Winter 2011 - Broward County Medical Association

The Record: Features & News
WINTER 2011
|
THE OFFICIAL PUBLICATION OF THE BROWARD COUNTY MEDICAL ASSOCIATION
10 | To Image or Not to Image
Tests, lawsuits and moral
dilemmas doctors ask the
question more and more.
16 | Effective Estate Planning
Fedra Vimercati provides
her Top 5 Tips for solid
wealth management.
20 | Hope South Florida
Inside: The President of the
Hope for homeless people
and families in our
community.
BCMA talks about healthcare
and the constraints of
patient care vs physicians’
rights and responsibilities.
32 | Sudden Cardiac Death
Identify and treat patients
who may be at risk for SCD.
THE RECORD is the official publication of Broward County Medical Association. Written contributions from members are always welcome. Opinions expressed are those of the authors and
not necessarily those of the BCMA and BCMA assumes no responsibility for statements made.
Advertising does not imply approval or endorsement by the BCMA. All advertising is subject to
acceptance. The BCMA reserves the right to edit or reject any material submitted. © 2011 BCMA
BCMA
Officers
Aaron Elkin, MD
President
Kutty Chandran, MD
President Elect
The Record: Winter 2011 Issue
Dana Wallace, MD
Vice President
Richard Steinman, MD
Treasurer
Joshua Lenchus, DO
Secretary
Alberto Casaretto, MD
Immediate Past President
Editor, BCMA Magazine
Tony Prieto, MD
Chair, Board of Trustees
Publisher’s Letter
|
Introduction
3
The Record is the
official publication
BCMA President’s Message
of the Broward County
4
Medical Association.
If you are interested
BCMA Vice President’s Message
in a subscription or
8
to advertise in the
magazine please contact
14
Education | 2011 Courses
Publisher, Pery Canan
[email protected]
Cynthia S. Peterson
Executive Vice President
954.812.3882
18
Calendar of Events
Co-Presidents
For membership
BCMA Alliance
Susan Flaten, RN
Kathy Molinet, ARNP
Diana Moll, MD
Joni Routhman, RN
Daniella Botoman, MD
Annual Inauguration & Dinner
information please
24
contact Cynthia Peterson
[email protected]
In The News
28
BCMA Community
36
954.714.9772
Board Members
Ely Brand, MD
Greg Burns, PA-C
Linda Cox, MD
Nabil El Sanadi, MD
Paul Flaten, MD
Mark Grenitz, MD
Edwin Hamilton, MD
David Kenigsberg, MD
Arthur Palamara, MD
David Perloff, MD
Ramsey Pevsner, MD
Alan Routman, MD
Angeleke Saridakis, MD
Yvonne Sherrer, MD
Sanford Silverman, MD
Caren Singer, MD
Marc Swerdloff, MD
Ralph Zagha, MD
The Record: Advertisers
Baptist Health
954-837-1100
IFC
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Westside Regional Medical Center
954-473-6600
BC
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ProAssurance Group
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IBC
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rwnk.com
Broward Home Care, Inc.
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browardhomecareinc.com
Real Estate Listing
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AMA Delegates
Vitas Innovative Hospice Care
800-938-4827
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Robert Cline, MD
Ronald Giffler, MD
Arthur Palamara, MD
Real Estate Listing
954-796-4000
31
Lubell & Rosen
954-755-3425
31
Vincent DeGennaro, MD
Vice President, Florida Medical Association
vitas.com
doctordefense.com
The Record: Publisher’s Letter
C
ardiovascular diseases, including stroke, are the nation’s number one
killers. In an effort to encourage Americans to educate themselves and
join the battle against these diseases, since 1963 the U.S. Congress has
required the President to proclaim February “American Heart Month.”
We felt it necessary to focus this issue of The Record on the heart from
both clinical and personal perspectives. You will learn about cardiovascular
diseases and arrhythmias, prevention and treatment protocols in “Heart
Rhythm Harmony,“ and you will get up close and personal with one local
cardiologist who has a genuine “Heart for Healing.”
In keeping with the heartfelt theme of this edition – and to address an
issue that is very close to my own heart – please take the time to read
about a new local movement, Hope South Florida, to learn what so many
people in our local community are doing to help families and individuals
who are homeless. Did you know that today there are close to 4,000
homeless people living in Broward County? Sadly, 20 percent of them
are children under the age of 16. I encourage you to consider becoming
involved in this movement which has unified the community in a unique
and powerful way to help those who might otherwise have no hope.
I hope that you enjoy this issue of The Record and welcome your comments about what you see, read and learn from the magazine. Remember,
this publication is dedicated to serving our medical community, and our
team wants to hear from you about what we can do to make it more
insightful, enjoyable, educational and entertaining. As always, I can be
reached by email at [email protected] or by phone at (954) 812-3882.
Blessings,
Pery Canan, Publisher
|3
2011 PRESIDENT
|
BROWARD COUNTY MEDICAL ASSOCIATION
Physicians’ Rights and Responsibilities + A Voice for
Unfettered Patient Care
I
Aaron Elkin, M.D.
Obstetrics and Gynecology
President
am honored to be elected to be the 84th President of the
BCMA and thankful for the opportunity to “help doctors
help patients”. I also applaud all of the people that touch
a life and make one better to reduce human suffering on a
daily basis.
We are at a crossroad today. Real and timely information
and communication are key provisions of the role we take
Broward County
Medical Association
in uniting together to better the health of our community
and ourselves. I would like to share with all of you some
facts, major issues, my views, plans and future solutions
for practicing medicine at this critical time and juncture.
HONOR OF BEING A PHYSICIAN
In the course of the past few years, the health care delivery
system has created an environment that has made it difficult
for physicians to practice medicine. Physicians are obligated
to devote more time to the business of medicine just to
stay afloat.
Declining reimbursements, increasing expenses and
looming reform experiments forced physician and hospitals
to examine how to best work together and stay competitive.
While there are major consolidations in hospital systems,
insurers, and physician groups, the majority of health care
in the US is still provided by small efficient quality practices
that choose to remain independent without being employed
or joining a large group.
MEDICAL STAFF ADVOCACY COMMITTEE
In 2008, the Medical Staff Advocacy Committee was created
at the Broward County Medical Association to address that
need. The structure was created to facilitate communication
and dialogue between various parties which include physicians, hospitals, insurance companies and networks as well
as government and accrediting agencies.
As physician rights have eroded they become alienated,
disenfranchised and disempowered that the well being of
patients and alignments let alone any dialogue was thereby
threatened.
44 |
BILL OF RIGHTS AND RESPONSIBILITIES
In fact it is our understanding that the well being of physi-
we will need to address the current economic climate
cians, patients and the community are inextricably linked, for
and the Medicare and Medicaid structure in our community
wellness cannot exist for one when it does not exist for all.
and the U.S.
We therefore created the first Bill of Rights and Responsibil-
As we all know, Medicare became a barometer for payment
ities model for physicians and medical staffs in the United
to physicians and hospitals by the government and insurance
States (see side bar). It defines our basic rights in the delivery
companies. A “public option” in Medicare or Medicaid places
of that care, so as to once again empower our profession to
enormous burden on federal resources. Inherent to this
fulfill its calling and to have our voice heard without political
social obligation is the question as to whether healthcare
or monetary compromise.
is a “right” or a “responsibility”. I say both.
