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See inside “It’s That Time of Year Flu Season”
by Beverley Townsend, M.D.
Society Office: 2300 Manchester Expressway, Suite F-7 • Columbus, GA 31904
706-322-1254 • FAX 706-327-7480 •
President’s Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Editor’s Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Hospital News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7, 13
Editor: David H. Levine, M.D. • Associate Editor: Casey Geringer, D.O.
Managing Editor: Lisa Venable
Officers 2014:
President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . James D. Majors, M.D.
President-Elect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .W. Frank Willett, III, M.D.
Past President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Glenn E. Fussell, M.D.
Secretary-Treasurer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Glenn E. Fussell, M.D.
Director to MAG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fred Flandry, M.D.
Alternate Director to MAG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W. Frank Willett, III, M.D.
Executive Committee: James D. Majors, M.D., W. Frank Willett, M.D., Glenn E. Fussell, M.D.,
Fred Flandry, M.D., Michael Borkat, M.D., Ryan Geringer, D.O., Kurt Jacobson, M.D., David H. Levine,
M.D., Ken Smith, M.D., Karen Stuart, M.D.
Delegates: Michael Borkat, M.D., Benjamin Cheek, M.D., Fred Flandry, M.D., Glenn E. Fussell, M.D.,
Ryan Geringer, D.O., James D. Majors, M.D., Folarin Olubowale, M.D., Karen Stuart, M.D., W. Frank
Willett, III, M.D., Joseph Zanga, M.D.
Alternate Delegates: Larry Brightwell, M.D., Casey Geringer, D.O., James Hagler, M.D., Kendall
Handy, M.D., A. J. Jain, M.D., David Levine, M.D., Henry Ngo, M.D., Kenneth Smith, M.D., Timothy
Villegas, M.D., John D. Watson, M.D.
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, 2300
Manchester Expressway, Suite F-7, Columbus, GA 31904. All material for publication should be sent to the Managing Editor not later
than 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 magazine
do not necessarily represent endorsement or support by the Muscogee County Medical Society.
James D. Majors, M.D.
My wife and I have an abundance of experience with the tooth
fairy. We have three kids and they all have lots of teeth. When
my son lost his first tooth, the only bills I had in my wallet were
twenty dollar bills. I cannot recall my reluctance to leave the
house to make change so the tooth fairy rewarded my firstborn
with a twenty dollar bill for the loss of his first tooth. I learned
my lesson and kept a hoard of smaller bills at the house for the
next several visits by the tooth fairy. My son was subsequently
weaned to a five dollar bill for his next tooth and a few one dollar
bills for his subsequent teeth.
My eight year old twins have been losing a lot of teeth lately. My wife seldom carries
cash and I have had trouble keeping small bills available. My kids have to give a
dollar each week for various mission offerings at St. Luke School, so I am often
unable to provide small change for the frequent tooth fairy visits. I have always
assumed my kids wanted dollar bills from the tooth fairy. It seems I was wrong.
On our last summer vacation, we rented a beach house on Jekyll Island. I carry a
money clip on vacation, typically flush with twenty dollar bills. My wife and I usually
use a credit card for all purchases so I seldom have smaller bills. My daughter Sam
(Samantha) lost a tooth this year on Jekyll and once again I had no smaller bills. My
wife and I ransacked purses, beach bags, and car seats and managed to find six
quarters. I took an old travel toothbrush and shined the quarters in the sink. I was
hoping that if they were all sparkling, perhaps Sam would overlook getting gypped
by the tooth fairy.
Sam changed beds overnight and I awoke to find her in bed with me. She had
brought her own pillow and thank goodness she had relocated the tooth as well. I
carefully removed the tooth from under the pillow and placed the six shiny quarters.
I was in the den having coffee with Marcy when I heard the clank of Sam locating her
reward from the tooth fairy. Sam immediately woke her twin sister with a grin and
said “Bam … I got six monies!” She proudly had the six quarters in her hand. She
carried the six quarters everywhere that day. She counted them over and over again.
On the ride home, she lost one quarter in her car seat and was inconsolable.
It seems I had misjudged the monetary value of the tooth fairy. Kids love shiny coins
and do not understand that a single five dollar bill is worth more than several coins.
My other two kids were jealous of Sam and her hoard of shiny quarters. I was forced
to give her twin sister Andi five nickels and pennies so she would not feel deprived.
Andi actually complained that her coins were not shiny enough. My kids have had
at least a dozen combined visits from the tooth fairy but this last visit was the most
memorable. It took me twelve attempts to learn that kids want coins. Adults want
the green stuff.
