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THE BULLETIN V O L U M E 6 0 • N U M B E R 1 See inside “It’s That Time of Year Flu Season” by Beverley Townsend, M.D. JANUARY 2015 A PUBLICATION OF THE MUSCOGEE COUNTY MEDICAL SOCIETY ERUDIRE ET DELECTARE THE BULLETIN Society Office: 2300 Manchester Expressway, Suite F-7 • Columbus, GA 31904 706-322-1254 • FAX 706-327-7480 • www.muscogeemedical.org Contents 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. 3 PRESIDENT’S MESSAGE 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. 4 EDITOR’S MESSAGE 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 remembrance. "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. 5 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 www.muscogeemedical.org 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 www.muscogeemedical.org • 706-322-1254 phone 706-327-7480 fax 6 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 7 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 www.wecareforlife.com. 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 notice. 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 www.kpdk.com 8 A RT I C L E O F I N T E R E S T 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 9 10 A RT I C L E O F I N T E R E S T 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 11 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. 5HVWDXUDQW+RXUV 7XHVGD\-7KXUVGD\ SP-SP )ULGD\-6DWXUGD\ SP-SP &KHI-DPLH.HDWLQJ&(& 3UH)L[H0HQX 7KUHH&RXUVH'LQQHU 7XHVGD\-7KXUVGD\ SP-SP )ULGD\-6DWXUGD\ SP-SP SHUSHUVRQ 7D[HV*UDWXLW\1RW,QFOXGHG 12 Ask About The Interactive Culinary ([SHULHQFH2I7KH&KHI·V7DEOH -- )URQW$YH6XLWH(&ROXPEXV*$ /RFDWHGLQWKH+LVWRULF(DJOH3KHQL[0LOO 3ULYDWH'LQLQJ$YDLODEOH5HVHUYDWLRQV5HFRPPHQGHG HSLFFXLVLQHFRPLQIR#HSLFFXLVLQHFRP C O L U M B U S R E G I O N A L H E A LT H N E W S 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 13 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? ThatsSimplyBetter.com 14 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. 15 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. 16 17 A RT I C L E O F I N T E R E S T 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 counties. 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 18 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 19 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. The cure for the common bank. Talk with us about our Medical Specialty Services available through CB&T Private Wealth Management. 706-644-6388 Columbus Bank and Trust is a division of Synovus Bank. Synovus Bank, Member FDIC, is chartered in the state of Georgia and operates under multiple trade names across the Southeast. Divisions of Synovus Bank are not separately FDIC-insured banks. The FDIC coverage extended to deposit customers is that of one insured bank. 20 When is it Time to Call Hospice? 706-569-7992 T T 7020 Moon Road Columbus, GA 31909 706-569-7992 ColumbusHospice.com he simple answer is right now. If you are thinking about hospice, don’t wait, call. Columbus Hospice’s staff is experienced with all the answers to questions racing through your head. The earlier you call, the sooner you will discover the advantages Columbus Hospice has to offer you. Let us provide support and comfort during your time of uncertainty. When should you call Columbus Hospice? As soon as \RXÀQLVKUHDGLQJWKLVDG 21 MCMS UPCOMING EVENTS J A N UA R Y 2 0 1 5 R.S.V.P. 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] 22 L E G I S L AT I V E U P D AT E 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 healthcare.gov 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 affordable. 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 23 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. SGR 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 sides! 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? 24 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! 25 6801 River Road 706-327-4242 Prescription, Compounding, and Delivery Services 26 Return Service Requested Muscogee County Medical Society 2300 Manchester Expressway Suite F-7 Columbus, Georgia 31904 PRSRT STD US POSTAGE PAID COLUMBUS GA PERMIT NO. 158