A second step is the adoption of these rights and responsi-
Patient responsibilities are key issue to health care reform
bilities into hospital medical staff bylaws and discussions
specifically: who will pay for it? While most patients are
about healthcare reform and alignments recognizing that its
financially responsible and empowered when making
value will significantly improve the practice environment,
decisions, a substantial number ignore that responsibility.
quality and cost efficient care.
Health insurers are reporting stronger earnings in 2010
More importantly it opens a line of dialogue similar to
in no small part simply because fewer of the members are
having a physician hot line for concerns and suggestions
going to their doctors. Plans are spending less on care be-
and making everybody’s voice count. It is our purpose to
cause of the current economy and higher deductible plans.
address all matters in a cooperative fashion and in a way
Despite these profits, insurers do not have a plan to lower
that promotes productive working relationships, and most
their premiums.
importantly, safe and quality healthcare in our community.
Some 45 years after Medicare, our government is attempting to re-structure the healthcare delivery system addressing
HEALTHCARE IN THE U.S. AND TIMELINE
the question of rights and responsibilities in the form of the
There is no dispute that the increased cost of healthcare
global insurance reform (Patient Protection and Affordable
has become one of the most important issues in our country.
Care Act (PPACA) of 2010) to the people who pay for it, try
The current economics of medicine demands that we
to get it and to those who cannot afford it. In fact it prevents
should know the facts and educate ourselves first and
insurance companies from canceling a policy if a patient gets
foremost and help the system be fixed. The future is unpre-
sick. Beginning in September 2010, discrimination against
dictable. There will be lots of new terms such as Accountable
children with pre-existing conditions will be banned – a
Care Organizations and Clinical Integration and some may be
protection that will be extended to all Americans in 2014. It
misunderstood. And any meaning may change over time. Not
prohibits setting lifetime limits on insurance policies issued
unlike IPA’s (Independent Physician Association) and PHO’s
or renewed after Sept. 23, 2010.
of the recent past, today, an ACO and or Clinical Integration
Even more aggressive than lifetime limits are annual dollar
could be an organization of group medical practices, net-
limits on what an insurance company will pay for health care.
works of individual practices, hospitals and others that join
For the people with medical costs that hit these limits, the
together to manage a large patient population of Medicare or
consequences can be devastating. It allows patients to
other insurance beneficiaries. But that is still in development
designate any available participating primary care doctor as
including any potential bonuses from CMS or insurance com-
a provider. A patient will be able to keep the primary care
panies for generating savings to the government and meeting
doctor or pediatrician they choose, and see an OB-GYN
their quality benchmarks and or the lessening of the FTC
without referral. It also removes insurance company barriers
guidelines for an organization that self refers.
to receiving emergency care and prevents them from charg-
So when we talk about adapting to current economical
ing a patient more because you’re out of network.
climate and aligning together with hospitals or other entities
Our voice and seat at the table when decisions are made will only matter if
we persist and define all of our rights and responsibilities and lead the way
to better the health of our community along with our own.
w
I believe that if we can have private insurers truly spend 90% of the premium
they collect on direct patient care it will allow our nation to count on private
companies and move away from a single payer system.
The Patient Protection and Affordable Act also establish an
placing Medicaid patients into managed care organizations
attempt at transparency with the costs of care to insurance
(HMO’s) and Provider Service Networks (PSN’s) in several
companies as a balancing act. It requires Insurance companies
counties in Florida. The Medicaid reform pilot is due to
to spend the majority of their collected premiums on direct
expire in 2011.
patient care. I believe that if we can have private insurers truly
After 5 years there is no clear and convincing evidence
spend 90% of the premium they collect on direct patient care
that the experiment has produced cost saving or ensures
it will allow our nation to count on private companies and
access and quality care. There is growing evidence that
move away from a single payer system (Complete socialized
there is increased cost, decreased access, deficient provider
system).
networks as well as instability and inconsistency in the
These are all good provisions and in fact have already
helped numerous patients in our community so why are
Medicaid plans available to patients.
The fundamental reason that it is so difficult to obtain both
we debating such. The answer is the same questions: Who
specialty and primary care is that very few doctors are willing
will pay for it? And is Healthcare a right or a responsibility?
to participate in Medicaid HMOs or PSNs. This is due to a
This massive law was also enacted with the understanding
that health care needs to be reformed in its entirety. A
key provision states that Americans have a responsibility
to buy insurance. Jurists differ on its constitutional
legitimacy with implications extending beyond the
Medicaid reimbursement rate too low to cover providers’
overhead, and bureaucratic barriers implemented.
As a consequence, medical care access through the emergency rooms is on the rise.
The Georgetown Health Policy Report for October, 2008,
commerce clause. Recently, in Florida a judge called the
raises the critical question: Do any potential savings represent
entire Act unconstitutional.
efficiencies that plans are making, or simply reduced access or
It is likely that such question will reach the supreme court
of the U.S. and will have a domino effect on the entire Act by
reimbursements to necessary care?
From my experience and observations regarding Medicaid
placing a roadblock for its implantation in the various states.
Reform: there is decreased access to care, inaccurate informa-
But all of us at one point or another in our lives will receive
tion provided, higher costs, poorer care, fewer services, more
healthcare and generate financial implications for our country
forms, less satisfaction and no informed choice. I do not know
particularly in the beginning and end life and have to come to
how long we want to hurt patients. As you may know, this
grips with the reality that we are not living in a vacuum and
Reform was called an “experiment.” In the U.S., we cannot
have some minimal responsibilities.
do an experiment on the most vulnerable population. In
my opinion, as a physician, Medicaid Reform must be
FLORIDA MEDICAID REFORM
The Medicaid program will be expanded as the only logical
immediately stopped and or re-directed.
As a physician who has seen the program at the trenches
vehicle to provide care to the uninsured. Medicaid payment
and in real time, I wrote a letter of concern to the Director of
rates to primary care doctors will increase to match Medicare
the Center for Medicaid and State Operations, Department of
payment rates for primary care doctors, facilitating further
Health & Human Services in Baltimore, Maryland on March 30,
access.
2010. The letter describes my experiences regarding Florida’s
Florida Medicaid Reform is a demonstration that was
looking to improve the value of the Medicaid delivery system.
Medicaid Reform Pilot.
Following public outcry and testimony, our letter and by no
The program operates under an 1115 Research and Demon-
small part by consumer protection groups such as Florida
stration Waiver approved by the Centers for Medicare and
CHAIN and Florida Legal Services, CMS send a letter to AHCA
Medicaid Services in 2005 for 5 years. The program was
and did not simply extend the waiver but will only process the
w
w state’s request under the 1115(a) social security act provision
system, it is likely to fail. To find a solution we have to start
and modify the special terms and conditions of the demon-
with physicians since we have a few thousands of years of
stration to address concerns. Unfortunately since the state
experience treating patients and staying in business.
of Florida is in budget crisis legislators refuse to believe
Our voice and seat at the table when decisions are made
that Medicaid reform experiment should be stopped and or
will only matter if we persist and define all of our physicians’
redirected.
rights and responsibilities and lead the way to better the
The Governor’s “Health Care Transition Team” also issued
health of our community along with our own.
major recommendations and they include consolidation of
We should pause and get to know the facts and educate
the state’s health care agencies, repeal of the federal health
ourselves first and foremost to help the system be fixed espe-
care law, and the continued shifting of Medicaid patients to
cially regarding any Healthcare reform. It is like any patient
managed care. Some of these recommendations are flawed
who experiences an illness for the first time and is most
because they fail to safeguard and account for the availability
fearful of the unknown. Physicians and Hospitals are fearful
of physicians and hospitals to provide quality care and access
of the unknown.
for patients creating new financial implications and inherited
It is my strong belief that Healthcare is both a right and a
bureaucracy. In fact most physicians do not agree with
responsibility in the U.S. and that should always be a platform
such an approach.
for our healthcare reform. And yes to be responsible to
Of particular interest is the section about hospitals and
the federal and state financial plan as well as Medicaid
purchase insurance is just as constitutional as paying taxes.