By David H. Levine, M.D., Editor, “The Bulletin”
Medicine: What We Love About It
With all the changes that the practice of medicine is
undergoing, one thing that I'm sure none of us want to see
change is the sense of fulfillment we feel when we learn that we
have improved a patient's life. I had an experience recently like
one I'm sure we've all had, but it made it clearer than ever to
me how much that can and should mean to us, and it is worth
recounting here.
We were visiting in Jackson, TN where we had lived and practiced prior to
coming to Columbus 12 years ago. Sunday morning after church a woman came
up to me with a huge smile on her face and said "Dr. Levine, I thought it was you.
Are you coming back? I am so happy to see you. I'm ______ ________." The
look of recognition on my face must have changed to one of understanding and
"Oh, my gosh", I said, "it is wonderful to see you".
"I wanted to tell you again how much you mean to us, and let you see James.
He's 12 now (almost 13)." Up walked a strapping red-headed boy, half a foot
taller than his mother.
"He looks perfect."
"He is, thank you so much. I'll never forget the first time you came to my hospital
room; you told me to have hope that he would turn out fine in spite of his
prematurity and brain hemorrhage, and we prayed together."
Then I chatted with James for a few moments and said, "Wow, thank you for
coming over to me. I want you to know that these are moments I live for; I'm
sure all neonatologists do."
We chatted a while, exchanged contact information and said "good-bye". I
couldn't help thinking, as we got into the car and drove away, that experiences
like these are the best part of being a physician. I was reminded that this is what
gets us out of bed in the middle of the night; what keeps us slogging through the
ever-increasing bureaucratic busywork that we have to do to keep our practices
alive; what allows us, even compels us, to impart our enthusiasm for the practice
of medicine to the next generation of physicians.
The patient-doctor relationship. It is the core of what we do, the foundation on
which the whole thing is built. Not money--Obama's taking that away. Not power
or prestige--they are so fleeting. We must not allow government or anyone else
to remove it from what we do every day. It's worth fighting for.
The Muscogee County Medical Society
Member Benefits
Patient Referral Service: Free to our members and the public this benefit
provides many referrals each year to our member physicians.
Membership Directory: Information resource on physicians, facilities, office
address and phone information. The directory is on our website. A great
marketing tool for your practice.
Bulletin: Monthly publication features news and information on the
Muscogee County Medical Society, its members, issues and topics affecting the
practice of medicine. You may submit articles, announcements or practice
changes as a member.
Continuing Medical Education: MCMS offers continuing medical education
credit hours during the year at a special meeting with an approved topic.
Meet and network: We have four yearly meetings with nice venues, good
food, and interesting speakers. We know that physicians are busy and want
social time to meet other members and network.
Physician Phone Listing: The Muscogee County Physicians’ Listing or “Yellow
Card” as it is known in Columbus, lists members’ phone numbers and those of
all physicians and hospitals in Columbus. It is distributed to all medical offices
and hospitals. Members receive 10 free copies and their names are in bold.
Website: We have a website with announcements, “The Bulletin”, photos from
our events and a “find a doctor” feature with you office address, specialty and
office phone number at
Mailing Label Service: Labels are available for medically oriented
correspondence and marketing which can be pulled by specialty. They can be
emailed or picked up at the office for your office’s convenience.
Legislative: MCMS provides legislative information to inform members on
issues relevant to medicine. Our Legislative Committee monitors legislation
and regulatory activities in our state. We make every effort to bring legislators
and candidates for office to Columbus to meet with us and hear our views.
Media Liaison: MCMS works with the media to publicize our events and
provide medical information to the media for our community.
Speakers Bureau: Our speakers’ bureau actively participates in speaking
engagements throughout the community.
Muscogee County Medical Society
2300 Manchester Expressway, Suite F-7 • Columbus, Georgia 31904 • 706-322-1254 phone 706-327-7480 fax
S T. F R A N C I S N E W S
Dr. Michael Metry Joins St. Francis as Director of Critical Care
Michael Metry, MD, an intensivist, joined St. Francis as director of Critical Care on
December 1. Dr. Metry was previously the senior medical director of the ICU at
Southern Ohio Medical Center in Portsmouth, Ohio. He has also been the ICU
director of the Genesis Medical Group/Genesis Inpatient Specialists serving the
Genesis Healthcare System in Zanesville, Ohio. Dr. Metry earned his medical
degree from the University of Health Sciences/Chicago Medical School in North
Chicago, Ill. He completed a residency in internal medicine at the Jackson
Memorial hospital/Veteran’s Administration Medical Center in Miami, Florida, and
has been board-certified in internal medicine since 1989. Dr. Metry completed a
fellowship in critical care medicine at Cook County Hospital in Chicago, Ill, and
has been board-certified in critical care since 1991. Dr. Metry has made more than
22 professional presentations on topics ranging from mechanical ventilation,
glucose control and respiratory failure to anoxic brain injury and end of life
issues. He is a member of the American Medical Association, the Society of Critical
Care medicine, the American College of Chest Physicians, and the American
Thoracic Society, among others.
