July 2009 - Greater Louisville Medical Society

Transcription

LOUISVILLE
GREATER LOUISVILLE MEDICAL SOCIETY
MEDICINE
VOL. 57 NO. 2 JULY 2009
I don’t just
have insurance.
I own the company.
Wayne Hudec, M.D., FACS
General Surgery
Medical Professional Liability Insurance
“Like me, you’ve probably noticed some professional liability insurance providers recently offering physicians what seem to be lower
rates. But when I took a closer look at what they had to offer, I realized they simply couldn’t match SVMIC in terms of value and
service. And SVMIC gives me the peace of mind that comes when you’re covered by a company with a stellar 30-year record
of service and the financial stability of an “A” (Excellent) rating. At SVMIC, I know it’s not just one person I rely on… there
are 165 professionals who work for me. That’s because SVMIC is owned by you, me, and over 15,000 other physicians across
the Southeast. So we know our best interests will always come first.”
Mutual Interests. Mutually Insured.
Contact Susan Decareaux or Jesse Lawler at [email protected] or call 1-800-342-2239. svmic.com
GLMS Board of Governors
Michael W. McCall, MD, board chair
Lynn T. Simon, MD, president
Kimberly A. Alumbaugh, MD, president-elect
Deborah A. Ballard, MD, vice president
David E. Bybee, MD, treasurer
Bernard L. Speevack, MD, secretary
Heather L. Harmon, MD, at-large Kerry Short, MD, at-large
Lewis Hargett, MD, at-large Elmer Dunbar, MD, at-large Russell Williams, MD, at-large Robert H. Couch, MD, at-large Bruce Scott, MD, AMA delegate
Robert A. Zaring, MD, AMA alternate delegate
Linda H. Gleis, MD, KMA ranking member
Gordon R. Tobin, MD, KMA 5th district trustee
Fred A. Williams, Jr., MD, KMA 5th district alternate trustee
Timothy S. Brown, MD, GLMS Foundation president Stephen S. Kirzinger, MD, Medical Society
Professional Services President
Edward C. Halperin, MD, MA, dean, UofL School of Medicine
Adewale Troutman, MD, MPH, director, Louisville Metro Dept. of Public Health & Wellness
Millicent Evans, GLMSA president
LOUISVILLE
GREATER LOUISVILLE MEDICAL SOCIETY
MEDICINE
VOL. 57 NO. 2 JULY 2009
FEATURE ARTICLES
6
A Bridge Over Troubled Waters:
The 20-Year Span of The Healing Place
Gordon R. Tobin, MD
10
18
20
Greater Louisville Medical Society Boards, Committees,
Councils 2009-2010
President’s Soiree Photos
Editor: Mary G. Barry, MD
Deborah Ann Ballard, MD
Laurie Ballew, EdD, DO
William A. Blodgett, MD
Eugene H. Conner, MD
Frank DeLand, MD
Arun Gadre, MD
Jeremy Gerwe, MD
Tracy Ragland, MD
Stanley A. Gall, MD
Larry P. Griffin, MD
Darin Harden, MD
Jonathan E. Hodes, MD
Thomas James III, MD
Louanda M. Kynhoff, MD
Michael T. Macfarlane, MD
Joe Mauer, MD
Teresita Bacani-Oropilla, MD
Danielle Pigneri
M. Saleem Seyal, MD
Bernard L. Speevack, MD
Dave Langdon, Louisville Metro Department of Public Health & Wellness
Michael W. McCall, MD, board chair
Lelan K. Woodmansee, CAE, executive director
Bert Guinn, MBA, communications & membership director
Matthew Ralph, communications associate
Donna Watts, communications designer 22
Greater Louisville Medical Society Foundation
50th Anniversary Celebration Photos
Advertising
16
Louisville Medicine Editorial Board
Cheri K. McGuire, director of marketing
736.6336, [email protected]
LOUISVILLE MEDICINE is published monthly
by the Greater Louisville Medical Society, 101 W.
Chestnut St. Louisville, Ky. 40202 (502) 589-2001,
Fax 581-9022, www.glms.org.
Articles to be submitted for publication in LM
must be received on electronic file on the first day
of the month, two months preceding publication.
Opinions expressed herein are those of individual contributors and do not necessarily reflect the
position of the Greater Louisville Medical Society.
LM reminds readers this is not a peer reviewed scientific journal. LM reserves the right to make the final decision
on all content and advertisements.
Circulation: 3,800
Donna Watts
On the Fringes of Greatness: Alban Gilpin Smith
(Goldsmith) 1795-1861
Eugene Conner, MD
Matt Ralph
26
31
38
Pearls From Lynda’s Garden
Tracy Ragland, MD
Polypharmacy: A Threat to Healthy Aging
Demetra Antimisiaris, PharmD, and James G. O’Brien, MD
Medaling In Mettle
Matthew Ralph
DEPARTMENTS
5
8
From the President
RAC and MAC - Attacks
Lynn T. Simon, MD Guest Commentary
Ethical Issues Involved in Delayed Use of New AMA
Guidelines for Evaluation of Permanent Impairment
Robert F. Sexton, MD
Reflections: Searching, Searching _ No Phone
Connection
17
28
29
30
Alliance Update
Millicent Evans, GLMS Alliance President
Book Review: Atlas of Unknowns by Tania James
M. Saleem Seyal, MD, FACC, FACP
We Welcome You
Physicians In Print
J U LY 20 09
3
From The President
Lynn T. Simon, MD
GLMS President
RAC and MAC-Attacks
I think we always realized that
medicine was both a profession and a
business, but it seems that there is
less and less time for the practicing
medicine part these days. In my 12
years of practice, I was amazed by the
increasing time commitment required
for appropriate documentation (“if it
was not documented, it was not
done”), learning appropriate billing
(how many review of systems do I
need to document?) and more recently, the need to document compliance
with quality metrics and best practices.
And just when everyone is trying
to keep their heads above water, and
see what health care reform might
bring, along come the RACs (Recovery
Audit Contractors). After a “successful”
demonstration project in which over
$900 million in alleged overpayments
were identified, Medicare has expanded this program in an attempt to
eliminate fraud and abuse within the
system. Medicare has contracted with
several companies across the country,
each working under a contingency
fee. Our local contractor will be CGI, a
Fairfax, Va.-based company. They will
audit claims in Michigan, Ohio,
Indiana, Illinois and Kentucky and will
“focus on companies and individuals
whose billings for Medicare services
are higher than the majority of
providers and suppliers in the community.” Yes, they will also be looking
for underpayments, but in the
demonstration project, only 4 percent
of the claims involved underpayments, while 96 percent were overpayments. Audits in Kentucky are to
begin in August 2009.
Clinical focus areas are said initially to include skin grafts and wound
debridements, cardiac procedures,
medical back problems and joint
replacement patients in inpatient
rehab facilities. Because 62 percent of
the “audit errors” for hospital inpatients involved “medically unnecessary services or setting,” many health
systems are hiring consultants or contracting with companies to put
processes in place to help mitigate
the risk of the RACs. The companies
do not offer the same services for
physician’s offices. And, even if they
did, could these practices afford the
cost? And how does what happens in
the hospital affect a physician’s
billing? That’s where the MAC –
Medicare Audit Contractor – comes in.
They will look for hospital-physician
claim concordance (hospital bills as
inpatient, physician must bill as inpatient, or hospital bills as observation,
physician must bill the same status or
a claim edit will identify these and
payment to each is at risk). Hospitals
and physicians have a very good
reason to work together on this issue. Because of the impact that this
process will have on physician’s practices, the GLMS professional relations
department is offering several educational workshops for physicians and
their practice staff to help them
prepare for these auditors. Office staff
need to learn how to recognize
notices from the RACs, and how to
track, monitor and handle the appeals
process. Two workshops were held in
June (hosted by Jewish Hospital and
Sts. Mary & Elizabeth Hospital) but
there are more workshops scheduled
(on July 7th at Baptist Hospital East,
July 29 at UofL Outpatient Center, July
30 at Floyd Memorial Hospital and
Clark Memorial Hospital - date TBD).
CME credit is pending and CEUs for
coders are approved for these workshops. For more information, please
contact Jessica Williams at 502-7366368 or e-mail [email protected].
GLMS will also organize a seminar
with some of our CGI representatives.
Please watch for the date/time
through our e-mails and other publications.
Optimally, health care reform
would focus on allowing physicians to
spend more time providing care, but
the focus continues to slant toward
the business side. GLMS remains committed to educating its members and
helping them navigate and adapt to
the changes that are occurring in
health care and impacting the practice of medicine. LM
J U LY 20 09
5
A Bridge Over Troubled Waters:
The20-Year SpanofTheHealingPlace
Gordon R. Tobin, MD
“When you’re down and out, when
you’re on the street,
when evening falls so hard,
I will comfort you.
I’ll take your part.
When darkness comes and
pain is all around,
Like a bridge over troubled
waters, I will lay me down.”
-Simon and Garfunkel, 1969
August 2009 is the 20th anniversary
of The Healing Place. This remarkable
program has become a bridge from
addiction and misery to recovery and
hope for many once-lost souls. Like the
bridges that span our great river at the
Falls of the Ohio, THP has been progressively built from bedrock to upreaching
superstructure. The original engineer of
THP was the Greater Louisville Medical
Society, named Jefferson County Medical
Society. Subsequent girders were added
by community support, and THP’s own
staff and alumni. The result is a nationally-acclaimed example of humanitarianism in action, which has become GLMS’s
finest legacy. Our city is symbolized by locks and
bridges. We are reminded of this during
the spectacular fireworks of Thunder
Over Louisville, and the motif is subtly
reflected in local architecture, such as
Michael Graves’ elegant Humana building. These are appropriate symbols for a
city that bridged the original colonies to
the frontier, bridged a divided nation
during Civil War, and bridged its healing
during reconstruction. Throughout these
eras, rough, hard-drinking boatmen and
6
L O UI S V I L L E M E D I C I N E
migrants chased their future down the
Ohio, and often became mired here in
the swamps of their addictions. The
Healing Place story describes a bridge
back to normalcy from those hopeless
swamps, and it calls for preservation of
this fine legacy. The Foundation:
A Homeless Shelter
The beginning of THP was a small
homeless shelter established by a compassionate Catholic priest, Father John
Morgan, in an aging church in the decaying neighborhood of 1970s West Market
Street. Father Morgan brought the plight
of his boarders to his physician, Dr. Will
Ward, who embraced their cause and
enlisted support from his JCMS colleagues. Led by Dr. Ward and President
Ken Peters, JCMS physicians gave an outpouring of volunteer medical services,
funding and broad support. This led to
our adoption of THP and its official incorporation as the JCMS Outreach Program,
Inc., later named THP. For treating acute intoxication, withdrawal and neglected medical conditions, the physicians established a clinic,
which included a pharmacy of donated
supplies and a van for bringing clients
from the street. To honor Dr. Ward’s
initial inspiration and ongoing service,
this clinic was rededicated as “the Will
Ward Clinic” in October 2003, and JCMS
honored all clinic volunteers, with special
recognition to Dr. Kitty Henry, the clinic
medical director, and Ken Peters, outgoing THP board chairman. The clinic and
THP today save taxpayers over $21
million annually in avoided medical, jail
and criminal justice costs. Transformation:
The Recovery Program
The physicians quickly recognized
that the underlying cause of their clients’
homelessness was addiction, particularly
alcoholism. Therefore, they added a
recovery program that has achieved out-
standing success and national recognition. The principal program architect was
Jay Davidson, who joined THP in 1991,
and now serves as president and CEO.