So this is the time of opportunity to be engaged in dialogue
reform. It is highly educational, well intended, descriptive
through organized medicine and keep it simple. Do what we
and explanatory when describing terms such as LIP payments
do best. Which is to practice quality medicine and advocate
(Low income pool), UPL, DSH, and IGT (a system of sophisti-
for the well being of our patients and continue to be a unified
cated intergovernmental transfers).
outspoken voice of reason, compassion and sensibility to
But sobering statistics are at play in light of our current
find solutions.
economy. According to the dept of children and families,
there are over 2 million calls a month from patients request-
WE SHINE THE MOST AT THE MOST DIFFICULT TIMES.
ing Medicaid coverage’s and food stamps yet it can only
I will dedicate myself to working together with physicians, hospi-
handle 300,000. So patients are in this void of unable to
tals, the State of Florida, the federal government and simply all
obtain care and services in a timely manner along with a
patients to continue the unfettered practice of medicine which is
freeze on hiring state workers who are going to be integral
our passion. Through the Broward County Medical Association I
to facilitate any state or federal healthcare reform.
will promote dialogue, education and solutions to our current
It is ironic that the recommendations are to repeal the
medical practice and healthcare reform.
Patient Protection and Affordability Act because of constitutional values yet Florida wants to take away the constitutional
I would like to thank my parents: Judy and Pinchas Elkin.
rights of patients to choose their providers by shifting all Med-
Without them I would not be here. I have become who I am
icaid into managed care and to a program that failed to show
because of what they thought of me and the unconditional
any increased access, decreased costs let alone true benefits
love I received. Last, but not least, I would like to dedicate the
to the people.
following to my daughter Alexis Jayde…Being an Obstetrician
you learn all the science about life, parenting and children…
My Conclusion and Plan The consensus by health experts
but not until you have a child of your own do you appreciate
is that unless patients and physicians are happy with any new
the beauty and miracle of life. I am still learning from you…
This is a time of opportunity to be engaged in dialogue through organized
medicine and kept it simple. Do what we do best. Which is to practice quality medicine
and advocate for the well being of our patients and continue to be a unified
outspoken voice of reason, compassion and sensibility to find solutions.
EXECUTIVE VICE PRESIDENT
|
BROWARD COUNTY MEDICAL ASSOCIATION
In 2011 - Flags, EHR and PECOS
the BCMA can assist with it all!
W
Cynthia S. Peterson
Executive Vice President
Broward County
Medical Association
BCMA Information
Please Contact:
elcome to the year 2011! I personally
period to provide guidance, technical assis-
believe this is going to be a better
tance and information on purchase and imple-
year. It just has to be. My sister passed away
mentation of an EHR to physicians. The SFREC
in July 2010, after being treated for endome-
has interviewed many vendors and has a list of
trial cancer for just 11 months. I wish to thank
certified EHR vendors to suggest.
the BCMA Board who were so supportive of me
Richard Ly, will be happy to make an appoint-
chemo and radiation, and thanks to many of
ment and meet with you and your staff. Contact
you for your cards and wishes. She was my only
Mr. Ly at 305-586-7054 or email rly@southflori-
sibling, and I now cherish even more the week
darec.org. BCMA has had one meeting in the of-
every summer I took off to spend with her in
fice for Physicians and Staff, and will be
Tennessee. The BCMA office was busy and
holding more. There will be incentive dollars
there were so many issues with the Medicare
for physicians who participate in e-prescribing
cuts last year and now that is over, thank
and EHR, up to $44,000 for Medicare and
goodness. So, I just know it is going to be a
$63,750 for Medicaid.
better and brighter year.
Cynthia Peterson
954.714.9772
[email protected]
PECOS (Provider Enrollment, Chain and
Because of the 10,000 plus calls made by
Ownership System) – It is hard to believe, but
physicians to Congress, the Medicare cuts of
there are still physicians’ offices who are NOT
23-25% were put off for the year of 2011. This
enrolled in PECOS. Beginning July 5, 2011,
will give Congress and the physician commu-
Medicare will begin to deny any and all services
nity time to develop a long-term permanent
ordered or referred by physicians who are not
solution to the SGR (sustainable growth rate),
in PECOS. Please check and make sure you are
part of a formula that aligns physician pay up-
enrolled. Go to www.cms.hhs.gov/Medicare-
dates with performance of the nation’s econ-
ProviderSupEnroll. Click on “OrderingRefer-
omy. So let’s hope for the best.
ringReport” then click in the middle of the page
Did you even know about the Red Flags
on “OrderingReferringFile.” There is an alpha-
Rule? The red flags rule was intended to en-
betical list of all doctors who are enrolled. If
sure that banks, credit card companies and
you are not listed, better go back to the web
certain retailers protected consumer financial
site and enroll. Time is running out.
information. However, out of nowhere, the
SAVE THE DATE – March 23, Riverside Hotel,
FTC extended the rule to physicians. Thanks to
6:00 pm, “Surviving the Health Care Chaos”,
the AMA and the Voice of Medicine, physicians
Providing more for less, Obtaining and using
were finally exempted from another adminis-
EHR, ACOs – Are they really going to happen
trative burden.
here?
Are you e-prescribing? Do you have EHR?
68 |
The Outreach Manager in Broward County,
and the time I needed to be at her side during
If you are having problems in your office
The BCMA is participating with the South
with HMOs, Medicare, etc., please give BCMA
Florida Regional Extension Center. The SFREC
a call. We are here to serve our members and
received federal grant funding for a two year
assist them with all problems.
to image or
not to image?
10 |
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I
n July 2010, the Wall Street Journal reported that 91% of 1,231
physicians who responded to a survey said they ordered more tests
and procedures than necessary to protect themselves from malpractice
suits. This fear may be reflected in a Centers for Disease Control report,
which found the number of MRI, CT and PET scans increased 500%
among adults under age 65 and 400% in adults over age 65 between
1996 and 2007 (Modern Healthcare, February 22, 2010).
According to a Sun-Sentinel article on July 8, 2010, South Florida
hospitals perform far more imaging tests than the national average,
often in the form of the same study done both with and without contrast. The question is: Are Broward doctors practicing defensive medicine, or merely using technology to confirm their clinical judgment?
The answer depends on who you ask
Liability worries are realistic
w By Holly Strawbridge
According
to internist Kutty Chandran, MD, worry about potential
lawsuits is a realistic concern in Broward County. He found
Doing the right thing As a radiologist in private
that South Florida’s reputation for being a litigious area
practice, Richard Steinman, MD, conducts tests ordered by
hindered his group’s ability to hire new physicians and
other physicians. In his opinion, the vast majority of his
made others question his decision to practice here. “When
Broward colleagues are trying to “do the right thing” for
I moved here, friends asked me why I wasn’t afraid of
their patients. “Most doctors don’t want to order extra tests.
getting sued,” he said. “Fear affects practices all over the
They are simply trying to get patients the care they need.
country, but it’s probably worse in South Florida than in
Can I point to a bad apple? Absolutely. But on average,
New York or New Jersey,” he says.
most doctors try not order more studies than necessary,”
he says.