Make Your Reservations!
Humorist Dave Barry to Speak at the 2015 Butler Service and Leadership
Award Dinner Honoring Dr. Rajinder Chhokar
Dubbed the “funniest man in America” by The New York Times, humorist Dave
Barry will be the keynote speaker at the 11th annual Dr. Clarence C. Butler
Service and Leadership Award dinner honoring Dr. Rajinder Chhokar February 4.
Barry, a syndicated columnist, won the Pulitzer Prize for Commentary in 1988. His
work has appeared in more than 500 newspapers in the United States and
abroad. He has also written 30 books, including Big Trouble, Lunatics, Tricky
Business and, most recently, Insane City. Two of Barry's books were the basis for
the CBS sitcom Dave's World. Rajinder Chhokar, MD, will receive the Dr. Clarence
C. Butler Service and Leadership Award for pioneering numerous advancements
in cardiology during her 32 years of practice in Columbus. She and Dr. Gordon
Miller brought angioplasty to the community. She has also brought many other
advancements in cardiology to the region, including interventional cardiology
and electrophysiology. She invited Dr. David Delurgio, an Emory-based
electrophysiologist, to Columbus, giving him space in her office to begin
practicing here.
Dr. Chhokar was St. Francis chief of staff from 2011-2012. She served on the
Medical Executive Committee for six years and was chief of cardiology for more
than a decade. Additionally, she served on the St. Francis Foundation Board of
Trustees from 1998-2005 and the St. Francis Hospital Board of Trustees from
2008-2014. She was the first female president of the Georgia Association of
Physicians of Indian Heritage in 2001. Dr. Chhokar was also on Columbus
Regional Healthcare’s Board of Directors from 2001-2007. The Muscogee County
Medical Society appointed her to its executive committee in 1995, and she served
as secretary-treasurer from 1996-1997. In 1998, she was as a delegate to Medical
Association of Georgia. Currently, she serves on the Columbus Health
Department Board of Directors. The dinner will be held at the Columbus Trade
Center. To purchase a table or reserve seats, call the St. Francis Foundation at
706-653-9375 or visit
January Educational Opportunities
St. Francis will offer these educational opportunities in January:
Cancer Conference: Wednesday, January 21, 12:30 p.m., Lecture Hall in the
Butler Pavilion. A reservation is not required. For more information, contact
Ruby Gladney at 706-660-6096 or [email protected]
Orthopaedic Journal Club: All meetings have been cancelled until further
Breast Cancer Conference: Friday, January 9, 7-8 a.m., St. Francis Hospital,
Lecture Hall in the Butler Pavilion. Breakfast will be provided. A reservation is not
required. For more information, contact Ruby Gladney at 706-660-6096 or
[email protected]
St. Francis Hospital is accredited by the Medical Association of Georgia to provide
continuing medical education for physicians. St. Francis Hospital designates this
live activity for a maximum number of 1 AMA PRA Category 1 Credit™. Physicians
should claim only the credit commensurate with the extent of their participation
in the activity.
Mike See
Fully Licensed GA/AL Realtor
706-315-5289 (CELL) • [email protected]
5670 Whitesville Road • Columbus, GA 31904
by James D. Majors, M.D., President, Muscogee County Medical Society
Columbus State Competitive Premedical Studies Program
Columbus State University is in the second year of offering a Competitive
Premedical Studies Program. This program has been designed to recruit
motivated, academically-talented students interested in a career in medicine. The
program provides unique resources and mentoring opportunities. Each academic
year, up to fifteen incoming freshmen are screened and selected for the program.
Selection criteria include SAT scores, high school GPA, and references.
Participants must maintain a cumulative GPA of 3.4 to stay in the program and
progress towards a CSU degree.