The program is based on principles pioneered by Alcoholics Anonymous, and it
emphasizes peer mentoring and experience sharing so those progressing in
recovery guide those entering. Progress
is closely monitored by peers, program
graduates and staff in a caring but strictly
disciplined environment, where responsibility for progress is clearly placed on
the client. In addition to regular AA-type
meetings, THP group meetings are held
three times weekly to enable self-examination and accountability. The program
progresses through early, middle and
long term recovery leading to job placement, legal assistance, housing, education and family reunification. The success
rate is extraordinary, with over 2,500
alumni and a sobriety rate over 65
percent at one year – five times the
national average.
Outreach to Women and Families
In 1995, the program expanded to
women and their children. The women’s
shelter and recovery program replicates
that of the men, but is smaller (300 men,
130 women). A greatly expanded facility
for women and children is now under
construction, which will double program
size in September 2009. The Parenting Program:
Breaking Generational Cycles
Addiction, hopelessness and devastation of self-respect are tragically passed
from generation to generation by emotional abandonment and/or abuse surrounding addiction. Children rarely
receive the emotional skills and insights
to escape the behavior patterns and
chemical dependencies that devastate
their parents. The Parenting Program
addresses this tragic repetition. First, children are removed from sexual and physical abuse, crack houses or houses of ill
repute. Then, children receive psychological rehabilitation, addiction education
and insight into their parents’ plight. The
mother’s rehabilitation must progress
sufficiently and new parenting skills must
be learned before attempted reunification. If possible, and when all reach an
appropriate stage, a carefully supervised
reunification process may be nurtured
within THP residency and continued into
independent outside living. This
program has great potential ultimately
to reduce large numbers of families
trapped in generational cycles of addiction and abuse. A Model for Statewide and
National Expansion
Although the size, scope and
budget of THP grew explosively, the
number needing shelter and recovery
remains vastly larger. In 1998, the U.S.
Department of Health and Human
Services cited the program’s
effectiveness, designating it a
“model that works.” This
caught attention of state,
national, and international
leaders, and widespread replication of THP is now underway. In 2005, Gov Ernie Fletcher
initiated Recovery Kentucky, a program
to establish 10 new sites across the state.
Seven are now functioning. Nationally,
replication has occurred in Lexington,
Raleigh, N.C., Richmond,Va., and
Huntington, W.V. (with six other locations planned). Internationally,
Belgarad, Russia, and Bristol,
England, are evolving. The
THP model has a spectacular future everywhere. as summarized in the Belmont Report as
beneficence (creating good), justice
(bringing the good to all in need) and
respect for persons (adapting the good
for each unique individual). Few other
professions possess this high degree of
ethical mission, and even fewer can
translate ethical callings so readily into
human benefit. Celebrate The Healing Place’s 20th
anniversary with us. Moreover, volunteer
personally. Our longtime volunteers have
served many tours of duty, and need
new replacements of active and retired physicians to staff clinics and
support programs. A core principle of AA
is that “helping
others helps me.”
If treating the
worried well has
New THP Women’s Center at –
scheduled to be completed Fall 2009 M
Jay Davidson,
Gordon Tobin, MD,
Sr. Glynnis
McManamon, Will
Ward, MD, and Phil
Marshall (former
THP Development
Director) at the dedication of the THP
Will Ward Clinic Sissy Ward,
Will Ward,
MD, Jay
Davidson,
Shirley
Davidson
THP on Market St.
2001
THP Clinic on
Market St. 2001
A Call for
Renewed
Support
Bridges
over great rivers require
much effort, but in turn give
their builders new freedoms
and new reach. Similarly,
building The Healing Place
required great effort but
gave back purpose and
meaning to GLMS physicians, and demonstrates to
all the ethical side of our
profession. It personifies the
principles of medical ethics,
eroded your store of patience and goodwill, you find renewal and joy in taking
care of truly needy men and women
who are desperately trying to deal with
life honestly. Sign up by contacting Lelan
Woodmansee at GLMS, or talk to Dr. Will
Ward. We need you, and you will love
this revitalizing experience. The Healing
Place is a noble, ethical legacy of the
Greater Louisville Medical Society, and it
provides a bridge to a future of humanitarian purpose for us and for coming
generations of our profession. L
Will Ward, MD, and
Gordon Tobin, MD
7
Guest Commentary
Ethical Issues Involved in
Delayed Use of New AMA
Guidelines for Evaluation of
Permanent Impairment
Since the early 1980s, the American
Medical Association has published very
carefully crafted guidelines for objectively assessing the degree of permanent impairment sustained by an individual patient from injury or disease.
Currently, the fifth edition of the compendium, “The AMA Guidelines to the
Evaluation of Permanent Impairment,” is
in use in the Commonwealth of
Kentucky. Medical professionals, insurance companies and the judiciary all
accept these fifth edition guidelines as
authoritative.
These guidelines serve both individuals and the public. The guidelines
provide an objective measurement by
which to evaluate a patient's degree of
impairment. This tool has obvious
importance in the following contexts:
1. Disability determinations by either the Social Security Administration or by private insurance. 2. Assessment of medical permanency of injuries mediated by
Worker's Compensation Insurance.
3. Assessment of the nature and degree of personal injuries outside the workplace. Using these guidelines protects the individual patient from those who would minimize the permanent effect of an injury or
disease. The guidelines also protect the public, the bottom-line payor for all such claims, from exaggerated non-verifiable claims of impairment.
These guidelines are taken very
seriously by medical professionals. The
objective nature of the guidelines
permits a transparency to decisions
regarding degree of impairment or
injury such that any medical professional should be able to make the same
determination. There is not a great deal
of room for creative elasticity.
Through six editions, the AMA has
updated these guidelines. Derived from
evidence-based medicine and specialty
society consensus recommendations,
these specific criteria continue to be
made more precise. This work has been
so lucid and detailed that other countries increasingly use the AMA
Guidelines to the Evaluation of
Permanent Impairment.
According to Kentucky Statue
KRS/342 – 00/0011, the edition of the
guidelines considered authoritative is
the most recent edition. Subsection 35
of the Worker's Compensation Act provides: "Permanent Impairment rating
means percentage of whole body
impairment caused by the injury or
occupational disease as determined by
the “Guides to the Evaluation of
Permanent Impairment (AMA), latest
available edition.” There is now a sixth
edition which by law should be the
edition used in making determination of
degree of permanent impairment.
However, the fifth edition is still in use.
Why is the fifth edition still in use?
There is strong opposition to use of the
sixth edition by plaintiff's attorneys and
some doctors. In my opinion, these
groups object to the new and improved
standards because they do not like to
see the degree of impairment from
chronic pain syndromes and psychological disorders more objectively delineated. Likewise, there is objection to the
updated and more realistic ratings in
the area of disability after spine surgery.
Neither the Greater Louisville
Medical Society nor the Kentucky
Medical Association was willing to
forward a resolution to the Kentucky
General Assembly to encourage the
Commonwealth to follow its own laws.
The proper use of the most recent
guidelines impacts both patient care
and health care cost. I believe that we
medical experts should offer guidance
to the people of the Commonwealth of
Kentucky and assure that the latest
guidelines are implemented. If you have
questions concerning this issue, please
contact me at the GLMS Bioethics
Committee. My e-mail address is [email protected]. LM
Dr. Sexton is a member of the GLMS
Bioethics Committee.
The views expressed in this commentary or any other article in this publication are not those of the Greater Louisville Medical Society or Louisville Medicine. If you would like to respond to an article or commentary in this issue, please submit your response in the form of a Letter to the Editor. You may submit letters to the Editor online @
www.glms.org or by emailing our editor directly at [email protected]. The GLMS Editorial Board reserves the right to choose which letters will be published.
8
J U LY 20 09
9
Greater Louisville Medical Society
Board, Committees, Councils
2009-2010
Membership in appointed committees remains open throughout the year.
If you are interested in serving, please email the GLMS Executive Director at
[email protected].
Ex-Officio Members of
All GLMS Committees
Michael W. McCall, MD, GLMS board chair Lynn T. Simon, MD, GLMS president
Kimberly A. Alumbaugh, MD, GLMS president-elect
Board of Governors
Michael W. McCall, MD, chair
Deborah Ballard, MD, vice president
Bernard L. Speevack, MD, secretary
David E. Bybee, MD, treasurer
Robert H. Couch, MD, at-large member (appointed by Dr. Simon 2009-2011)
Elmer Dunbar, MD, at-large member (2011-elected)
Russell Williams, MD, at-large member (2011-elected)
Kerry Short, MD, at-large member (2010-elected)
Heather L. Harmon, MD, at-large member (2010-elected)
Lewis Hargett, MD, at-large member (appointed by Dr. McCall 2008-2010)
Ex-Officio with Vote
Bruce Scott, MD, AMA delegate
Robert Zaring, MD, AMA Alternate delegate
Linda H. Gleis, MD, KMA ranking member
Gordon R. Tobin, MD, KMA trustee
Fred A. Williams, Jr., MD, KMA alternate trustee
K. Thomas Reichard, MD, Foundation president
Stephen S. Kirzinger, MD, MSPS president
Edward C. Halperin, MD, MA, dean, UofL School of Medicine
Adewale Troutman, MD, MPH, director, Metro Department of Public Health & Wellness
Jay Davidson, The Healing Place, president & CEO
Millicent Evans, GLMS Alliance president
Ex-Officio without Vote
Patrick Padgett, KMA executive vice president
Charles J. Cronan, IV, society legal counsel
GLMS Staff
Glenda Klass, controller
Dottie Hargett, professional relations director
Cheri K. McGuire, director of marketing
Bert Guinn, communications & membership director
Terry Todd, Foundation director
Onvia McDaniel, administrative assistant to executive director Athletic Subcommittee
(To be announced in the August newsletter) Mark G. Smith, MD, chair
10
Bioethics Committee
Esther Costel, MD, chair
David Doukas, MD Peter Hasselbacher, MD
Barbara S. Isaacs, MD
Serge Martinez, MD
Roy J. Meckler, MD
Terry Meyer, RN
Kathie Rose, RN
Paul Simmons, PhD
Rebecca Tamas, MD
Elisabeth Tobin, PhD
Juan Villafane, MD
Ed Wunsch, Ed.D
Hospital Ethics Committee
Representatives
Maureen Chambers, Kindred
Mary Haynes, Nazareth Home
GLMS Staff
Donna Jones, administrative assistant
CAPS Committee
John F. Klink, III, MD, chair
The centralized application processing
service oversight committee is composed of
representatives nominated by the credentials committees of participating hospitals.