Ordering scans with and without contrast makes
Although the Wall Street Journal survey found that all
types of physicians are equally concerned about liability,
there’s no doubt emergency physicians are in the hot seat.
financial and clinical sense to him. “Contrast enhances the
Due to the nature of acute care, every patient is treated
organs, so doing a CT scan with and without contrast can
like a new patient and given a full workup. Tests are
be helpful in answering important questions. Although
routinely performed to confirm clinical judgment.
there are certain circumstances when you only need a ‘with
“All of us have been taught that although we can make a
or without’ exam, it is better to do both at the same time
diagnosis by examination, we should back our decision with
when appropriate,” he says.
diagnostic tests. Even if there’s a 99% chance a patient has
Family practitioner Tony Prieto, MD, agrees with Dr.
the flu, we do a throat culture. We may feel the cause of
Steinman that Broward physicians are doing what’s best
neck pain is probably muscular, but we still get an X-ray or
for the patient. At the same time, he feels they are protect-
CT scan. Headaches are uniformly sent for a CT scan to rule
ing themselves. “Patients should accept their doctor’s
out stroke or tumor. This may lead to doing some tests that
clinical judgment, but most doctors order a test to cover
were done recently, but we didn’t know. We don’t have the
themselves. CT is the usual choice, because it is a broad-
patient’s records, and they don’t always tell us,” says Nabil El
spectrum test that might yield a finding,” he says.
Sanadi, MD, chief of emergency medicine for Broward Health.
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| 11
TR Report: To image or not to image
w
a complex problem
While there’s no doubt a few doctors order unnecessary tests to
augment their income, and certain attorneys thrive off frivolous
lawsuits, patients are at the heart of the problem. And it’s a
complex one. There appear to be five major reasons:
1. High expectations Whether treatment is provided in the office or ER, patients want a full workup, and they want it
now.“They have almost a demanding and threatening attitude. This obligates us in the ER to do some tests we would
not otherwise do to make sure we are not missing any life-threatening condition,” says El Sanadi.“It doesn’t matter
what age they are or what condition they are in, we are obliged to do everything we can. There is no limit,” adds
Dr. Chandran. “When do we say enough is enough, the patient will not benefit?”
2. Patients playing doctor Easy access to medical information on the Internet is leading a growing number of patients
to self-diagnose. As a result, they tell their doctor how to proceed. “They say they want to rule our this or that. God
forbid I don’t think they have it,” says Dr. Chandran. This puts pressure on doctors to do even more tests. Headache
is a good example. It’s a common problem with a small chance of being caused by an underlying tumor, yet patients
assume the worst.“The patient says, ‘My friend died of a stroke, so do this test for me.’ It’s useless to try to explain
that you are not related, so your friend’s stroke doesn’t increase you risk. We just do the test,” says Dr. Chandran.
3. Lack of primary care Some patients don’t take of themselves, then use emergency medicine physicians for primary
care at no cost to themselves.“Emergency medicine is the only specialty required by law to see all comers. Acute
distress and no insurance? We provide care for them,” says Dr. El Sanadi.
4. No continuity of care Most visitors to Broward don’t carry their medical records with them, so when they are admitted to a local ER with an acute problem, the physician does not have access to the patient’s history. “The patient may
have had a CT scan last week in another state, but we don’t know this, so it generates a repeat study,” says Dr. Steinman. Even when patients have access to their medical records, many appear to be reluctant to request copies and bring
them to a new physician. They don’t appear to understand the advantages to their care.“To find the smallest, earliest,
most treatable stage of breast cancer, it is important to be able to look back through successive mammograms for
subtle differences. If I have a woman’s mammograms from last year or earlier, I can look for changes. But some women
don’t want to be bothered to bring their prior mammograms,” says Dr. Steinman.
5. Greed The prospect of easy money motivates certain individuals to sue physicians. Lawsuits settled out of court may
fan this fire.“Some patients are trying to get easy money. These lawsuits are simply economical. It’s not a matter that
the doctor has done something wrong,” says Dr. Prieto. “People are more likely to sue a doctor here than in a smaller
town, where the doctor is your friend,” he adds.
12 |
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Changing the culture
Broward physicians
have ideas on how factors leading to the practice
of defensive medicine can be changed. It may be a
long process to change the expectation of immediate
gratification, but measures can be taken to jump-start
the process. “We need to make sure legislators, citizens
and medical educators know that defensive medicine
and rising costs are unavoidable, unless these issues
are addressed,” says Dr. El Sanadi.
The Wall Street Journal article
found that same percentage
of physicians who said they
practiced defensive medicine
felt that protection against
liability will be necessary
before this will change.
Dr. El Sanadi agrees. “Tort reform must be part of
health care reform. An unavoidable cost is produced
by frivolous lawsuits. Not only can they result in huge
payouts, but they cause a tsunami effect: If we think
one person will sue us if we miss a lung cancer, we
do a CT on everyone with a cough,” he explains.
Likewise, he feels the medical education system
must undergo a paradigm shift in expectations to
break the vicious cycle. “Everyone being trained now
is anticipating they will be sued if they don’t do tests
and miss a diagnosis,” he says.
So where do we begin to break the cycle? Dr. Chandran
offers this practical idea: “Patients demand that every
technology available should be used. Someone has to
pay for it. Whether you have insurance or money or
neither does not affect demand. So let’s experiment by
putting a one-year moratorium on liability suits. During
this time, doctors everywhere will practice using clinical
judgment and approved guidelines. Then the cost
savings versus deaths can be evaluated. There is
no scientific way of knowing otherwise,” he says.
EDUCATION
The Record: BCMA 2011 Calendar of Courses
CME information:
Baptist Health
South Florida
Tel: 786-596-2398
Email
christinek@
baptisthealth.net
Title:
Date:
Location:
Third Annual Mental and Behavioral Health Symposium
Title:
Knock Out Stroke:
Current Practices and Future Directions in
Cerebrovascular Disease Treatment
Date:
Location:
Saturday, March 12, 2011 (5, Cat 1)
Biltmore Hotel, Coral Gables
Activity Details Register
Title:
Date:
Location:
Director:
Spine Surgery Symposium
Title:
Transanal Endoscopic Microsurgery (TEM)
Hands-on Workshop
Date:
Location:
Sunday, February 20, 2011
Harbor Beach Marriott, Fort Lauderdale
Director
Dana R. Sands, MD
Title:
Date:
Location:
Director:
Female Pelvic Floor Disorders
Web
[email protected]
CME information:
Cleveland Clinic Florida
Tel: 954-659-5490
Fax: 954-659-5491
Email
[email protected]
Web
ccf.org/florida/cme
14 |
Saturday, March 5, 2011 - 7:30 am-12:30 pm (4, Cat 1)
South Miami Hospital Auditorium
Activity Details Register
Saturday, March 19, 2011 (5, Cat 1)
Biltmore Hotel, Coral Gables
Activity Details Register
March 31 - April 4, 2011
Ritz Carlton Hotel, Fort Lauderdale
G. Willy Davila, MD and Gamal M. Ghoniem, MD
By Fedra Vimercati
Private Banking VP – Florida
TD Wealth Management
Top 5 Tips
For Effective Estate Planning
D
eveloping a comprehensive estate plan is one of the
3. Avoid Probate
most important actions you can take to protect your
Avoid costly and time consuming probate, if possible. Con-
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sider pay on death, transfer on death, joint tenants with right
you can be confident your wishes will be carried out after
of survivorship and other similar registrations for banking and
death, such as providing income for your surviving spouse,
investment accounts. Place assets into one or more types of
protecting future generations, and transferring charitable
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gifts to the organizations you most want to support.