The program perks include free Kaplan MCAT preparation and a senior
scholarship, as well as medical school application preparation and interview
strategies. Also offered are shadowing opportunities with local physician
mentors. The students are typically scheduled to shadow local physicians on a
month-to-month basis. The student may spend 2-3 hours with a physician once
or twice a week. Katey Hughes is the program director and is seeking the
assistance of the Muscogee County Medical Society in recruitment of physicians
willing to have premedical students shadow them in the clinic. This requires a
minimal time commitment but provides a wonderful opportunity for the students.
If anyone has interest in this mentoring program, please contact Katey Hughes at
706-568-2325 or [email protected]
2821 Harley Court, Suite 300
Columbus, GA 31909
(706) 576-4900
By William M. Harper IV, MD, FACS
CAP and Testing Recommendations
Cancer of the Prostate (CAP) is the most common cancer diagnosed in men and
is the second most common cause of cancer deaths in men, second only to lung
cancer. CAP can be a silent killer in that there are seldom any early warning signs,
underlining the importance of education, screening and evaluation of men so
that CAP can be diagnosed at an early and curable stage. For many years, PSA has
been our most important tool in diagnosing and treating CAP at earlier stages
which has improved survival rates. What we know about PSA has evolved over the
years. In the past it was thought that a PSA of 4.0 was normal. We now know levels
in the 2.0-2.5 range are the normal cut off for men in their 40’s. There are
important facets of PSA that we now recognize like PSA Velocity and PSA Density.
PSA Velocity is the rate at which PSA rises over time. Depending on the source, a
rise of over 0.3-0.7 per year is abnormal and deserves further evaluation. PSA
Density refers to PSA relative to the volume or size of the prostate. The higher the
ratio, the more likely cancer is present. At this point, PSA is the “gold standard”
but newer tests, more specific to prostate cancer, are being developed.
The article that L-E ran last year with recommendations from the U.S. Preventative
Services Task Force advising against prostate cancer screening with PSA has
understandably caused a lot of confusion. I would have to take exception with the
statement that no major medical group recommends PSA blood tests to check
men for prostate cancer. Some of the statements in this article are true but need
explanation while I believe others are misleading. While PSA is far from a perfect
test, at present it is the best we have readily available. PSA stands for prostatespecific antigen. An antigen is simply a protein and PSA is a protein that is
specifically released only by prostate tissue. Prostate tissue, both benign and
malignant, releases PSA however malignant prostate tissue releases more than
benign prostate tissue. An ideal test would be a “prostate cancer” specific
antigen, which is under development but not yet readily available.
The panel may be technically correct in stating that an estimated 2 of every 5 men
diagnosed with prostate cancer tumors that may not need treating, but the real
trick is identifying which 2 do not need treatment. We have no reliable means at
this point in time of identifying those cancers which are not likely to be
aggressive, spread and cause death. If you do not treat until the cancer shows
itself to be aggressive and spreading, it may be too late for curative treatment.
There was also a statement in the article indicating that there was harm caused by
routine screening. The screening itself is in no way harmful. The treatments from
prostate cancer can have side effects including impotence, incontinence,
infection and in some cases death, but failure to treat almost certainly results in
death. With modern technology and methods, the side effects of all types of
treatments have been minimized.
I have been in practice 30 plus years and PSA was just in its infancy when I
started. During my years of practicing, there is indisputable evidence that death
rates from prostate cancer have dropped dramatically which is due to a number
of reasons, the most important of which are PSA testing and public awareness.
PSA testing allows us to detect more prostate cancers at an earlier, more curable
stage so death from prostate cancer is less likely. Men should continue to have
PSA testing, especially those in high risk groups, until a better, more specific test
is available. Providers should also be well informed, more deliberate and
judicious when ordering PSA, or any test, on their patients in order to minimize
wasteful spending.
It appears that there is evidence that some supplements may help reduce the risk
of CAP. Some of these include green tea, lycopene, soy isoflavones, vitamin D,
pomegranate, selenium. Some other things that have been reported to reduce
the risk are a low fat diet, vitamin E and aspirin. There are risk factors that every
man should know. Family history is one of the most important. Statistically, one
in every six men will develop CAP. If you have one family member who has CAP,
your risk doubles. The risk quadruples with two family members and increases to
eleven times normal if there are three direct family members that have CAP.
African American men are also at higher risk.
There are less invasive tests and procedures to facilitate early diagnosis now than
we have had in the past. Once diagnosed, men have more options for treatment
than they had just 10 years ago. Some of these include external beam radiation,
radioactive pellet implants, high dose radiation, cryo surgery, HIFU (High
Intensity Focused Ultrasound) and surgery ranging from traditional open
prostatectomy to laparoscopic and robotic. In conclusion, prostate cancer is
prevalent. It is easily detected when men submit to screening and it is certainly
curable by more techniques than we have ever had before.