Community Health Committee
Robert W. Powell, MD, chair
Deborah Ballard, MD
Juliana Hayden, MD
Scott Hedges, MD John P. Howard, MD
Thomas James III, MD John N. Lewis, MD
Bryan Loy, MD
Michael D. Needleman, MD
Nancy J. Newman, MD
Isabella B. Nyan, MD
Neal J. Richmond, MD
Jacqueline Simmons, MD
Mark G. Smith, MD
Gerald F. Sturgeon, MD, Adewale Troutman, MD
Matthew M. Zahn, MD
Ex-Officio Members with vote
Ron Alsup, American Heart Association state alliance director
Julie Brackett, American Heart Association
Bonnie Ciarroccki, Health Promotion Schools of Excellence
Ron Crouch, director of Kentucky Data Center
Jay Davidson, executive director of The Healing Place
Kim Dees, Kentucky Hospital Association
Lori Fields, Health Promotion School of Excellence
Ryan Irvine, Metro Louisville Department of Health and Wellness
Kristin Paul, Kentucky Cancer Program, UofL
Phyllis Skonicki, community representative
Wendy Corrigan, VNA Nazareth Home Health GLMS Staff
Onvia McDaniel, administrative assistant
Editorial Board
Mary G. Barry, MD, editor
Deborah Ann Ballard, MD
Laurie Ballew, Ed.D, DO
William A. Blodgett, MD
Frank DeLand, MD
Arun Gadre, MD
Jeremy Gerwe, MD
Tracy Ragland, MD
Stanley A. Gall, MD
Larry P. Griffin, MD
Darin Harden, MD
Jonathan E. Hodes, MD
Louanda Kynhoff, MD
Thomas James III, MD
Danielle Pigneri
M. Saleem Seyal, MD
Joe Mauer, MD
Dave Langdon, Health Department
GLMS Staff
Bert Guinn, communications & membership dir.
Donna Watts, communications designer
Public Safety and Diversion Council
William S. Smock, MD, chair
Paul Barth, suburban fire districts
Richard Bartlett, KY. Hospital Association
Lisa Benner, Jewish & St. Mary’s Hospital
Nathan Berger, MD, VA Hospital
David Biddle, MD, Baptist East
Jenny Blanchard, WMD Coord., Louisville FBI
Michael Brown, EMA deputy director
*Randa Bryan, Norton Audubon Hospital
Ruth Carrico, RN, School of Public Health
Roger Cecil, University Hospital ED
Donald Clark, Rural/Metro EMS
Christopher Collett, 41st Civil Support Unit
Kevin Combs, FPS
*Robert Couch, MD, JHSMH
Edward Cox, Metro Safe Communications
*Ron Crafton, MD
Stuart Crawford, Oldham Co. EMS
Sean Denton, MD, Jewish & St. Mary’s Hospital
Kim Doan, Jewish & St. Mary’s ED Mgr
Greg Gitschier, law enforcement coordinator
Marcy Heilman, LM EMA Medical Reserve Corps
Sherman Hockenberry, Yellow Ambulance
Mindy Glenn, MetroSafe
Paul Freibert, University Hospital
Kathy Jenkins, Norton Aubudon safety officer
Marty Johnson, University Hospital ED
Belinda Jolly, Yellow Ambulance
Patricia Keeling, VA
*Robert Knies, Baptist East HospitalYES
*Chief Walter J. Lage, Anchorage Fire/EMS
Lana Lynch, LM EMA
*Ken Marshall, VP, University Hospital
Mario Maya, MD, Medical Supp. Ryder Cup
Benita McNally, Baptist Northeast
Karen Newman, vice president, Baptist East
Kevin Nuss, Oldham Co. EMA director
*Daniel J. O’Brien, MD, Major Roger Parvin, LM EMS
Steve Petty, Dir., Public Safety, Lou Int’l Airport
Mike Phillips, Bullitt County EMS
Joyce B. Pickett, Jewish & St. Mary’s HealthCare
*Robert Pringle, MD, Norton Suburban ED
Lisa Richardson, Sts. Mary & Elizabeth ER
*Neal Richmond, MD, LM EMS director
Derrick Riddle, Rural/Metro EMS
Maurice Risner, Jefferson County Schools
Lt Col Craig Rodgers, LM EMS
Lt Col Rick Roller, LM EMS
Lewis Rowe, MD
Melissa Schreck, School of Public Health
Captain Jeff Sherrard, LM Police
Steve Sikkema, US Marshals Service
*Kathy Watson, Jewish & St. Mary’s
Bill Wetter, LM Public Health & Wellness
*Ron Wilder, Oldham EMS
*Ken Wilson, MD, Norton Healthcare
Nathan Wilson, RN, BSN, Audubon ER
Matt Zahn, MD, LM Public Health & Wellness
*Voting members of voting Diversion Council
GLMS Staff
Onvia McDaniel, administrative assistant
GLMS Foundation Board of Trustees
K. Thomas Reichard, MD, President
David R. Watkins, MD, Vice President Barton H. Reutlinger, MD, Secretary
William Summers, Central Bank, Treasurer
Class of 2009
Greg Ehrhard, Stites & Harbison
John Roth, MD
Steven Smoger, MD Sandra Vance Neal, Advance Resources
Class of 2010
Linda H. Gleis, MD Lewis Hargett, MD
Thomas James, MD
Virginia Keeney, MD
Michael McCall, MD, GLMS Board Chair
Richard S. Wolf, MD Class of 2011
Timothy S. Brown, MD
W. Stewart Cobb Joseph E. Kutz, MD
Toni Linville, GLMS Alliance
Lynn Simon, MD, GLMS President Janice W. Yusk, MD
GLMS Foundation Committees
Healthcare Careers & Scholarships – Linda Gleis, MD, chair
Indigent Care – Sandra Vance Neal, Advance Resources, chair Medical Missions – Tim Brown, MD, chair
Old Medical School Building Preservation –
Barton Reutlinger, MD, chair
GLMS Staff
Terry Todd, GLMS Foundation director
Angelique Bagshaw, Foundation assistant
Louisville Health Information
Exchange (LouHIE) Liaison Committee
S. Lyle Graham, MD, chair
William Hymes, MD, vice chair
Kenneth N. Zegart, MD
David H. Bizot, MD
Divya Cantor, MD
Stephen S. Kirzinger, MD
John N. Lewis, MD
Ketan Mehta, MD
Cynthia Rigby, MD
Stephen R. Roszell, MD
Wayne Tuckson, MD
GLMS Staff
Grievance Committee
Philip T. Browne, MD, chair
David A. Casey, MD
Sandra M. Elam, MD
Samuel G. Eubanks Jr., MD
Lewis Hargett, MD
James I. Harty, MD
Morton L. Kasdan, MD
Terry McCurry, MD
Jason M. Meckler, MD
J. Patrick Murphy, MD
Charles R. Oberst, MD
Vinay Puri, MD
Molloy G. Veal, MD
GLMS Staff
John Downs, credentialing specialist
Judicial Council
Kenneth C. Anderson, MD
Jannice O. Aaron MD
David H. Bizot, MD
Rebecca J. Booth, MD
Richard T. Holt, MD
John M. Karibo, MD
Christopher J. Schrodt, MD
Stephen Wheeler, MD
Danny Woo, MD
GLMS Staff
M. Stephen Bassett, peer review director
KMA Delegation
Elected Delegates
David R. Watkins, MD, chair
Kimberly A. Alumbaugh, MD
Deborah A. Ballard, MD
Susan M, Berberich, MD
David H, Bizot, MD
Rebecca Booth, MD
David E. Bybee, MD
Mary Helen Davis, MD
R. John Ellis, Jr., MD
Beverly M. Gaines, MD
Jeffrey Glazer, MD
Robert A. Goodin, MD
Robert R. Goodin, MD
Larry Griffin, MD
Anna K. Huang, MD
Sheri A. Kalbfleisch, MD
John M. Karibo, MD
Morton L. Kasdan, MD
Virginia T. Keeney, MD
A. O’tayo Lalude, MD
Michael W. McCall, MD
C. Kenneth Peters, MD
Cynthia R. Rigby, MD
G. Randolph Schrodt, Jr., MD
Lynn Simon, MD
Bernard Speevack, MD
Stephen Wheeler, MD
Fred A. Williams, Jr., MD
Russell A. Williams, MD
Danny Woo, MD
Kenneth N. Zegart, MD
Elected In-Training Delegates:
Kelly Church, MD
Jonathan Wilkerson, MD
Appointed Delegates
Charles J. Bisig, Jr., MD
Frank O. Bonnarens, MD
Timothy S. Brown, MD
Stephen D. Burton, MD
Michael G. Cassaro, MD
Robert Couch, MD
Michael W. Dee, MD
Elmer E. Dunbar, MD
W. B. Owen Edelen, MD
Samuel G. Eubanks, Jr., MD
Darius Ghazi, MD
Eugene Giles, Sr., MD
Shawn D. Glisson, MD
Harold D. Haller Sr., MD
Edward C. Halperin, MD
Robert Hammer, MD
Lewis Hargett, MD
Heather L. Harmon, MD
Peter Hasselbacher, MD
Jiapeng Huang, MD
Arthur H. Issacs, MD
Thomas James, III, MD
Stephen S. Kirzinger, MD
Eric F. Lydon, MD
Kenneth Mook, MD
James P. Murphy, MD
John D. O’Brien, MD
Christopher K. Peters, MD
K. Thomas Reichard, MD
Lewis L. Rowe, MD
Ricky L. Rowe, MD
John D. Rumisek, MD
Charles Shane, MD
Rajesh K. Sheth, MD
Kerry Short, MD
Michael Sowell, MD
William Trent, MD