table trusts, testamentary trusts and living trusts, and you
How can you pass on your wealth with the smallest tax
may be able to protect the trust’s heirs from creditors, too.
liability and greatest benefit to loved ones? Here are some
Also consider who you want to serve as personal representa-
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tive (PR) of your estate. The PR is responsible for distributing
your assets how you specify. The most obvious choice is a
1. Assemble The Right Team
spouse or adult child; however, a professional representative
Many estate plans require the expertise of banking, legal,
relieves family members from the responsibility and can help
wealth management and other professionals. Take the time to
avoid conflict of interest or family resentment that can arise
meet with those to whom you are considering entrusting your
when the PR is also a beneficiary. If you choose to place your
affairs. Ensure you feel comfortable not only with their knowl-
assets into a trust, carefully select who will serve as trustee,
edge but also with your personal interactions, understand
such as yourself, a loved one or a financial advisor, or name
how they will be compensated and find out what services
co-trustees.
they may continue to provide once your plan is in place.
2. Plan For Tax Efficiency
Estate planning specialists will tell you that there are two
estate tax systems: one for the informed taxpayer and one for
the uninformed taxpayer. The more you know,
the more you may be able to save. Beginning this year, unless changes are
made, $1 million of an estate is exempt from federal estate tax,
and the remainder may be
taxed up to as much as 55 percent. However, the law provides an unlimited marital
deduction allowing married
people to leave any amount
of property to their spouse (if
the spouse is a U.S. citizen)
which is free from Federal estate
and gift taxes. Efficient tax planning is critical to ensure your assets
are passed to your heirs, and not
paid in taxes to the IRS.
16 |
w
4. Purchase Adequate Insurance
The right amount of term life insurance, the simplest and
least expensive type of life insurance, can make a huge difference in the lives of your beneficiaries. It provides protection over the period of time that premiums, which are based
on your age and lifestyle, are paid.
5. Consider Charitable Giving
Family foundations, donor advised funds, Charitable
Remainder Trusts and other options offer a variety of
immediate and future benefits, including tax deductions
and income streams for you and surviving family members.
A charitable giving component in your estate plan can also
teach your children about philanthropy while allowing you
to leave a legacy and support the organizations that are
most important to you.
When you have created your estate plan, you can update
your will and trust documents as your life situation changes,
such as with the birth of a child or grandchildren, divorce,
retirement or a host of other situations. When you partner
with a team of trusted professionals, an estate plan is a flexible tool that allows you to take care of those you care about.
TD Wealth Management professionals offer integrated, comprehensive and customized financial solutions to cultivate and preserve
wealth including Private Client Services and Private Investment
Counsel. Fedra Vimercati can be reached at (954) 233-2996 or
mailto:[email protected] [email protected].
Securities and other investment and insurance products are: not a deposit;
not FDIC insured; not insured by any federal government agency; not
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investment risk, including possible loss of value. TD Wealth Management is
a service mark of The Toronto-Dominion Bank. Used with permission.
SECURITIES AND INSURANCE
NOT FDIC INSURED
NO BANK GUARANTEE
MAY LOSE VALUE
CALENDAR
The Record: BCMA 2011 Calendar of Events
March
2011 at a glance
9
BCMA EMS Committee
11:45 am - 1 pm (place TBD)
Board of Directors Meetings
14-15 FMA Days at The Capitol, Reception
February 24
July 21
March 31
August 25
April 28
September 22
May 26
October 27
June 30
November 17
December 15
February
18 |
17
B.D. Peds. Society Board of
Directors Meeting
BCMA 6:30 pm - 8:30 pm
22
How to Reduce Insurance Costs
Pro Health USA, BCMA Noon - 1:30 pm
24
BCMA Board of Directors Meeting
BCMA 6:30 - 8:30 pm
25
American Red Cross Cocktails
Silent Auction, Fashion Show,
Pier 66, 7:30 pm - 9:30 pm
begins March 14 6 - 8 pm
Reception at FMA Headquarters
15
Broward County Pediatric Society
CME Dinner, Riverside Hotel
William Klish, MD, Prof. of Ped,
Baylor College of Medicine
“Prevention of Childhood Obesity” 6 - 9 pm
19
BCMA Alliance Doctor’s Day Party
“Tarzan & Jane” Hugh’s Catering, 7 pm - 10 pm
23
Surviving the Healthcare Chaos:
Providing More for Less, Obtaining & Using
E-Prescribing & Electronic Health Records
ACOs, Panel Discussion
Riverside Hotel, 6 pm - 8:30 pm
31
BCMA Board of Directors Meeting
BCMA, 6:30 pm - 8:30 pm
April-May
28-1 Florida Academy of Family Physicians
Educational Event (20 Cat., 1 CME)
Westin Diplomat, Hollywood
July
28-31 FMA Annual Meeting
Disney’s Contemporary Resort, Orlando
It’s about
Advocacy and Grass Roots Lobbying
BCMA informs legislators at the local level on state and
Membership benefits you
national key legislative issues that impact physicians
and their patients in conjunction with the AMA and the
FMA.
BAMPAC
Workers Compensation Insurance
Broward Allied Medical Political Committee –
Through the BCMA's Group Program with OptaComp,
Works via voluntary contributions from physicians
members receive up to 24.8% of their premium back
and their spouses to support pro-medicine candidates.
in the form of a dividend.
Referrals
Medical Liability Insurance
BCMA provides the public with information
Through the BCMA's Group Program, members
about member physicians' credentials, address,
receive a 5% discount on their premiums.
and telephone number.
Support Services
Grievances
Services available are Banking, Billing, Collection, Coding
BCMA communicates with patients who experience a
and Compliance, Credit Card Processing, e-prescribing,
breakdown of communication with their physician or
EHR, Financial Planning, Healthcare Lawyer On Call Pro-
the office staff.
gram, Legal Defense Insurance, Office and Health Insurance, Payroll and Personnel Services, Phone Services,
Speaker’s Bureau
Telephone, and Transcription.
BCMA provides organizations with speakers
for their meetings.
Practice Management
The BCMA routinely communicates with Medicare and
Camaraderie
insurance companies regarding physicians' economic
Socializing and networking with colleagues
(getting paid) and enrollment issues. BCMA supports
and their spouses through various social events.
the physicians' office staff with answers to their
day-to-day problems.
Communications
Physicians' offices receive information on key issues via
Education
fax or email. The Record, BCMA's official journal pro-
BCMA holds seminars on the latest practice management
vides a wide variety of key information for physicians.
information and state mandated CME programs.
Please contact Cynthia S. Peterson for membership information: 954.714.9772 [email protected]
| 19
A
ful
hea rt for the homeless
By Sandra A. Richards
A
s far back as the late 1990s, the homeless population
work at an hourly job, you don’t get a sick day. You lose a
in Broward County was exploding as meal programs
day’s wages and ultimately may lose your job because you
attracted more and more people in dire need of assistance.
can’t juggle getting the kids to childcare and making it to
Despite an uprising against the programs, the court ultimately
work on time,” said Robin Martin, M. Div., Executive Director
ruled that the City of Fort Lauderdale could not stop them.
of Hope South Florida and The Shepherd’s Way.