Ask About The Interactive Culinary
Leadership Changes Include Dr. Hannay as Chief Medical Officer
at Midtown Medical Center
Several leadership changes have been announced at Columbus Regional Health,
including the appointment of Dr. R. Scott Hannay as Chief Medical Officer at
Midtown Medical Center. Dr. Hannay has been on the medical staff at Midtown
Medical Center for 13 years. During this time, he served as Chairman of Surgery
and Chief of Staff as well as in many other leadership roles. Dr. Hannay currently
leads the trauma program, serves as the Chief of Surgery and has served on the
Board of Directors since 2013. He will serve as CMO in a part-time capacity while
he remains in the clinical practice of medicine.
In other leadership changes, Doug Colburn has been named Vice President of
Operations for Midtown Medical Center. He previously served as Senior Vice
President and Chief Information Officer for Columbus Regional Health. Oliver
Banta, former Senior Director in Information Technology, has been promoted to
Vice President and Chief Information Officer for Columbus Regional Health. Freya
Gilbert, RN, Director of Quality for Columbus Regional Health, has been named
Interim Chief Nursing Officer for Midtown Medical Center as a national search is
performed to recruit the next CNO for the hospital.
Columbus Regional Health Hospitals Receive National Recognition
Columbus Regional Health hospitals have received several national awards
recently for quality and patient satisfaction. Recognition was given to:
Midtown Medical Center, sixth best large hospital in the United States for
hospital-acquired conditions, given by Billian’s HealthDATA
Midtown Medical Center West, Top Performer on Key Quality Measures in 2013 in
Surgical Care, given by The Joint Commission
Northside Medical Center, first place Guardian of Excellence award by Press
Ganey for achieving the 95th percentile or higher for the composite overall rating
during course of the award year for May-April 2014
Northside Medical Center, Beacon of Excellence award by Press Ganey as one of
three top performers based on overall composite mean score for the three-year
award period (May 2011-April 2014)
Outpatient Physical Therapy Clinic Opens off Gateway Road
Columbus Regional Health opened an Outpatient Physical Therapy Clinic on
Dec. 1 adjacent to the Walmart Supercenter at 6563 Gateway Rd. in Northeast
Columbus. Physical Therapist Kyle Hogarth, who holds a doctorate in the
specialty, will provide patient care and manage this facility, bringing multiple
years of experience to the new location. The 2,800-square-foot facility will feature
state-of-the-art equipment, private treatment rooms and a larger gym space to
accommodate each patient’s need, regardless of age or ability level. Columbus
Regional Health also has a physical therapy practice at 2200 Hamilton Road near
Good: a hospital dedicated to children
Simply Better: a hospital dedicated to children right around
the corner from the treehouse in your backyard
The region’s only children’s hospital, pediatric ER, neonatal and
pediatric intensive care units are right here. And that’s simply better
for the people who live here. Because what better place is there to be treated
than home?
Midtown Medical Center. Northside Medical Center established in-house
outpatient physical therapy services in 2012, and a satellite clinic at 7830 Veterans
Parkway in the Veterans Commons shopping center opened in 2013. Physician
offices and patients can call 706-320-8884 to schedule an outpatient appointment
at any of Columbus Regional Health’s four outpatient physical therapy locations.
Annual Tree Lighting and NICU Graduate Celebration Held
Midtown Medical Center’s 34th annual Tree of Light ceremony on Dec. 5 signaled
the start of the holiday season with the tree lighting and a Neonatal Intensive Care
Unit graduate celebration. NICU graduates and their parents reunited with many
of their caregivers, enjoyed an evening of fun and entertainment, and visited with
Santa Claus.
CME Opportunities Offered for Physicians
Each of the following Continuing Medical Education (CME) opportunities for
physicians has been approved for one hour of CME credit:
Pediatric Grand Rounds: Every Thursday, 8:15 a.m., Columbus Regional
Conference Center at Midtown Medical Center. Open to any physician or other
health professional providing care for children. For more information, call Lori
Sitch at 706-571-1220.
Cancer Conference: Every Monday, 12:30 p.m., Conference Room at the John B.
Amos Cancer Center, except for first Monday which is held at Columbus Regional
Conference Center at Midtown Medical Center. (Approved as a series.) For more
information, call 706-571-1102.
Thoracic Oncology Conference: 1st and 3rd Friday, 7 a.m., Conference Room at
the John B. Amos Cancer Center. For more information, call 706-571-1102.