Juan Villafane, MD
A. Franklin White, MD
Erica Williams, MD
Robert A. Zaring, MD
Continued on page 13
J U LY 20 09
11
12
Continued from page 11
Appointed In-Training Delegates
William Adams, MD
Martin Huecker, MD
Volunteer Delegates
Jannice O. Aaron, MD
Christine, B. L. Adams, MD
Susan G. Bornstein, MD
Charles F. Bowlds, MD
W. Cooper Buschemeyer Jr., MD
Marjorie R. FitzGerald, MD
Michael B. Flynn, MD
Gregory E. Gleis, MD
Linda H. Gleis, MD
Daniel L. Hafendorfer, MD
Kevin J. Heine, MD
Steven T. Hester, MD
John G. Hubbard, MD
Scott Jones, MD
Veronnie F. Jones, MD
Julie Summers Lee, MD
Samuel B. Pollock Jr., MD
Trudi L. Rash, MD
Bruce A. Scott, MD
Kenneth L. Silk, MD
Lloyd R. Taustine, MD
Gordon R. Tobin, MD
George H. Zenger, MD
GLMS Staff
Leadership and Program
Development Committee
Erica Williams, MD, chair Traci Edwards, MD
Christopher Peters, MD John Roberts, MD
David Watkins, MD
Robert Zaring, MD
GLMS Staff
Medical Society Professional
Services Board of Directors
Officers
Stephen S Kirzinger, MD, president
Cynthia R. Rigby, MD, secretary
Forrest Kuhn, MD, treasurer
Divya B. Cantor, MD
Samuel G. Eubanks Jr., MD
Richard T. Holt, MD Bryan A. Loy, MD
Kathy Vincent, MD
GLMS Staff
Ludmilla Plenty, employment service director
Nominating/Tellers Committee
David Watkins, MD, chair
Susan M. Berberich, MD
David H. Bizot, MD
Rebecca J. Booth, MD
Jerry B. Buchanan, MD
James F. Fitzpatrick, MD
Jeffrey D. Glazer, MD
Robert G. Hammer, MD
Steven T. Hester, MD
Anna Huang, MD
Sheri A. Kalbfleisch, MD
Michael W. McCall, MD
Kenneth A. Mook, MD
Christopher K. Peters, MD
C. Kenneth Peters, MD
G. Randolph Schrodt, Jr., MD
Kerry Short, MD
Lynn T. Simon, MD
Bernard Speevack, MD
Gordon R. Tobin, MD
James E. Wheeler, MD
Erica D. Williams, MD
Fred A. Williams, Jr., MD
Russell A. Williams, MD
Robert A. Zaring, MD
Pictorial Roster
Lawrence G. Goldberg, MD, chair
David E. Borden Jr., MD
Nemesio B. Bucayu Jr., MD
Richard A. Fellows, MD
GLMS Staff
Cheri McGuire, director of marketing
Physician Practice Advocacy Committee
Michael Dee, chair Frank O. Bonnarens, MD Cooper Buschemeyer, Jr., MD
Renee Girdler, MD Lawrence Goldberg, MD
Richard Goldstein, PhD, MD
Cathy Hammond, MD, Family Medicine Kenneth M. Hodge, MD
Steven M Howell, MD Alvin W. Martin, MD Vani Nadar, MD
Ben A Reid, MD John Rumisek, MD
Daniel Scullin, MD
Rajesh Sheth, MD
C. Steven Smith, MD
Stuart White, MD
Sharon Grasch, Ellis & Badenhausen Ortho. Joe Laden, Anesthesia Associates of Louisville, PSC Mary Langdon, X-ray Assoc of Louisville Bunny Leep, Accredited Asthma & Allergy Care
Connie Leffler, Just For Women Theresa McCoy, Kentuckiana Allergy Loretta McGinty, Caritas Physicians Group
Julie Morris, Norton Physicians Svc. Diane Myers, East Louisville Pediatrics Paul Newsom, Cardiovascular Specialists Tricia Niendam, Women’s Health Care
Lora Norrenbrock, Accredited Asthma & Allergy Care Roxanne Oyler, KY Eye Care PSC Genny Pellerin, Women First of Louisville Cyndi Powell, Norton Healthcare Mark Prussian, The Eye Care Institute Karen Risinger, Gastroenterology Consultants of Louisville Sherri Ryan, Joseph Banis Plastic Surgery Patti Sacra, University Ped Surgical Assoc, PSC
Frances Shouse, Pediatric Assoc
Jaimelee Steurer, The Eye Care Institute Kathy Wilkinson, Women First of Lou
Alma Williams, University Physicians Associates Jane Hyland, Tyson, Schwab, Short & Weiss
Kathy Key, Louisville Medical Associates Debbie King, dGv Services, LCL GLMS Staff
Dottie Hargett, director of professional relations
Stephanie Woods, advocacy specialist, professional relations
Jessica Williams, compliance specialist, professional relations
PPAC INSURANCE ISSUES
RESOLUTION COMMITTEES
GLMS Staff
Stephanie Woods, advocacy specialist, professional relations
Jessica Williams, administrative assistant, professional relations
Insurance Issues Resolution Committees
Anthem IIRC
Ben Reid, Jr. MD, chair
Connie Lefler, office manager, LKMGMA Stephanie Woods, advocacy specialist, representative
professional relations
Susan Thompson, Precision Healthcare Delivery
Jessica Williams, compliance specialist, Richard Lane, MD, Anthem medical director
professional relations
Mike Lorch, Anthem vice president
Kathy Lower, director, provider relations Practice Management
and network operations
Representatives to PPAC
Rosie Jones, Anthem senior provider relations
Mary Alvey, Anthem provider relations
Darin Bennett, Rehab Associates
Karen White, Anthem senior network relations
Susan Bezy, Norton Healthcare
Holly Bracco, The Physicians Group Humana IIRC
Angela Capshaw, Beverly M. Gaines, Lawrence Goldberg, MD, chair
MD & Associates Joe Laden, Business Mgr, co-chair
Anita Carr, Endocrine & Diabetes Assoc. Diane Myers, CPA, officer manager and Terri Christian, Endocrine & Diabetes Assoc. LKMGMA rep.
Alice Cissell, University Physicians Associates Bryan Loy, MD, Humana market medical officer
Paul Coogan, Avoca Thomas James III, MD, Humana national Jeanie Crow, Louisville Bone & Joint
director for network operations
Anita Daily, Louisville Neurology Catherine Sauner, Humana director of Jolene Eicher, Commonwealth Ear, Nose & Throat network operations
Mary Emmons, Chest Med Associates
Elaine Esterle, Scott Jones, MD, Surgery National Government Services – NGS IIRC
Shelley Gast, Norton Healthcare Frank Bonnarens, MD, chair
Danielle Graham, Commonwealth ENT Carolyn Cunningham, MD, NGS medical director
Charlotte Granzow, Total Woman
GLMS Staff
J U LY 20 09
13
AVAILABLE MEDICAL
OFFICE PROPERTIES
LOUISVILLE | KENTUCKY
FOR SALE
2303 GREENE WAY
FOR LEASE
SHOPPES AT FOREST GREEN
From 1,510± SF to 9,900± SF
Fronting Hurstbourne Pkwy near Dorsey Ln
Former medical office space available
Across from Hurstbourne Green Office Park
FOR SALE
1901 EMBASSY SQUARE BLVD
18,000± square foot building on 2.10± acres
Near Bachman Chevrolet
Visible from Hurstbourne Pkwy/I-64 interchange
Near retail amenities
13,335 square foot building
Single story, easily accessible / ample parking
Easy I-64 access off Hurstbourne Pkwy near
Stony Brook Shopping Center
FOR SALE
9710 BUNSEN PARKWAY
8,424± square foot building on 1.06± acres
Convenient location off Hurstbourne Pkwy with
easy access to I-64
Near Wal-Mart & Swope Auto Center
For these and a list of other available properties, please call or visit:
502 429 6700 |
www.cbrelouisville.com
6060 Dutchmans Lane, Suite 100 | Louisville, KY 40205
14
Mark Prussian, office administrator and LKMGMA rep.
Mike Davis, NGS manager of external affairs
Lindy Lady, NGS provider outreach and education
Nathan Kennedy, NGS Part B POE team lead
Passport Health Plan IIRC
Renee’Girdler, MD, chair
Patti Sacra, office administrator and LKMGMA rep
Denise Schifano, Passport Vice president provider relations
Jeri Cross, Passport manager of provider relations
United Healthcare IIRC
Kenneth M Hodge, MD, chair
Jeffrey Beardmore, MD, UHC medical director
Ryan Miller, UHC physician lead, KY/IN
Matthew Holbrook, UHC network account manager
Jolene Eicher, office administrator and LKMGMA rep.
Holly Bracco, office administrator and billing specialist, LKMGMA rep.