Such began the cycle of public feeding of the homeless,
Regardless of how they may have become homeless, many
which brought more homeless to our community, which led
of these people face long nights sleeping under bridges, in
to increased pressure on limited resources in a lagging econ-
their cars or in the wooded areas around I-95 exits. Of the over
omy, which in itself increased the homeless population.
4,000 South Floridians in Broward County who find them-
Today, thousands of South Floridians from all walks of life
are homeless and on the waiting list for shelter. Many of them
are former professionals who experienced corporate layoffs.
selves homeless each night, almost 20 percent of them are
children under the age of 18.
In recent years, this escalating crisis became the equivalent
Many of them are hard-working folks who simply lost their
of a perfect storm: an increasing homeless population, local
jobs. Many of them are single parents who found it impossible
government’s growing awareness of their needs, and a com-
to continue to make ends meet.
munity of people committed to helping their neighbors in
“It’s said that many people are two paychecks away from
need. In response to the crisis, a unique partnership – Hope
homelessness, but I’ve come to realize the fallacy in that
South Florida – was launched last summer, with promising
statement. It doesn’t take into consideration how important
early results.
community is in one’s life. I like to say we are all two paychecks
Hope South Florida is a non-profit organization with the
and two friends from homelessness. When you work for an
mission to end family homelessness and provide love and
hourly wage, a small car repair can spiral into an unmanage-
support for those living on the streets in Broward County by
able situation that leads to homelessness. If you can’t get to
providing housing, support services and partnerships that
“Although Hope South Florida is an organization with a Christian-based philosophy to serve
others, we welcome people of all beliefs and denominations. Homelessness impacts people
across all religions, ethnic and social backgrounds, so our community-wide effort should
embrace all those who share a common desire to become part of the solution.”
– Dr. Stephen Ranae, BCMA Member and Member of the Board of Directors of Hope South Florida
20 |
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transform lives. The Shepherd’s Way, a non-profit founded in
Build Housing will increase housing capacity for the homeless
1995, is now a part of Hope South Florida and brings with it a
through crisis, transitional housing and long-term housing
history of serving the local homeless population with emer-
options. In addition to current housing programs, this
gency shelter, housing assistance, and support.
initiative is working to acquire, rehabilitate and refurbish
foreclosed homes, and then use them as housing for those
Hope South Florida is focused
on three core initiatives:
participating in Hope South Florida programs.
Build Hope will create two multipurpose centers to care for
people facing homelessness and those who are currently living on the streets. Each location, one for families and one for
individuals, will provide essential services such as housing
placement, meals, clothing and crisis counseling. These centers will be “one-stop” entry points into the community’s on-
Build Community is a coordinated effort to build a social
services safety net to ensure that the men, women, and
children who regain stability never again become homeless.
If the root cause of homelessness is a lack of community
and social support, the answer must include systems that
improve social capital.
going system of care for the homeless. Future plans include
an onsite community health clinic where volunteer medical
professionals can engage homeless families and individuals as
well as others in need of care.
Hope South Florida has organized dozens of volunteer
opportunities for adults and children. For more information,
visit HopeSouthFlorida.org or call 954.566.2311
“Through these housing initiatives, mentoring relationships
and community one-stop service centers, we are seeing broken
families renewed and lives restored.”
– Robin Martin, M. Div., Executive Director of Hope South Florida
How you can collectively lead, specifically
help and generally participate
| 21
If you’re a member call for your code, and get started BCMA 954-714-9477
The BCMA
Healthcare Lawyer
On Call Program
Members of participating medical associations are given the opportunity to speak with qualified healthcare legal
counsel on issues such as: integration strategies, regulatory compliance, subpoenas, electronic medical records,
HIPAA, medical malpractice situations, Board of Medicine matters, AHCA and Department of Health issues and
other healthcare law matters. During normal office hours, medical association members can call their associations
and receive a code, then call the number given to them by the medical association after hours. The lawyer on call
will return your call by noon the next day and spend up to 15 minutes with each medical association member.
A Special Thanks to the Sponsors
24 |
SPONSORS
BCMA: 84th Presidential Inauguration & Dinner
| 25
26 |
GALA EVENT
BCMA: 84th Presidential Inauguration & Dinner
Thanks to the Honorary Co-Chairs and Host Committee for a wonderful evening
| 27
Dr. Dana Wallace
Receives the
President's Gavel
from Dr. Sami Bahna
during the Annual Business
Meeting in Phoenix.
Dana V. Wallace, MD, FACAAI, Fort Lauderdale, Fla.,
was installed as president of
the American College of Allergy, Asthma and Immunology Nov. 13 at the Annual
Meeting in Phoenix.
w
Dr. Wallace is associate clinical professor of medicine at Nova South
eastern University of Osteopathic Medicine in Davie, Fla., and is a
private practitioner in allergy, asthma, and clinical immunology in Fort
Lauderdale, Fla.
She is serving her second terms on the ACAAI Board of Regents and on the
Executive Committee. She is the chair of the Annual Program Planning
Committee, is website associate editor, and is a member of the Marketing
Task Force, SETTaF-Specific IgE Testing Task Force, Task Force on Maintenance of Certification, Task Force on Website and the Workgroup to
Restructure Committees. She has been ACAAI's representative on the Joint
Task Force on Practice Parameters since 2005 and was chief editor of "The
Diagnosis and Management of Rhinitis: An Updated Practice Parameter."
She also represents the ACAAI on the Joint Task Force on EMR Standards,
the Joint Task Force on Quality Measures, and the Health Level 7 (HL7)
Clinical Interoperability Council, and she is the representative to, and
reviewer for, the WAO Immunotherapy Special Committee developing the
document "Grading of SLIT Reactions."
Dr. Wallace has served on the Annals of Allergy Manuscript Review Committee since 2005 and has been
a Nationwide Asthma Screening Program coordinator since 2000. She is former chair of the ACAAI FIT
Program Relief Grants Committee, Bylaws Committee, Drugs and Anaphylaxis Committee, Communications
Council, Symposia Committee, and Website Redesign Committee, and was a member of numerous other
committees. Her ACAAI honors include the 2009 Distinguished Service Award, the 2008 Bela Schick lectureship and the 2007 Women in Allergy Award.
Dr. Wallace is Vice President of the BCMA, and has been a member since 1976.
Broward Health Heart Center of Excellence Cardiologist
Becomes Broward County’s First Physician to be Board
Certified in Advanced Heart Disease & Cardiac Transplantation
Gellman, M.D., F.A.C.C., a cardiologist for Broward Health’s Heart Center
w Joel
of Excellence was recently awarded a Board Certification by the American
Board of Medical Specialty in Advanced Heart Failure and Cardiac Transplantation. Dr. Gellman is the only physician in Broward County, and is one of only 227
physicians across the country to have earned this certification.
The recent creation of the Advanced Heart Failure and Cardiac Transplantation
subspecialty represents an advance in the field of cardiology that will lead the
way in providing technically advanced care for patients with heart disease – the
number one killer in the U.S. contributing to more than 300,000 deaths each year.
The proposal to establish the new subspecialty, originated and advocated by the
Heart Failure Society of America, was approved in 2009 by the American Board of
Medical Specialties.The new specialty is needed because of the rapid progress in
treatment options for patients with heart failure, such as heart transplantation
and ventricular assist devices (VADs).
Dr. Gellman has been an active member of the BCMA since 2002.
South Florida Endoscopy
Has Been Ranked the
51st Best Place to
Work in Healthcare
in the United States
w
South Broward Endoscopy
named in the Modern Healthcare magazine’s third annual
“Best Places to Work in Healthcare” supplement. The Top 100
organizations were listed in the
publication’s October 25, 2010
issue and were honored at an
awards banquet held in Dallas,
Texas.