Midtown Medical Center is accredited by the Medical Association of Georgia to
provide continuing medical education for physicians. Midtown Medical Center
designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™.
Physicians should claim only the credit commensurate with the extent of their
participation in the activity.
In Memoriam
Robert Durley Dean, M.D.
October 8, 1924 – November 7, 2014
Robert Durley Dean, M.D., was born in Lake Horn Mississippi and
graduated Phi Beta Kappa from the University of Mississippi in 1946.
He received his medical degree from the John Hopkins University
School of Medicine in 1951 where he was AOA. He interned at Charity
Hospital, New Orleans and did general practice in Mississippi and then
spent two years in the U. S. Air Force as a Medical Officer. He then
completed his OB-GYN residency at the University of Mississippi
Hospital I n1960. He was board certified in obstetrics and
gynecology in 1963. He practiced medicine in LaGrange for 10 years
and moved to Columbus to practice with Dr. Ward and Dr. Everidge for
15 years. Following his retirement he spent ten years doing locum
tenens around the country. He was a member of the Alpha Omega
Alpha honor medical society, Georgia OB/GYN Society, AMA, Muscogee
County Medical Society and the Medical Association of Georgia.
He was predeceased by his wife Walterine and is survived by his sons
Reagan W. Dean, Jeffrey A. Dean, M.D., R. Jonathan Green, M.D.
and Charles W. Dean. Two of his sons are M.D.s and a grandson is also!
Durley was well liked by both patients and colleagues
and had an interesting life.
– by James H. Venable, M.D.
By Beverly Townsend, M.D., Director, Georgia West Central Health Department
It’s that Time of Year Flu Season!
By Beverly Townsend, M.D., Director, Georgia West Central Health Department
The New Year is a special time for gatherings with family and friends, celebrating
and enjoying delicious meals. As healthcare providers it’s important to remind
our patients about things they can do to prevent getting sick over the holidays
and the importance of getting a flu vaccine so they can enjoy this festive time of
year. Although seasonal flu activity in the US and Georgia as a whole is low it is
beginning to increase in the region of the West Central Health District 16
Health care facilities in the West Central Health District Counties who voluntarily
report were noted to have identified one quarter (24.5%) of all rapid tests done
during the week of November 24 through 30, 2014 as positive for influenza.
Influenza A (not typed) was identified in 22.4% and Influenza B in 2.1% of the
tested samples. Most of the rapid tests done were in persons under the age of
50. Positive tests for both influenza A and B were identified across all age groups.
Year to date through November 22, 2014 Georgia reported that in Metropolitan
Atlanta there have been 52 flu related hospitalizations across the age span and
two deaths; one in a person age 50 to 64 and the other in a person 65 or older.
West Central Health District voluntary reporters identified one person
hospitalized age 25- 49 and no deaths through November 30, 2014. Recently, The
Centers for Disease Control and Prevention (CDC) advised clinicians that the
2014-2015 seasonal flu is likely to be a bad one.
Influenza A (H3N2) was identified in 91% of the samples tested through
November 22, 2014 at CDC. It has been observed in the past that rates of
hospitalizations and deaths are higher when Influenza A (H3N2) is the dominate
circulating strain compared with the times when Influenza A (H1N1) or Influenza
B viruses have predominated. In addition, less than half the samples tested (48%)
are matched to the Influenza Vaccine formula prepared for this year. The World
Health Organization (WHO) made recommendations for the preparation formula
of Northern Hemisphere Influenza Vaccine in mid-February, 2014. Influenza A
(H3N2) was first noted to have drifted in March, 2014 but the drift was not
significant until September, 2014. In the past seasons when the predominant
circulating influenza drifted decreased vaccine efficacy was observed but vaccine
has been noted to provide some protection against drifted viruses. In addition
the seasonal formula will continue to protect against the Influenza A and B flu
viruses that have not had a significant drift.
The CDC encourages the continuation of influenza vaccinations as the single
most effective means of protection for all persons aged 6 months and older. This
year in the presence of circulating antigenic drifted Influenza A (H3N2), it is
critical for rapid treatment with antivirals of symptomatic patients who may be at
higher risk for flu complications. Tamiflu (Oseltamivir) is approved for treatment
of children two weeks and older and for chemoprophylaxis to prevent influenza
in people one year of age and older. Relenza (Zanamivir) is approved for
treatment of persons seven years and older and for prevention of influenza in
persons five years and older. Adamantane antiviral medications are not
recommended for treatment of influenza because of the high levels of resistance
to circulating influenza A viruses.