Payor Survey Task Force
Anita Carr, billing manager
Terri Christian, office administrator
Diane Myer, CPA, office administrator
Mark Prussian, office administrator
Patti Sacra, office administrator
Public Policy Council
Deborah A. Ballard, MD, chair
Michael W. McCall, MD, chair, board of governors
Bruce A. Scott, MD, AMA delegate
David A. Watkins, MD, KMA delegation chair
Linda H. Gleis, MD, KMA treasurer
Gordon R. Tobin, MD, KMA trustee
Fred A. Williams, Jr., MD, KMA alternate trustee
Robert A. Zaring, MD, Legislative Quick Action Team chair & AMA alt. delegate
Mary G. Barry, MD, Editorial Board chair
Rebecca J. Booth, MD, Judicial Council chair
Esther E. Costel, MD, Bioethics Committee chair
Michael W. Dee, MD, Physician Practice Advocacy Committee chair
Stephen S. Kirzinger, MD, Medical Society Professional Services, Board chair
John N. Lewis, MD, Quality Improvement and Patient Safety Committee chair
Robert W. Powell, MD, Community Health Committee chair
K. Thomas Reichard, MD, GLMS Foundation chair
G. Randolph Schrodt, Jr. MD, Trends in Medicine Committee chair
Erica D. Williams, MD, Leadership & Program Development Committee chair
Mary Helen Davis, MD, at-large member
S. Lyle Graham, MD, at-large member
John B. Roth, MD, at-large member
Charles C. Smith, Jr., MD, at-large member
GLMS Staff
Quality Improvement & Patient Safety
John Lewis, MD, chair
Cynthia Rigby, MD
Thomas James, MD
Geetha Joseph, MD
A O’Tayo Lalude, MD
Rick Rowe, MD
James O’Brien, MD
Demetra Antimisiaris, PharmD, U of L
Randa Deaton, UAW-Ford
Mary Lyle, UAW-Ford
GLMS Staff
Patient Safety Task Force
Thomas James III, MD, chair
John Lewis, MD
Geetha Joseph, MD
Cynthia Rigby, MD
Rick Rowe, MD
Lyle Graham, MD representing LouHIE
James O’Brien, MD
Demetra Antimisiaris, PharmD from U of L
School Medical Transfers Subcommittee
Bernard L. Speevack, MD, chair
Stephen H. Church, MD
John P. Howard, MD
Barbara Isaacs, MD
David Lohr, MD
Brenda O. Osborne, MD
Senior Physicians Committee
Eugene H. Conner, MD, chair
Billy F. Andrews, MD
Joseph B. Brill, MD
Phillip T. Browne, MD
Anne Dunbar-Richman, MD
William C. Durham, MD David Nightingale, MD
Nicholas W. Glaser, MD
John R. Gleason, MD
Paul P. Hess, MD
Hunt B. Jones, MD Virginia T. Keeney, MD
Frank W. Lehn, MD
James F. Molloy, MD
William N. Nash, MD
William H. Powers Sr. MD
Mary A. Smith, MD
Harry D. Stambaugh, MD
Norton G. Waterman, MD
GLMS Staff
Donna Jones, administrative assistant
EMERITI MEMBERS
Robert J. Alberhasky, MD Trends in Practice of Medicine
Committee
G. Randolph Schrodt, Jr., MD, chair
James Fitzpatrick, MD – JHSMH physicians
Jon Wilding, MD – Norton physicians
Richard Goldstein, MD – U of L physicians
Jeff Reynolds, MD – Baptist physicians
H. Lynn Speevack, MD – VA physicians
Jenny Gentner, MD – young physicians
John O’Brien, MD – private practice/KMA
KMA Representatives
Diane Maxey Miranda Mosely
Vital Signs
David R. Watkins, MD, editor
William J. Oliver, MD
John Roth, MD
Charles Smith, MD
Mary Smith, MD
GLMS Staff
Bert Guinn, director of communications and membership
Donna Watts, communications designer
The Healing Place Board of Directors
Officers
John G. Hubbard, MD, immediate past chair
Kelley Abell, chair
Mike Joksimovic, chair-elect
Scott Neff, treasurer
Deane Stewart, secretary
Directors
John Y. Brown III
Nancy Bush
Christi Lanier-Robinson
Sandra McLaughlin
Kim Blinkhorn
Keith Reynolds
Jan Karzen
Dan Caudill
Helena Schulz
Mary Therese Dinga
Laura Douglas
Marcia Lewis
Jennie Meador
Tim Martin
Rob Samuels
Greg Brown, MD
David Cronan
Rev. John G. (Fr. Jerry) Eifler
A. G. Artie Meyer
Stephanie Massler
Daniel Swintosky
Ex-Officio Members with vote
K. Thomas Reichard, MD, GLMS Foundation
president
Louis R. Kirtley, MD
David H. Bizot, MD
Christopher M. Stewart, MD
Lelan K. Woodmansee, CAE, GLMS executive director
Karen DeCosta, alumna member
Charles Anderson, alumnus member
Board Advisory Members without vote
Jay P. Davidson, president and chief executive officer
Greg Givan, chief operating officer
Karyn Hascal, vice president for mission advancement
Cliff Whalin, vice president of development
and communications
Burns Brady, MD, volunteer medical director
Rob Campbell, MD, volunteer clinic medical director
Elizabeth Allen, GLMS Alliance LM
GLMS Staff
J U LY 2 00 9
15
R E F L E C T I O N S
Searching, Searching No Phone Connection
“When it’s springtime in
the Rockies, I’ll be
coming back to you”
-From the song, “Springtime in the Rockies”
A successful youngish physician and his wife, having
attained their professional and financial dreams, faced the
prospect of their elder daughter having been asked for her
hand in marriage. As a little girl, she loved to stage outdoor
weddings with her Barbie dolls. Having grown into a lovely
accomplished woman she now wanted to have her own
wedding in a mountain lodge in Colorado where her parents
once worked. Among the imposing buttes whose tops looked
like castles one could almost expect an Indian sentinel on a
horse scouting the vast valley below. The air, crisp and cool,
was scented by wild flowers that peeked out of the mountainsides. In the distance the snow-capped Rocky Mountain peaks
provided an imposing view. Her parents indulged her wish and to make it more festive,
invited relatives and friends to join them. They were warned
that this was the West and to bring proper attire, boots
perhaps? They were told their quarters would be at a mountain
lodge. Sure enough, the view was breathtaking, the peace and
quiet palpable. Guests found out that their rooms had all the amenities of
the modern world that would please any tenderfoot, with one
exception. In order to have cell phone contact with the outside
world they had to drive down the mountain to the nearest
town. The monitor would read “Searching, searching, no
contact available.” With everyone devoid of the electronic
device that seems to be a permanent fixture to the modern ear,
people turned to each other for company. It was a great bonding ploy. Brothers, sisters, friends, and
guests talked to each other and reestablished relationships,
16
Photo
found new friendships, and disabove
cussed the different life styles
and inset
on cellthat they led. phone by
However, two physician
Teresita
guests were practicing teleBacaniOropilla,
radiology. One covered night
MD
calls for emergency rooms in
Cleveland on a regular on
call basis. The other had a
license to cover emergency
rooms all over the United
States. Both did it from
home, enabling the
younger of the two to
attend to his six and two year
old daughters’ needs. Another physician opined that these readings were reliable, helpful, and
could alert physicians on call to get with it instead of procrastinating.
The wedding was exactly how the bride had planned it,
under a rose covered arch beside a little woodland bower, and
behind, the grandeur of the mountains as the sun begun to set,
as a backdrop. Whether it was a rehearsal dinner at an elegant
lodge beside a lake, a formal tent reception at the wedding site,
a garden barbecue, or breakfasts at the nearest town’s quaint
restaurants, simple and elaborate cuisine was in abundance. A side trip to the Rocky Mountains National Park the day after
the wedding was an added treat. A 12,000-foot-high peak had
become accessible by car via a newly opened road after the
spring melt. It was exhilarating to be surrounded by snowcovered peaks on every side and breathe rarified air. Getting to
see the miniature flora of the tundra below the alpine altitude
and the stand of pine trees at an even lower level made one
truly appreciative of the beauties of this earth and the need to
preserve them. A wedding, a visit to a wonderful place in this vast land,
where even cell phones dare not disturb the peace. What a trip
to renew one’s soul! LM
Alliance Update
A Charming
Home with
Warmth and
Character
Millicent Evans, GLMS Alliance President
The mission of the Greater
Louisville Medical Society Alliance
is to encourage support among
doctors’ families and to promote
health education and community
service.
I am a Louisville native and currently live in the house
where I grew up as an only child. My father, Oscar Demling,
was a pharmacist and owned Demling’s Drug Store for 50
years. My mother, Belle Pace Demling, was a music teacher
and a business owner. I graduated from University of
Kentucky with a BA degree, received a MA in counseling
from Western Kentucky University, as well as a Rank I in
teaching.
While attending the University of Kentucky, I met my
husband, Dr. Donald Lee Evans. He is a diagnostic radiologist
presently working for University Radiological Associates. I
taught biology for eight years before having two children
eleven years apart. My older daughter, Dr. Laurelee Rubsch,
is a small animal veterinarian at Crestwood Veterinary
Hospital. She has a five-year-old daughter, Isabelle Donna.
My younger daughter, Kristilee Williams is a real estate
agent. She has a three-month-old son, Evan Jay. I am blessed
to have both daughters living in Louisville. Currently, I am secretary of the Kentucky Medical
Association Alliance and the secretary of InvestHers
Investment Club. I am on the board of St. Matthews Area
Ministries representing Beargrass Christian Church where I
am a member and deacon and a past president of the
women’s group, Disciples Women. I am also past president
of The Mutual Investment Club of Louisville and present secretary of that club. I am a member of The Fillies, University of
Louisville Woman’s Club, and The Woman’s Club of
Louisville. I have been a substitute teacher for 17 years in the
parochial and Jefferson County Public Schools.
My family and friends have given me strength and
encouragement when I needed it most. They have been the
most supportive of me. My personal goal is to live my life to
the fullest, and my favorite saying is: “cherish yesterday,
dream tomorrow, live today.” I look forward to my year as
the alliance president and working with such a terrific and
dedicated board. Welcome to the 2009-2010 Officers of the
Greater Louisville Medical Society Alliance
President: Millicent (Mrs. Donald L.) Evans
President-Elect: Lisa (Mrs. Barry) Sosnin
Vice-President: Michelle (Mrs. Timothy A.) Feger Recording Secretary: Rhonda (Mrs. John D.) Rhodes
Corresponding Secretary: Ann (Mrs. Morton ) Kasdan
Financial Secretary: Karin (Mrs. George) Sonnier
Treasurer: Adele (Mrs. James Patrick) Murphy
Parliamentarian: Ruth (Mrs. John) Ryan
628 Wataga Drive
· Approximately 2,038 square
feet
· Three bedrooms, two and a
half bathrooms.
· Freshly painted interior.
· Hardwood floors; arched
doorways.
· Nine foot ceilings on first floor.
· Updated kitchen and bathrooms.
· Glassed porch.
· Large deck overlooking private
rear yard.
· In ground pool with removable,
child-resistant fence.
· $375,000.
View online at
WRRealtors.com
Uplifting the Patient Experience
One patient at a time.
At Concentra, one of the largest providers of health care services in
the nation, we’re reinventing the health care experience, reshaping it,
and making it what it should be for our patients and our care providers.
Founded and still led by physicians today, our focus is on clinically
excellent care and long-term wellness programs in a practice that becomes
a rewarding experience for every patient and doctor. We are seeking BE/
BC physicians, preferably with Occupational Medicine and/or Urgent Care
experience for the following position in Louisville:
Center Medical Director
To learn more, please contact Julie Thomas at 866-839-7660 or
email: [email protected].
www.concentra.com/careers
We are a diverse team dedicated to
improving America’s health,
one patient at a time. EOE.
LM
J U LY 20 09
17
President’sSoiree
A.Past President & Outgoing Chair, Randy Schrodt, MD, President, Lynn Simon, MD and Outgoing President, Michael McCall, MD
B.Randy Schrodt, MD presents Michael McCall, MD with a plaque honoring his service as President
C.Randy Schrodt, MD presents an award to Clifford Kuhn, MD , the Richard Spear,
MD Memorial Essay Contest Practicing and Life Member Category Winner
D.Mindy Needleman and Lynn Simon, MD
Sunday, May 31, 2009 at the Speed Art Museum
E. Kim Alumbaugh, MD and husband, Dan Varga, MD
F. Gregory Gleis, MD and Clifford Kuhn, MD
G. Rishi Kumar, MD and guest
H. Randy Schrodt, MD presents an award to Lyle Bohlman, MD, Richard Spear, MD Memorial Essay Contest Honorable Mention I. Kristen Miller and Neil Richmond, MD
J. Sharon Watkins and David Watkins, MD
K.Ceremony slide presentation
L. David Easley, MD andDavid Seligson, MD
A.
B.