Modern Healthcare’s “Best
Places to Work in Healthcare”
recognizes outstanding employers in the healthcare industry on
a national level. From economic
development to employee retention, this program benefits individuals, organizations and the healthcare industry. For Wayne
Schonfeld, MD, managing partner of South Broward Endoscopy, receiving these awards is a culmination of many years of providing
excellent care to patients. “For many years, my partners and I wanted to develop our own surgery center exclusively for the physicians of our practice and our collective patients. South Broward Endoscopy has truly been the realization of those plans and has exceeded our expectations at every level,” says Dr. Schonfeld. “The combination of our outstanding staff, along with the quality care
provided by the physicians of our group, have allowed us to realize our ultimate goal and we are truly proud of our accomplishments.” Excerpt from EndoEconomics publication, Winter 2011 issue
w
Baptist Medical Plaza Opens Third Location in Broward County
Baptist Health opened its third medical plaza in Broward County today, adding Pembroke Pines to its Davie
and Coral Springs locations. Baptist Medical Plaza at Pembroke Pines – located at 15885 Pines Boulevard
in the Westfork Shopping Plaza – features urgent care and diagnostic services for the whole family.
“Our long-term strategy has always been
to bring our healthcare services closer to
home,” said vice president Luis Bellmas, who
oversees the Baptist Medical Plaza division,
“When we decided to move into Broward,
our primary focus was to offer added convenience to the patient, as well as easier
access to the high-quality services for which
our brand is known.”, Luis Bellmas, Vice President.
| 29
In The News: Continued…
w
Congratulations to Paula Thaqi, MD, Director
Broward County Health Department, Who was
Elected Chair of the Children’s Services Council.
Dr. Thaqi has been Director of the Broward County Health Department since April
2008. Prior to that, she served as Director of the Health Department in Highlands
County, Florida “I have been honored to serve with the members of this body
and am truly honored to have been selected as its Chair, “she said. “I have some
really big shoes to fill,” she added referring to Ms. Valladares.
The Children’s Services Council of Broward County is an independent taxing authority which was established by a public referendum that passed on September
5, 2000, and which through Public Act, Chapter 2000-461 of the laws of Florida,
authorized the Council to levy up to 0.5 mills of property taxes. The role of the
Council is to provide the leadership, advocacy and resources necessary to enhance children’s lives and empower them to become responsible, productive
adults through collaborative planning and funding of a continuum of quality
care. For more information on the Children’s Services Council of Broward and its
funded programs, visit www.cscbroward.org or call 954-377-1000.
“I have been honored to serve as its Chair –
I have some really big shoes to fill.” Dr.. Paula Thaqi
Prominent Pediatrician
Ending His 54-Year Career.
Sunday, January 30, 2011 Dr. Tanis
gathered his patients and friends for
a party at Memorial Regional Hospital
and signed off from active practice.
Dr. Tanis said, “The children are so
charming. It’s what has kept me
young.” Dr. Tanis was a co-founder of
Pediatric Associates, which started as a
two-doctor team in a tiny Hollywood
office in 1957 and has grown into the
nation’s largest private practice for children with 130 doctors and 21 offices.
Dr. Tanis has served as President of the
Broward County Pediatric Society and
of the Florida Pediatric Society. Some of
his earliest patients are now approaching retirement and have brought their
children and grandchildren into his
care. At least 60 families have been
three-generation Tanis patients.
Enjoy retirement Dr. Tanis!
30 |
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Advertise with the BCMA
and reach…
w
5000 Doctors
+ Hospitals and
Local Businesses
Linda Cox, MD was Elected
Secretary / Treasurer of the
American Academy of Allergy,
Asthma and Immunology
with an Automatic Acension to
President Elect. She will
Take Office in March 2011.
Linda Cox, MD an Associate Professor of
Medicine at Nova Southeastern University
College of Osteopathic Medicine, practices
pediatric and adult allergy and immunology in Fort Lauderdale, FL. She earned her
MD degree from Northwestern University,
Chicago, Ill. Dr. Cox completed her
residency in Internal Medicine at the
University of Miami, Jackson Memorial
Hospital, Miami, FL, and fellowship in
Allergy and Immunology at National Jewish
Medical Research Center, Denver, CO. She
has been a member of the annual meeting
program planning committees for the
Florida Allergy, and Immunology
Dr. Cox has been a member of the BCMA
since 1993, and is a past BCMA President.
y
n
o
m
r
hm Ha
t
y
h
R
Heart
Identify and Treat
Patients at Risk for
Sudden Cardiac Death
32 |
By Sandra A. Richards w
According to the Heart Rhythm
Society, more than 450,000 deaths each year result from sud-
identifies patients who might most benefit from an
implantable cardiac defibrillator,” Dr. Zelnick said.
den cardiac death (SCD). In fact, SCD claims one life every two
The MTWA test uses an EKG measurement of the heart’s
minutes, taking more lives each year than breast cancer, lung
electrical conduction to detect the presence of repolarization
cancer or AIDS. More than 70 percent of Americans not only
alternans (T-wave alternans), a variation in the vector and
underestimate the seriousness of SCD, but also believe it is a
amplitude of T-waves. Since the amount of variation is small,
type of heart attack. Rather, SCD arises from electrical prob-
on the order of microvolts, sensitive digital signal processing
lems in the heart, usually caused by ventricular tachycardia
techniques are required to detect MTWA.
or fibrillation, whereas a heart attack results from myocardial
Clinical trials indicate that patients from at-risk populations
who test MTWA negative will likely not experience a ventricular
infarction.
event for 12 to 24 months after their initial MTWA test. Patients
Identifying SCD Risk Factors
who test MTWA positive or indeterminate for heart rate or
Patients at the highest risk of dying from SCD are people in
dense ectopy should be referred to a cardiac electrophysiolo-
the general population who are not known to have any heart
gist for further evaluation. Patients who have an indeterminate
disease, although they may have other “hidden” contributing
MTWA test should be retested immediately; studies indicate
factors such as genetic disorders or undiagnosed structural
that over 50 percent of these patients become determinate
heart disease. SCD research has been dedicated to studying
if retested during the same session.
prevention and treatment in
people who have discernible
Surgical SCD Prevention
heart disease, and as a result
“There are a number of traditional
specialists are able to save a
higher percentage of these
lives.