Antivirals are most effective when administered within 48 hours of the onset of
flu symptoms. The decision about starting antiviral treatment should not wait for
laboratory confirmation of influenza.
Those especially at risk for complications of influenza are:
• Adults 65 years of age and older
• Children younger than 2
• Pregnant women or within 2 weeks after delivery
• People with certain chronic diseases such as chronic pulmonary disease
(including asthma),cardiovascular disease (except hypertension alone), renal,
hepatic, hematologic (including sickle cell disease), and metabolic disorders
(including diabetes mellitus), or neurologic and neurodevelopment conditions
(including disorders or the brain, spinal cord, peripheral nerve, and muscle such
as cerebral palsy, epilepsy {seizure disorders}, stroke, intellectual disability
{mental retardation} moderate to severe developmental delay, muscular
dystrophy or spinal cord injury)
• Persons with immunosuppression, including that caused by medications or by
HIV infection
• Persons aged younger than 19 years who are receiving long-term aspirin therapy
• American Indians/Alaska Natives
• Persons who are morbidly obese (i.e. body-mass index is equal to or greater
than 40
• Residents of nursing homes and other chronic-care facilities.
As healthcare providers we need to remind and reassure our patients that the first
line of defense in preventing the flu is getting their annual influenza vaccination.
Please continue to encourage your patients to frequently wash their hands, and
develop the safer habit of coughing in their sleeve or in a tissue, staying home if
they are sick. Remind your patients who may be at high risk for influenza
complications to seek care promptly to determine if treatment with influenza
antiviral medication is warranted.
Public health stands prepared to assist by providing vaccinations not only for
influenza but other vaccine preventable diseases. Persons who receive
vaccinations at the health departments are provided a printout of their
vaccination record so that it is available for their private provider in addition to
the electronic entry of the vaccination into the State of Georgia’s Immunization
Registry, commonly referred to as GRITS (Georgia Registry Immunization
Transactions). I will conclude with this flu season’s slogan from the Georgia
Department of Public Health: Don’t Procrastinate, Schedule a Time to Vaccinate!
For more information, contact the Georgia West Central Health Department
at 706-321-6300.
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J A N UA R Y 2 0 1 5
Wine and Cuisine Pairing and Tasting
Monday, January 19, 2015 • 6:30-9:30 p.m.
Epic Restaurant
Featuring cuisine by Chef Jamie Keating and Wine by Quality Wine and Spirits
Sponsored by The Hudson Financial Group
2015 Muscogee County Medical Society Dues have been mailed and invoiced
please call if you did not receive an invoice - 706-322-1254
If you would like to write an article for “The Bulletin”
Contact Dr. David Levine or Dr. Casey Geringer
Please send all practice changes of phone, retirement or address to:
706-322-1254 phone or [email protected]
By Kurt Jacobson, M.D., Chair, Legislative Committee
As we enter the next six to nine month period of time, there
are major challenges facing President Obama’s signature
healthcare law. We are all familiar with the well-known
problems, including the website which, in fact,
has been improved. The significant negative public opinion of
the bill, most recently 58% against, 38% in favor, and now
facing a new onslaught of legal challenges at both the federal
and lower court level, keeps the ACA in the news. Within the
906- page Patient Protection and Affordable Care Act, there is
one four-word stretch that seems to have developed into one of the most
controversial four words of the bill. These four words are “established by the
state”. The basis of this controversy is that when the original legislation was being
created, the thought was that all 50 states would ultimately have their own
exchanges to meet the specific needs of their residents. As we all know, as the bill
rolled out, ultimately 34 states elected to use the federal exchange. This legal
challenge, King vs. Burwell, basically contests previous opinions that all should be
eligible for subsidies whether they were in a state or federal exchange. There
have been rulings on both sides of this argument, some at the lower court levels,
but it has now reached the Supreme Court level. Jonathan Gruber, who was a
consultant for this bill, has opined that the law was created in such a way that the
only way to receive subsidies is through a state exchange. He stated that this was
intentional so the states would be more inclined to establish their own exchanges.
Those advocating for subsidies for all do so citing the goal and context of the law
which was intended to make health insurance more widely available and
During the last challenge to this law, the legality of the ACA was upheld by a 5 to
4 vote with the deciding vote written by Justice John Roberts. Early predictions,
based on the current court makeup, show he may cast the deciding vote again. A
concern for people who do receive subsidies is that if this challenge is upheld,
they could experience a “claw back”, denying them the tax subsidies and
requiring restitution.