M.Lelan Woodmansee, Patrick and Elizabeth Padgett and Bert Guinn
N. Marsha James and Thomas James, MD
O. Glenn Stoutt , MD and wife, Tyleen, Roger Shott, MD and wife, Diane
P.Marlena Woodmansee, Liberacion Soriano, MD and Nora Sessoms, MD
Q. Mona Changaris, Stephanie Mosley, MD and David Changaris, MD
R.Elaine Stauble, MD, Bruce Tasch,MD and Rebecca Terry, MD
S. Miren Asumendi, MD and guest
T. Kenneth Harrison, PhD and Jessica Dowe-Harrison, MD
U. Tom Courtenay, MD, Ro VanVooren, Charles Smith, MD, Rosemary Smith and Glenda Haller
V.Venkat Sharma, Aneeta Bhatia, MD and Bob Goodin, MD
W.Marilyn Bornstein, Alan Bornstein, MD, and Harold Haller, Sr., MD
C.
F.
H.
G.
E.
D.
L.
K.
I.
J.
M.
N.
T.
P.
Q.
U.
R.
V.
S.
W.
O.
J U LY 20 09
19
On the fringes of greatness:
Alban Gilpin Smith (Goldsmith)
1795-1861
Eugene Conner, MD
A
LBAN GILPIN SMITH was
born in New Castle County,
near Wilmington, Del., to
Quaker parents, Samuel and
Lydia Gilpin Smith, on March 22, 1795.
Nothing much is known of his parents,
although his maternal ancestors were
paper makers for several generations.
Alban’s parents established a permanent residence in
Philadelphia in 1797. Alban’s formal schooling was obtained at
the Westtown (Quaker) School in Westtown, Chester County,
Pa., from January 1809 until April 1810. He apparently then traveled to Danville, Boyle County, sometime before his 15th birthday, to begin his apprenticeship in surgery and medicine under
Ephraim McDowell (1771-1830). His apprenticeship was completed prior to September 1815, for on Sept. 27 he stated he
had begun practice in Port Tobacco, Md. At this time, he transferred his membership from the South Philadelphia (Quaker)
Monthly Meeting to the one in Alexandria, Va. This change was
granted Dec. 21, 1815.
In Port Tobacco, he met and married Taliaferro H.
Middleton (died 1849) in 1817. She was not a member of the
Society of Friends. This alliance resulted in Alban’s removal from
membership in the Alexandria Meeting in April 1818. The
couple eventually had seven children, but only three lived to
maturity. One, Middleton (1818-1887) became a physician,
graduating from the College of Physicians and Surgeons at
Columbia College in 1840.
Alban left his established practice in Maryland and
removed his family to Philadelphia, where he could further his
medical education. He chose to enroll in the private medical
lectures of the Quaker physician Joseph Parrish (1779-1840) at
the Philadelphia Alms House. He chose to attend these private
lectures instead of enrolling in the University of Pennsylvania
Medical Department as Dr. Parrish’s tuition was much less
expensive, and classes were conducted during the summer
months. Parrish’s didactic lectures were supplemented by clinical cases from his larger practice caring for both public and
private patients. Surgical operations by Dr. Parrish, as well as
20
other practitioners, could be monitored in the hospitals that
Parrish attended.
In 1822, Dr. Smith returned to Danville where he became a
partner of his former preceptor, Ephraim McDowell, until 1826.
During this partnership, Dr. Smith performed the third successful ovariotomy on a free black patient in May 1823. In October
1827, Dr. Smith performed the world’s first dorsal laminectomy
for treatment of fracture of the spine and subsequent paralysis
below the shoulders. Although function did not return, the
operation had demonstrated that the fragments of the fractured vertebrae could be removed and the spinal cord exposed.
It would be over a century before more definitive information
concerning management of such procedures would be forthcoming.
Alban studied chemistry under his preceptor and Dr.
Parrish, and in 1823 he received his first academic appointment
as professor of chemistry at Centre College in Danville. Since there was a very high incidence of urinary tract
stones among local patients, Dr. Smith sought a less invasive
and traumatic method for the treatment of patients suffering
with urinary calculi. In 1824, the French surgeon Jean Civiale
(1792-1867) introduced the technique of crushing urinary tract
stones with specially designed instruments by transurethral
approach, a technique known as lithotrity. This eliminated the
invasive and risky open surgical method of treatment.
Dr. Smith went to Paris in mid-1829 to study under Dr.
Civiale, and returned to the U.S. in December 1830. On his
arrival in Philadelphia, he met, by chance, fellow Kentucky
physician Daniel Drake (1785-1852). Dr. Drake was then the
editor of The Western Journal of Medical and Physical Sciences.
He requested that Dr. Smith submit some comments on Dr.
Civiale’s technique and the special instruments for publication
in his journal. Dr. Smith complied. After his return to Danville,
Dr. Smith soon performed the first lithotrity in the Western
country.
Being frustrated by the absence of a hospital in Danville,
Dr. Smith moved to Louisville in 1831. He soon received an
appointment to the surgical staff of Louisville Marine (City)
Hospital, the first and only general hospital in Kentucky at the
time.
In Louisville, the largest city in Kentucky, Dr. Smith sought
to utilize the Louisville General Hospital patients for clinical
teaching. He obtained a charter in 1833 for the Louisville
Medical Institute. The charter named Dr. Smith and eight other
local physicians as incorporators. Oversights and omissions in
the original charter resulted in several revisions in 1835, 1836
and a final workable charter was completed in 1837, identifying
a board of trustees separate from the faculty. Dr. Smith did not
become a member of this faculty.
Unwilling to tolerate inaction on the part of his fellow
incorporators, Dr. Smith left Louisville for Cincinnati in 1833 to
accept the chair of surgery at the Medical College of Ohio. The
medical-political climate in
Cincinnati was unfavorable; some
aspects of which were directly
attributed to the newcomer. Many
of these polemics were published
in the Cincinnati Whig and
Commercial Intelligencer (1835). Alban Smith was a multi-talented individual whose professional attainments were confined
to the fringes of greatness. He was
a skillful and innovative surgeon
and anatomist. He obtained the
first charter in 1833 for the first
medical school in Louisville, but
was too impatient to await the
completion of the necessary revisions in the charter until a medical
faculty could be assembled in
1837. He left for Cincinnati in
1833, and soon left from there to
go to New York City in 1837. He
continued to practice genitorurinary surgery, but was unable to
maintain his focus on academic
activities. He published several
books, including “Lithotripsy of
the Breaking of the Stone in the
Bladder” (1843) and “Diseases of
the Genito-Urinary Organs” (1857).
While in Cincinnati, Dr. Smith
became identified with and an
active participant in an informal
group of artists. His artistic talent
was promising and he utilized it
by illustrating one of his published
texts. Seeking a more favorable
location in which to teach and
practice, Dr. Smith accepted the
chair of surgery at the College of
Physicians and Surgeons of the University of the State of New
York in New York City in 1837, which he resigned after only two
sessions. He continued to practice in New York City. After
assuming and soon resigning his academic appointment in
1837, he petitioned the legislature of the State of New York to
change his surname to Goldsmith. This was granted in 1839.
He continued to practice his specialty in the vicinity of New
York City until his death in Barrytown, New York, on Aug. 5,
1861. LM
J U LY 20 09
21
Cynthia Rigby,
MD, (bottom
left) and
husband Ron
Rigby with their
grandchildren
Noah Rigby and
Taylor Nguyen.
GLMS
Foundation
President
Timothy
Brown, MD,
(middle) and
,
David Watkins
MD.
Natalie Chou
hoola hoops
to the music
on the
dance
floor in
The Old
Medical
School
Building.
board
dation
n
D,
u
o
F
ut z , M
GLMS
seph K
o
.
J
l
r
e
e
e
wh
me mb
e cake
h
t
g
n
worki
22
Popsy the
Clown pose
s for a
photo wit
h Matthew
,
M
ichael,
Brandon a
nd Natalie
Chou.
Aime
e
Gord and
on S
mith
and
his
cous
in, E
ric.
J U LY 20 09
23
Jake, Greg
(From left) Nick,
ard member),
(a foundation bo
e Ehrhard.
Kathryn and Carri
Kim’s Dance Stud
io keeps
guests engaged
in dancing
to '50s era mus
ic.
gets her face
Natalie Chou
h Romine as
et
painted by B
hael
brother Mic
her younger
looks on.
24
ansee, 3,
Harper Woodm
slide.
le
on the inflatab
Drs. Braidi an
d Martin
Huecker with
their
children Isab
ella and
Emerson.
LM
J U LY 20 09
25
Tracy Ragland, MD
AS I AM WRITING THIS, IT IS
SPRING, A WONDERFUL TIME OF
YEAR FOR MANY REASONS. For
those of us who love the outdoors and sunshine, it brings the promise of many months of
leisure, recreation, and adventure -- water activities, hiking, cookouts and get-togethers, sports, and family vacations. Gardeners
and yard people get especially excited this time of year. My
mother, a teacher and woman of many talents, was a Master
Gardener. I remember, as a young child, watching her transform
into a high-energy, incredibly happy person in April or May every
year. Her garden was like a magnet, drawing her outdoors for
hours at a time. Mom had an impressive work ethic in the garden. She diligently tilled and hoed the vegetable garden, mowed the yard, pulled
weeds, and pruned plants. Without a hint of fatigue, she sowed
seeds, planted and transplanted, fertilized, harvested, mulched,
and developed compost. Amazingly, she did nearly all of it herself,
while excelling in her career and taking care of my brother and me.
Mom shared a lot, giving away bushels of vegetables regularly and
taking freshly cut flowers to neighbors and friends. She loved
helping others develop their own gardens. Enthusiastically, she
transferred countless plants and shared design and pest control
ideas with other yard people. There are many gardens in my hometown that carry her signature style. As she got older and retired,
with fewer family obligations, her garden and yard became fulltime work. Nearly 10 acres of a rustic paradise was her reward.
My mom died suddenly and unexpectedly nearly two years
ago. She was 64 years old, but looked and acted like a “young 50.” I
miss her terribly, of course. Since her death, I have been drawn to
her sister and two best friends, and naturally, the garden. Spending
time there and transplanting some of her plants
to my much smaller and less interesting yard
has become a very important part of my
life. Her name was Lynda. As the growing
season is gearing up, I'd like to share a
little bit of what I've learned about some
of mom's favorite things.
26
The Iris
The iris was mom's signature flowering plant, probably her overall favorite in the
garden. Every garden should have one sort of iris or another. The plant is named for the
Greek goddess of the rainbow, and is available in a variety of stunning colors. Mom
loved purple irises; she planted them primarily along fence rows separating her yard
from the cattle pasture and in clusters around trees. Daylilies are great companions in
flower beds, especially in cottage gardens. Most irises grow very well in our climate
zone, blooming from late spring to midsummer. They all have flat, sword-shaped foliage
and a flower made up of three outer petals (falls) and three inner petals (standards).
