.D.Larry Brightwell, M.D.Casey Geringer, D.O.Norman Luton, M.D.

Henry Ngo, M.D.Mac Molnar, Jr., M.D.

If you would like to nominate another member or you would like to be nominated contact Dr. Glenn Fussell at 706-322-1254.

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MCMS President Glenn Fussell (and his predecessor) and your Program Committee have worked diligently over the past few years to organize educational and

entertaining dinners for members and their guests. Attendance has been good andcomments have been even better. The opportunity to socialize, have a good meal, andlearn something is always useful. Unfortunately these events require the spending ofyour money and every reservation made is a meal already paid. Our last event had

at least 19 “no shows” or many hundred dollars wasted. So PLEASE MAKERESERVATIONS AND IF YOU DO, PLEASE COME. You won’t regret it. Thanks.

– Joe Zanga, M.D., Chair, MCMS Program Committee

JUNE 2013Preceptor Training with a Focus on 4th Year Curriculum

Mercer University School of Medicine &Georgia Campus-Philadelphia College of Osteopathic Medicine

Saturday, June 29th 9am – Noon • Pastoral Institute AuditoriumSessions on: Preparing for the Student • Giving Feedback

The Problem Learner • Office Based Precepting

MCMS Meeting, Monday July 15th, 2013Congressman Phil Gingrey, M.D. speaker

Business Meeting with voting on officersRiverMill Event Centre • Cocktails 6:30 p.m. • Dinner 7:00 p.m.

MCMS - 2013 Meeting Sponsors:Quality Wine – Epic Restaurant Wine Tasting • MAG Mutual – Dr. Jeffrey English

Practice Change of Address:Kaizad Shroff, M.D. Rivertown Psychiatry

705 17th Street, Suite 410 Columbus, GA 31901Phone: 706-223-1933 Fax: 706-223-1934

W E L C O M E N E W M E M B E R

We welcome our new member to the Muscogee County Medical Society:

Timothy Goodrich, D.O., earned his medical degree fromArizona College of Osteopathic Medicine, Glendale, AZ. Hecompleted a general surgery internship at William BeumontArmy Medical Center, El Paso, TX and his residency inOtolaryngology at Walter Reed Army Medical Center,Washington, D.C., and Bethesda Naval Hospital, Bethesda,MD. He is a member of the American Academy ofOtolaryngology. Dr. Goodrich practices at St. Francis ENT,2300 Manchester Expressway, Suite 005, 706-324-7753. Wewelcome Dr. Goodrich to Muscogee County Medical Society!

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MAG BOD Report - April 20th, 2013In April the MAG Board of Directors met starting with an introduction of thegraduates and new enrollees of The Georgia Physicians’ Leadership program byWilliam Clark, III, M.D. Most of the meeting was on the mega issues and the firstmega issue was the general assembly. Some highlights of the legislative sessionare:

- HB 235(SB 206) the optometry bill, allows optometrists to prescribe oralsteroids and oral antibiotics and a 48-hour supply of hydrocodone. This billpassed the house and senate with some modifications and all of the MuscogeeCounty legislators (senators and representatives voted for it). The bill wasamended to require optometrists to obtain a patient history and to cap the oralcorticosteroid prescription at 14 days.

-SB 94 Allows APRNs the authority to order advanced imaging. The bill passedalthough our state senators; Senators McKoon and Harbison did vote against it.The radiologists say this is a bad idea and we need to have strong discussions withour legislators about this since it will be studied in subcommittee.

-SB 128 to allow family and marriage counselors to diagnose emotionalproblems, mental problems and conditions to be eligible for reimbursementsunder Medicaid and insurance plans. It was passed and will be recommitted toregulated industries. Both of our state senators voted for this. MAG recommendsthat these diagnoses should be reserved for M.D.s and D.O.s to safeguardpatients.

-SB 85/SB 134 Pharmacists to administer vaccines under blanket protocol froma physician. Both of our state senators voted for it the bill and amendment.Physicians are split on this but now pharmacists can order any vaccine. Specialtysocieties are making their own decisions about this and we as physicians need tobe unified on this issue. A unified stance means we are less likely to lose.

Bills that MAG supported and passed include; HB 94 Future Damages, HB 209Prescription Pad Fix, and HB 499 Provider Shield Act and all were supported byour legislators and senators.

The Provider Shield Law makes it clear that federal standards or guidelinesdesigned to enhance access to high-quality health care cannot be used to inventnew legal actions against physicians. Physicians may use either CMS approvedprescription pads for schedule II drugs or state approved pads. The way futuredamages can be calculated is a concern and damages should be capped. Thegeneral overview of the session is that expanded scope of practice is now and willcontinue to be an issue.

M A G B O A R D O F D I R E C T O R S R E P O R Tby W. Frank Willett, III, M.D.

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The second mega issue is how to avoid a medical malpractice suit when there ismedical error. Charity Scott, J.D., an attorney and Georgia State professor spokeon early resolution programs. How early an adverse event is reported usually toa hospital and a disclosure of error is important in reducing legal costs.Documentation that steps are taken to prevent errors again and communicationto patient’s family are key. A non-adversarial, non litigation approach can preventa claim. If a patient or family wants to talk about this before litigation is takingplace this can be positive. This approach has helped the University of Michiganprevent lawsuits and prevent patient injuries. Costs of litigation and insurancehave gone down by using this approach. There are four reasons for this newapproach, ethical, legal, operational, and reputational.

Ethical-AMA guidelines say to fully disclose when there is an error

Legal-putting the patient’s interests or clients’ interests above our own

Operational-improved costs, less litigation, reduced insurance costs, frequency ofclaims reduced

Reputational-it was found that the more transparent physicians were and thequicker that they reported the mistake and followed up with appropriate actionthe more favorable their reputation became.

There needs to be leadership to promote this approach. Having conversationsahead of time when errors were discovered cut the incidence of going forward totrial. For the University of Michigan four times as many cases are brought forwardbut according to the University of Michigan study this did not increase costs.

The Treasurer reported on the audit by Mauldin & Jenkins which was anunqualified clean opinion. Books and records are in good condition with onemanagement recommendation. Revenue is good due to membership dues mostly,followed by annuity income, grants, expenses cut and revenues increased. MAGhas cash reserves of over a million, liquidity is good, and we have a financial ratioof 1.8. There were changes in financials from the January Board Meeting in 2013.MAG ended 2012 with a surplus of over $500,000.

Dr. Scott Bolke-Executive commented about the good year we are having andDonald Palmisano our Executive Director also said that MAG is doing well. MAGmembership is at the highest active level since 1999.

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