The potential down side to this is that if the challenge is upheld between seven
and eight million people could lose their subsidies in 2016; with those subsidies
contributing up to 75% of their premium cost. The second aspect is that without
these subsidies, insurance would not be affordable and these same people would
become exempt from the individual mandate. It would also impact the employer
and employer mandate, in that the employers would become exempt from
penalties if their workers could not be subsidized in federally operated exchange
states. In short, this legal challenge will most likely make or break the bulk of the
bill. Those unhappy with the legislation see this as a serious means to be able to
chip away at the Affordable Care Act, recognizing that outright repeal is not likely
with the President holding veto power.
Additional legal challenges working their way up the legal tree include challenges
to the Independent Payment Advisory Board, which has itself been a very
controversial subject. Also under assault is the “risk corridor” program with
substities for insurance companies in the uncharted waters of the ACA exchanges.
Currently, fees are collected from programs making money to support those
operating at a loss amounting to a safety net for insurance companies.
Lame Duck as defined by Wikipedia: “A lame duck is an elected official who is
approaching the end of his tenure, especially one whose successor has already
been elected.” This creates an opportunity to do nothing or even to be bold
knowing the lack of political consequences. As of two weeks ago, it was hoped
that the SGR (Sustainable Growth Rate) formula tried to be “doc fix” was ripe for
action during the lame duck session. There were several bills that offered
solutions, albeit with a price tag (fiscal restraint seems not to be a major concern
at this time in Washington). Alas, the deal was shot down by parties on both
HR 4015
The current patch hits at the end of March 2015. What is next? Intuitively, there is
no good reason why physician payments from Medicare should be tied to the
GDP. More logically, it could be tied to pay for performance so that if higher
payments can be shown to improve the quality of care subsequently saving money
elsewhere, it will become a win-win situation. Current payments to physicians
run about 12% of the total Medicare program cost. Some Medicare Advantage
programs have demonstrated higher payments can improve quality of care with
associated savings.
As a separate issue, additional challenges are faced at the state level with the
current structure for providing community primary care healthcare programs.
The discretionary funding for these programs have declined approximately 40%
during the Obama Care process. Particularly in a state like Georgia, which has not
expanded its Medicaid program, the community health centers have been a key
life line for those who need healthcare and are financially challenged. The
combination of not expanding Medicaid and the potential cutbacks in these
community health center funds will produce significant challenges for a state like
Georgia. Currently up to ¾ of the budgets of these community health centers
come through federal funding as opposed to state.
Primary care physicians who provide care for low income patients will face a 40%50% reduction in Medicaid fees as the current ACA program expires next year.
These proposed fee cuts reinforce the concern for states that federal programs
like these are subject to loss of funding, thus, placing an unreasonable burden on
state government and programs. How does a physician 50% fee reduction taste?
Currently, Medicaid covers more than 60 million people with about 9 million
added under the expanded Medicaid programs of the ACA in 27 states.
By reference, Medicaid is larger than Medicare. Sylvia Burwell, the Health and
Human Services secretary, hopes to push for Medicaid expansion in the
remaining 23 states.
Additional funding challenges will be the reduction in support for teaching
health centers that train primary care providers as well as programs that
subsidize education and loan repayment for those that participate in providing
healthcare in exchange for underserved areas. With the change in the political
landscape in Washington, there has been a lack of leadership to effectively deal
with this situation.
Looking at the overall landscape of healthcare, it is obvious there will be
numerous legal and legislative issues that will need to get sorted out in the next
few years. While I think anyone would say that the Affordable Care Act is beyond
repeal, it will face numerous challenges and will evolve going forward. The likely
scenario is that there can be a collective agreement on aspects of the bill that are
worth preserving. The challenge faced by the new leadership is crafting a more
responsive and nimble program to meet the healthcare needs going forward.
Physician participation in this process is critical. There is no one who will state
that the status quo can be sustained. The architects of this bill will tell you that
its main purpose was to increase coverage and did not inherently address
controlling cost. It is to be hoped that future efforts in the legislative forum will
necessarily combine cost control and efficiencies with increased coverage. There
are some good programs that have sprung up that need to be emulated, field
tested and gradually incorporated at the federal level.
Most concerning to all of us is the fragility of primary care access with a system
propped up on legs that are constantly under assault. The problem with
healthcare in America is not at the upper levels but rather providing the entry
level care that is most critically needed. Hey Washington, why don’t you let the
doctors help you design a plan to fix this problem? We are ready!
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