They generally grow best with full sun. Rhizomatous irises are often preferred by growers over bulbous ones. These irises
are generally either bearded or beardless. The bearded irises have a row of hairs at the
base of the falls and they require good drainage. Beardless irises have smooth falls and
need much more moisture. The Japanese iris, a particularly lovely plant, thrives in heavy
soil like the muck of a lake or pond. Learning when and how to divide irises is an important part of keeping the plant
healthy. Generally, this is done in the late summer and fall after flowering. Clumps
should be kept relatively small. After leaves and stems are trimmed, a square-bottomed
spade can be used to cut pie-shaped wedges from the large clump. These can be
replanted like any other transplant. Yellow foliage on irises, one of mom’s pet peeves, is
probably the result of a too alkaline soil. Other common problems include boring
insects that create small holes in the rhizomes (roots) and diseases like “mosaic” and
“rot” that can attack stems and leaves. There are often several possible remedies for
these common problems. A great local resource during trial-and-error learning is the
Louisville Area Iris Society (www.lais-ky.org).
Monkey (Mond o) Grass and o ther
Favorites
Monkey grass was definitely mom’s favorite ground cover and border plant.
Growing up to 16 inches in length, Mondo has half-inch wide green leaves with lavender flowers and blue berries in the fall. It is a tough plant, thriving in either sun or full
shade. It prefers moist soil, but stands up well to drought. Mondo grows well in ordinary garden soil and requires very little attention once established. It stays attractive all
year, although leaves may become ragged by late winter. Shearing shaggy leaves in
early spring is about all the care my Mondo requires. I use it primarily as ground cover in
areas of my yard where erosion has been a problem. Mom used it along her sidewalks
and path borders, between flower beds, and to “fence in” her fruit orchard.
Speaking of fruits, her favorite was the tomato. As she never felt she mastered it
and I know very little about tomatoes myself, I won't offer any advice about growing
them in this article. I have discovered a very helpful question and answer book on
growing and caring for vegetables and fruits, however. Published in 2008, Barbara Ellis’
The Veggie Gardener’s Answer Book offers more than 20 pages of easy-to-read insights
on tomatoes. Further, the summer 2009 publication of Gardeners Supply Company
(www.gardeners.com) is officially the annual tomato issue. I think it is a very good
catalog. I will mention a few other favorite gardening resources. Fine Gardening (www.finegardining.com) was probably mom’s favorite monthly magazine. Although it has the
potential to make the average yard person feel like an under- achiever with its stunning
photographs, I think it can be quite helpful with garden design ideas. HomeGrown, a
radio show on National Public Radio, is a favorite of mine. It is more entertaining than
educational; but it is definitely worth listening. The Flower Gardener’s Bible, by Louis
and Nancy Hill, has a lot of technical and problem solving information about growing
and caring for many different types of plants. Finally, local cooperative extension offices are often very helpful in diagnosing and treating problems in plants, as well as recommending good companions for specific plants locally.
I am not a gardener. I am merely a yard person. As I learn more about plants, however, I can't help but be grateful to my mom for being a wonderful example for me. She taught me about hard work, patience, giving, resilience, overcoming adversity and faith. I still have much to learn. LM
J U LY 20 09
27
B O O K R E V I E W
Atlas of Unknowns
by Tania James
Reviewed by M. Saleem Seyal, MD, FACC, FACP
Publisher: Alfred K. Knopf in the USA
Simon & Schuster in the UK,
336 pages, April 2009
ON A CRISP AFTERNOON IN THE
SPRING OF 2009, Tania James read from
her remarkable debut novel in her American patois to a
standing-room-only crowd at the Carmichaels Book Store on
Frankfort Avenue, to high applause. For Tania, it was a homecoming and to her beaming father, Dr. Koduvathara James,
who has been practicing cardiology in the Kentuckiana area
for over 25 years, it was a triumphal moment. She was born in
Chicago, raised in Louisville and attended Kentucky Country
Day. She graduated from Harvard in film-making and
obtained her MFA from Columbia in fiction. She has written
for the New York Times and her short story “Aerogramme”
was judged as one of the 100 Distinguished Stories of 2008
by “Best American Short Stories.” Atlas of Unknowns is a fresh, nuanced and poignant
novel about sisterhood, betrayal, the pangs of uprootedness
and complex family dynamics. The main characters are two
teenage sisters, Linno and Anju, who live in a small city in
Kerala, South India, with their father of limited means, Melvin,
and their perceptive and opinionated grandmother, lovingly
called “Ammachi.” Their mother Gracie died mysteriously. The
younger sister, Anju, is academically brilliant while the older
sister, Linno, a one-hand amputee because of a freakish fireworks accident, has cultivated artistic proficiency in drawing
and sketching. Anju wins a scholarship to attend an American
high school in New York. Unfortunately, the main reason she
received the prestigious scholarship was the artistic work she
submitted as hers although in fact it was the creation of
Linno. Linno did not know of Anju’s shenanigans. Anju arrives
in America, boards with a highly successful Indian American
couple, the Solankis, in their mansion and also meets with
their quirky American-born and bred son, Rohit. She works
hard and wins accolades at the school regarding her academic performance but when asked to produce artistic work by
her teacher, she cannot deliver and grapples with her misrepresentation of Linno’s work as her own. Finally filled with
shame and embarrassment, she absconds from school and
28
runs away from
her host family.
She is too
ashamed to
inform her family
back in Kerala
about the incident and
her whereabouts. She ends up staying with an
older Kerala émigré by the name of Bird, a one-time actress in
a traveling theater company many years before. Bird procures
a job for Anju in Queens in the Indian-dominated Jackson
Heights, in a beauty salon where she ends up working as a
bikini waxer. Meanwhile, her family back in India is devastated by the
news of her disappearance. Linno has been working successfully as an invitation cards designer and her employer’s business has blossomed due mainly to her originality and artistic
gift. Linno tries to procure a visa to come to America and look
for her sister, and the description of the scene at the consulate by the author is memorable. Rohit, the quirky son of
the fabulously wealthy Solankis, is a Princeton dropout and
an aspiring documentarian who is looking for a break for his
own success. He eventually seeks Anju out and locates her in
the salon. He is bent on documenting Anju’s travails and
struggles in gaining legal immigrant status, much to her
chagrin. Tania James has produced an engrossing debut novel
which is a true page-turner. Throughout the book, she has
created a magnificent and impressive array of characters in a
beautifully evocative prose. There are many unexpected turns
and twists in the story, described with vivid expression and
heart-felt conviction. I have been an avid reader and admirer
of Chitra Banerjee Divakaruni’s literary work that deals with
the main theme of immigrant experience( her work includes
a collection of short stories, “Arranged Marriage” in 1995 and
a novel “Mistress of Spice” in 1997). Regarding Atlas of
Unknowns, she writes, “Tania James paints the dual worlds of
the novel - India and America - with masterful care, choosing
beautiful, shocking details, and peopling them with characters we will remember long after closing the book.” I thoroughly enjoyed reading the book and am looking forward to
her upcoming collection of short stories that is reportedly set
in Louisville. LM
W E W E L C O M E Y O U
GLMS would like to welcome and congratulate the following physicians
who have been elected by Judicial Council as provisional members.
During the next 30 days, GLMS members have the right to submit written
comments pertinent to these new members. All comments received will be
Candidates Elected to
Provisional Active
Membership
Downey, Mark P (20440)
Carolyn Roth Downey
PO Box 34748 40232
473-2132
Anesthesiology 92
Jefferson Medical College
Edwards, John Dudley (20578)
Susan
3991 Dutchmans Ln Plaza 2 Ste 103
40207
897-0635
Vascular Surgery
Rush Medical College 82
forwarded to Judicial Council for review. Provisional membership shall
last for a period of two years or until the member’s first hospital reappointment. Provisional members shall become full members upon completion of this time period and favorable review by Judicial Council.
Gardezi, Nasir Hussain (3106)
Nausheen
207 Sparks Ave Ste 104
Jeffersonville IN 47130
282-1617
Cardiovascular Diseases 91; Internal
Medicine 89
Nishtar Medical College 80
Sattenberg, Ronald J (20407)
Nancy Sattenberg
UL Radiology 530 S Jackson St
CCB-C07 40202
852-5875
Radiology 99; Neururadiology
00
Albert Einstein College 93
Hadley, Terence James (544)
Susan
Audubon Medical Plaza West
2355 Poplar Level Road Ste 405
40217
636-7845
Oncology; Hematology 88; Internal
Medicine 79
Columbia U 74
Stewart, Aaron David (2964)
Anne Stewart
4130 Dutchmans Ln Ste 400
40207
897-0697
Obstetrics Gynecology 97,07
U of Louisville 91
Keller, Bradley (20516)
Susan Keller
601 S Floyd St Ste 602 40202
585-4802
Pediatric Cardiology 91,01, 08
Pediatrics
Pennsylvania State U 85
• Full Time Hospitalist
• Well Established Private Practice
• One Hospital Location
Salary and Bonus
combined above $200K
Confidential responses to:
Hospital Internal Medicine Associates, PLLC
201 Abraham Flexner Way
Suite 1003
Louisville, KY 40202
Attn: Susan Shacklette
502.584.4479
[email protected]
J U LY 20 09
29
P H Y S I C I A N S I N P R I N T
Adamkin DH. Late preterm infants: severe hyperbilirubinemia and
postnatal glucose homeostasis. J Perinatol. 2009 May;29 Suppl
2:S12-7. Liu J, Gunn L, Hansen R, Yan J. Combined yeast-derived betaglucan with anti-tumor monoclonal antibody for cancer
immunotherapy. Exp Mol Pathol. 2009 Jun;86(3):208-14. Bates PJ, Laber DA, Miller DM, Thomas SD, Trent JO. Discovery and
development of the G-rich oligonucleotide AS1411 as a novel
treatment for cancer. Exp Mol Pathol. 2009 Jun;86(3):151-64. Martin RC 2nd, Augenstein V, Reuter NP, Scoggins CR, McMasters
KM. Simultaneous versus staged resection for synchronous colorectal cancer liver metastases. J Am Coll Surg. 2009
May;208(5):842-50; discussion 850-2. Bryant KA, Wesley GC, Wood JA, Hines C, Marshall GS. Use of standardized patients to examine physicians' communication strategies when addressing vaccine refusal: A pilot study. Vaccine. 2009
Jun 2;27(27):3616-9. Chang W, Chen J, Schlueter CF, Hoyle GW. Common pathways for
activation of proinflammatory gene expression by G proteincoupled receptors in primary lung epithelial and endothelial cells.
Exp Lung Res. 2009 May;35(4):324-43. Crawford CH 3rd, Carreon LY, McGinnis MD, Campbell MJ,
Glassman SD. Perioperative complications of recombinant human
bone morphogenetic protein-2 on an absorbable collagen sponge
versus iliac crest bone graft for posterior cervical arthrodesis. Spine.