Identifying SCD risk factors
falls into two main categories:
More than 70 percent of
Americans not only
underestimate the seriousness
of SCD, but also believe
it is a type of heart attack.
and innovative surgical techniques
to treat patients at high risk for SCD,”
said Jonathan Hoffberger, DO,
FACOS, a cardiac surgeon specializing in minimally invasive valve re-
preventing heart disorders and
placements. “Left ventricular
monitoring and treating exist-
hypertrophy is treated with minimally invasive surgery (a two to three
ing heart problems. All patients
should embrace lifestyles that include exercising, stopping
inch incision in the side of the chest) to replace damaged
smoking, maintaining a healthy weight, avoiding unnecessary
valves and stimulate ventricular remodeling. If a patient suffers
stress, limiting the intake of alcohol and caffeine and carefully
from ischemia, a lack of blood flow to the heart which can lead
monitoring the use of diet pills and prescription medications.
to arrhythmia, coronary bypass surgery is performed to allow
Physicians should evaluate the patient’s ejection fraction (EF), a
blood to reach oxygen-starved heart muscle. To remove exist-
measure of the proportion of blood the heart pumps out with
ing scar tissue resulting from a previous heart attack or heart
each beat. An abnormally low EF is the single most important
aneurysm, ventricular aneurysmectomy restores the left ventri-
factor in predicting the risk of SCD.
cle to viable muscle and relieves symptoms like shortness of
Interventional cardiologists, such as Kenneth Zelnick, MD,
breath.”
are testing an additional risk factor predictor called microvolt
T-wave alternans (MTWA). “MTWA is an innovative, noninvasive
Arrhythmia Episodic Remedies
method most often used as a risk stratifier in patients who are
The arrhythmic causes of SCD are ventricular tachycardia (VT)
at increased risk of SCD because they have had myocardial
and ventricular fibrillation (VF). “VT is an arrhythmia that oc-
infarctions or other heart damage. The testing predicts the
curs around scar tissue caused by a previous infarct. Ventricular
likelihood of ventricular tachyarrythmic events such as sus-
tachycardia is most common in hearts with post infarct or is-
tained ventricular tachycardia and ventricular fibrillation, and
chemic cardiomyopathy,” said David Kenigsberg, MD, a board
w
| 33
SCD: Identify and Treat Patients at Risk
w certified clinical cardiac electrophysiologist specializing
catheters are directed to specific areas of heart tissue and
in complex ablations to treat cardiac arrhythmias.
radiofrequency energy is applied to destroy small areas of
“VF occurs when the electrical signals controlling the ventricles’ contraction suddenly become random, rapid and chaotic,
tissue that cause abnormal electrical signals.
Another advancement in the field of electrophysiology that
and electrocardiographic deflections continuously change in
has improved the lives of patients with congestive heart failure
shape, magnitude and direction. The ventricles begin to quiver
resulting from structural heart disease is Cardiac Resynchro-
and can no longer pump blood from the heart to the rest of
nization Therapy. During this procedure a biventricular pace-
the body. VF occurs most frequently in patients with structural
maker defibrillator is implanted to pace both the left and right
heart disease, but also occurs in people with no discernible
ventricles of the heart simultaneously, resynchronizing muscle
heart pathology who are not currently being monitored or
contractions. The result is increased heart muscle function
undergoing preventive treatments. Within seconds, they lose
which improves the patient’s comfort and quality of life; it
consciousness and, without immediate emergency treatment
may also save the patient’s life.
they could die within minutes. The institution of early by-
A cardiac surgeon can also help treat these heart failure
stander cardiopulmonary resuscitation (CPR) and the use
patients by implanting epicardial leads on the epicardium, the
of early automated external defibrillation with AEDs have
outer surface of the heart, in situations when these areas are
helped to save people who have a SCD episode,” he said.
difficult for an electrophysiologist to reach from the inside,
Not long ago, the only remedy to prevent deadly arrhyth-
endocardialy. “This procedure is usually done at the same time
mias was medication and bed rest. Today, we can identify
as coronary bypass surgery and less commonly as a standalone
those at risk and implant an Implanted Cardioverter Defribilla-
procedure,” said Dr. Hoffberger.
tor (ICD) or perform ablation to treat post infarct ventricular
tachycardia. Other complex arrhythmias can be treated
The bottom line: help keep your patients’ hearts in
by ablation, including atrial fibrillation, an area in which
harmony with vigilant monitoring and the latest
Dr. Kenigsberg specializes. During this procedure, multiple
diagnostic and treatment techniques.
SCD Considerations…
SCD is a leading cause of death in the United States, accounting for an estimated
450,000 deaths each year, killing 1,000 people a day or one person every two minutes.
Ventricular fibrillation occurs when the heart abruptly and unexpectedly ceases to
function due to an “electrical problem”, and the heart is no longer able to pump blood
to the rest of the body.
SCD is NOT a heart attack; however, it may occur in association with a heart attack.
Without emergency help, SCD leads to death within minutes and 95% of cardiac
arrest victims die before they reach a hospital or other source of help.
SCD most often occurs in patients with heart disease, especially those who have
congestive heart failure and have had a heart attack, or those who are not aware
of their heart disease. It may also occur in outwardly healthy people.
As many as 75% of people who die of SCD show signs of a previous heart attack,
and 80% have signs of coronary artery disease.
34 |
A good h
ead
and a go
od
heart are
always a
formidab
le
combina
tion.
– Nelso
he currently serves as
the Director of the
Clinical Cardiac Electrophysiology Laboratory.
True to his mission,
shortly after moving back
to South Florida, Dr. Kenigsberg established the Outpa-
n Mand
ela
tient Electrophysiology Clinic
at Broward General Medical
Center to provide indigent
patients with cardiac electrophysiology services. “We still
see about 10 patients each
David Kenigsberg, MD:
A Heart For Healing
week who come in presenting classic symptoms – passing out,
heart palpitations and abnormal heart rhythms – and then we
schedule them for the appropriate procedure,” he said.
In 2009, Dr. Kenigberg joined with Dr. Ahmed Osman to establish their practice, Florida Heart Rhythm Specialists. “Ahmed is a
devout Muslim and I am a modern Orthodox Jew. We come from
By Sandra A. Richards w
For some people, the passion to
different backgrounds, but we have found a wonderful common
serve others is realized later in life, after careers are complete and
ground and enjoy each other as individuals, personally and
children are grown. For David Kenigsberg, MD, the passion to
professionally,” Dr. Kenigsberg said.
serve others was inspired at an early age and nurtured by strong
family traditions.
“My grandparents and parents taught me that when we are
Religious traditions are extremely important to him, his wife,
Susana, and their six children, who range in age from one to 10
years old. “When I am not working or on call, I am dedicated to
blessed, we should give back to others. As a physician, that
my family, spending time and playing games with my children,
means living out my oath, whether helping my private practice
attending synagogue and sharing meals together. On Saturdays,
patients or others who need medical care. It is a common
we observe the Sabbath,” he said.
misperception that people without health insurance should
In addition to playing an occasional round of golf and serving
not or do not receive excellent medical care, and that simply is
on the BCMA board of directors, Dr. Kenigsberg also serves on
not true,” Dr. Kenigsberg said.
the board of directors of The Holocaust Documentation and
He estimates that there are only about 45 electrophysiologists
Education Center in Hollywood. The Center is creating a
in the tri-county area, and not all of them perform complex abla-
permanent record of the testimonies of survivors, liberators,
tion. “Since there are few specialists in this field, patients’ heart
and rescuers to enrich and enhance Holocaust education. It
ailments often go undetected until a crisis occurs. That’s why it’s
houses a collection of more than 2,400 Holocaust-related
my mission to reach those at high-risk for heart disorders, includ-
recordings, 7,500 books and a restored railroad car.
ing youth and the elderly,” Dr. Kenigsberg said.
Dr. Kenigsberg grew up in South Florida and moved to Michi-
“As George Santayana once said, ‘Those who do not remember
their past are condemned to repeat their mistakes.’ My grandfa-
gan and Virginia for his cardiology and electrophysiology train-
ther was a Holocaust survivor, so supporting the Center’s work
ing. In 2007, he moved back to South Florida and opened his
is a deeply personal commitment for me to ensure that
private practice next to Westside Regional Medical Center, where
the lessons of the Holocaust endure,” Dr. Kenigsberg said.
| 35
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Extends heartfelt sympathy
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December 9, 2010
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October 29, 2010
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October 7, 2010
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January 11, 2011
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