2009 Jun 1;34(13):1390-4. Dimar JR 2nd, Glassman SD, Burkus JK, Pryor PW, Hardacker JW,
Carreon LY. Clinical and radiographic analysis of an optimized
rhBMP-2 formulation as an autograft replacement in posterolateral
lumbar spine arthrodesis. J Bone Joint Surg Am. 2009
Jun;91(6):1377-86. Gadient P, Bolton J, Puri V. Juvenile myasthenia gravis: three case
reports and a literature review. J Child Neurol. 2009 May;24(5):58490. Harandi A, Zaidi AS, Stocker AM, Laber DA. Clinical Efficacy and
Toxicity of Anti-EGFR Therapy in Common Cancers. J Oncol.
2009;2009:567486. Harris BT, Franklin GA, Harbrecht BG, Richardson JD. Impact of
hollow viscus injuries on outcome of abdominal gunshot wounds.
Am Surg. 2009 May;75(5):378-84. Henson JT, Roberts CS, Giannoudis PV. Gluteal compartment syndrome. Acta Orthop Belg. 2009 Apr;75(2):147-52. Huang J, Bouvette MJ, Zhou J, Dwyer GJ 3rd, Bhopatkar S,
Bhatia A. A large angiosarcoma of the right atrium. Anesth Analg.
2009 Jun;108(6):1755-7. Khan MI, Chesney JA, Laber DA, Miller DM. Digitalis, a targeted
therapy for cancer? Am J Med Sci. 2009 May;337(5):355-9. Lane AN, Fan TW, Higashi RM, Tan J, Bousamra M, Miller DM.
Prospects for clinical cancer metabolomics using stable isotope
tracers. Exp Mol Pathol. 2009 Jun;86(3):165-73. 30
Mirsaeidi M, Peyrani P, Ramirez JA; Improving Medicine through
Pathway Assessment of Critical Therapy of Hospital-Acquired
Pneumonia (IMPACT-HAP) Investigators. Predicting mortality in
patients with ventilator-associated pneumonia: The APACHE II
score versus the new IBMP-10 score. Clin Infect Dis. 2009 Jul
1;49(1):72-7. Montoya-Durango DE, Liu Y, Teneng I, Kalbfleisch T, Lacy ME,
Steffen MC, Ramos KS. Epigenetic control of mammalian LINE-1
retrotransposon by retinoblastoma proteins. Mutat Res. 2009 Jun
1;665(1-2):20-8. Parker LP, Taylor DD, Kesterson S, Gercel-Taylor C. Gene expression profiling in response to estradiol and genistein in ovarian
cancer cells. Cancer Genomics Proteomics. 2009 May-Jun;6(3):18994. Pugh AJ, Barve AJ, Falkner K, Patel M, McClain CJ. Drug-induced
hepatotoxicity or drug-induced liver injury. Clin Liver Dis. 2009
May;13(2):277-94. Rabinowits G, Laber DA. Bladder cancer: clinical practice. J Ky Med
Assoc. 2009 Apr;107(4):129-33. Richardson JD, Franklin G, Santos A, Harbrecht B, Danzl D,
Coleman R, Smith J, Miller F, McMasters K. Effective triage can
ameliorate the deleterious effects of delayed transfer of trauma
patients from the emergency department to the ICU. J Am Coll
Surg. 2009 May;208(5):671-8; discussion 678-81. Snow AB, Khalyfa A, Serpero LD, Capdevila OS, Kim J, Buazza MO,
Gozal D. Catecholamine alterations in pediatric obstructive sleep
apnea: effect of obesity. Pediatr Pulmonol. 2009 Jun;44(6):559-67. Winters SJ, Chennubhatla R, Wang C, Miller JJ. Influence of obesity
on vitamin D-binding protein and 25-hydroxy vitamin D levels in
African American and white women. Metabolism. 2009
Apr;58(4):438-42. Woods CR. Congenital syphilis-persisting pestilence. Pediatr Infect
Dis J. 2009 Jun;28(6):536-7. Yalcin A, Telang S, Clem B, Chesney J. Regulation of glucose
metabolism by 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatases in cancer. Exp Mol Pathol. 2009 Jun;86(3):174-9. Polypharmacy:
A Threat to Healthy Aging
Demetra Antimisiaris, PharmD, and James G. O’Brien, MD (pictured at left)
M
EDICAL SCIENCE is at a
crossroads, caught
between extending life
with multiple chronic diseases, improving
quality of life, and managing the means
by which this is achieved. Today we are able to extend life
expectancy due to improvements in sanitation, living conditions and medical technology. In 1900 those aged 65 years and
older constituted 4 percent of the population, which had a life
expectancy of 46 years. Today those over 65 represent 13
percent of the population, which enjoys a life expectancy of 75
years for men and 80 years for women (1). By 2030 elders will
constitute 22 percent of the population with the percent over
80 years of age set to quadruple (2). Elders are most vulnerable
to medication problems, and suffer increased exposure to medication. They are frailer and lack the physiological reserve to
survive adverse events. The PDR in 1969 contained 1,415 pages, inclusive of OTC
products in 2008, the PDR held 3,482 pages of prescription
products with a separate OTC and dietary supplements book. In
addition to the supervised use of medications
there is an unprecedented level of self medication due to direct to consumer marketing and
more prescription items going over the counter
annually. Surveys of mean daily OTC drug use in
people over 65 years old range from 31-96
percent of the population, with a 70 percent
average (3). A 2004 Boston College survey
reports that 42 percent of all adults take vitamins
daily and 19 percent take herbals and supplements daily. In any given week, 82 percent of U.S.
adults take at least one medication (prescription
or nonprescription drug, vitamin/mineral,
herbal/natural supplement), while 30 percent
take at least five (4). The use of multiple medications is accompanied by significant risk due to anything from
drug-drug and drug - disease interactions to a
patient’s own cognitive ability to manage his or
her medications. A linear relationship exists
between the number of medications taken concomitantly and the risk of adverse reactions. The
same linear relationship has been seen with the
number of medications used and mortality, even
after adjusting for disease severity (5, 6). At particular risk are
the elderly. Eighty-eight percent of people over 65 live with
chronic health problems. Adults over 65 years of age currently
account for just 13 percent of the general population, but constitute 40 percent of all hospitalizations and 50 percent of hospital days. Approximately one third of hospital admissions in
the elderly result from medication related problems (7, 8). With
increasing pressure on primary care physicians to manage
complex medical problems in less time, it is not surprising that
adverse events occur. Similarly, sub-specialists adhering to
practice guidelines may excessively treat an older, frail adult,
with negative consequences.
If “Medication Related Problems” were a disease, it would
rank sixth of the top ten with regard to the economic impact of
diseases affecting Americans 65 years of age and older (9). In
particular, the state of Kentucky ranks second in the country for
expenditure on antidiabetics, antihypertensives, GI medications
and analgesics/anti-inflammatory meds, and antidepressants.
We lag behind West Virginia but rank ahead of Alabama,
Mississippi, Louisiana, and Arkansas (10, 11). In prescriptions per
person in 2006, Kentucky ranked 3rd (see figure 1 below).
J U LY 20 09
31
Strategies to minimize the risk of multiple medication use
require awareness and the use of a systematic approach to minimize adverse events. The points offered in this discussion represent basic mechanisms to fight unintended medication
related problems. A Diagnosis for Each Drug
A simple way to minimize unnecessary medication use is to
ensure that each medication used has a purpose, so a diagnosis
should be next to each medication listed in the chart. The list
should include medications prescribed by other physicians.
Additionally, a medication that had been acquired through
other prescribers may no longer be indicated, as frequently
happens during hospitalization when a medication for GI prophylaxis is added but not removed at discharge. In the office
setting perhaps an ancillary medical staff member could be
trained to do medication verification and then the 15-minute
office visit could be reserved for other priorities.
Avoid the Prescribing Cascade
The prescribing cascade is when a non specific symptom
caused by a medication side effect results in a new prescription.
Ideally, an identified medication side effect can be remedied by
removing the offending agent. There are some times however
when the offending medication is essential and not substitutable, and another medication needs to be used to help the
patient remain on that essential agent. In general, side effects
of medications tend to be non-specific (particularly in elderly
patients), such as confusion, nausea, headache and falls.
Because these symptoms are identified as an organic problem,
more medication is added to the patient’s current regimen,
leading to more symptoms or side effects, and then in turn
more medication. An example of a prescribing cascade is
depicted in Figure 2.
This poor outcome perhaps could have been avoided by
previous detection of the patient’s liberal and inappropriate use
of OTC nonsteroidal anti-inflamatories, or earlier detection and
adequate treatment of osteoporsis. Whenever an elder presents
with a status change, medication related problems must first be
ruled out, particularly when the onset of symptoms coincides
with a new prescription (12). The consideration of medicationinduced problems should be included when confronted with a
new symptom complex. A detailed history may reveal the onset
of symptoms proximate to introducing a new medication.
Assessment of OTC, Herbal, and
Supplement Use
The use of over the counter medications, herbals and supplements is often overlooked. Patients and prescribers may
possess the view that these substances are safe, that’s why they
are over the counter in the first place. Unfortunately, this is far
from true. Under-reporting of OTC and supplement use is
sometimes due to the common belief by patients that if the
doctor did not prescribe it, then they don’t have to report it.
However, disclosure of what a patient is truly taking can be very
important. Acetaminophen, for example, is a safe choice for
pain relief and definitely a better choice than Nonsteroidal Antiinflammatory for chronic pain treatment (13), however, in 2002
acetaminophen related liver toxicities accounted for 13,000
Emergency Department visits, 2,100 hospitalizations and 100
deaths after adjustment for intentional suicide attempts annually (14). Although acetaminophen is the analgesic of choice
with warfarin therapy, it may elevate the INR, especially at
higher doses. Chronic use of acetaminophen for example can
lead to toxicity just as well as over dosing. Acetaminophen has
been shown to be safe up to three grams daily in elders and
four grams daily in younger adults; however other factors
including total drug burden on hepatocytes and alcohol ingestion can make chronic acetaminophen ingestion unsafe (15). A major hazard of OTC medications is an anticholinergic
effect. Anticholinergics decrease acetylcholine, a vital neurotransmitter in cognition. Many OTC sleep aids, antitussives, cold,
sinus and allergy remedies contain the same class of antihistamines with powerful anticholinergic effects resulting in confusion, disorientation, sedation and memory loss.
The elderly are most vulnerable as a result of
decreased muscarinic receptors (16, 17).
Herbals and supplements may markedly
affect coagulation and sometimes patients do
not realize when told to stop taking medications
before surgery that they also need to stop all
herbals and supplements. Lastly, supplements in
the form of dietary shakes may contain weight
control supplements that can raise blood pressure, cause insomnia and encourage anorexia.
Guarana, which is present in many energy drinks
and diet supplement drinks, can cause the above
effects.
*The mechanism of warfarin-acetaminophen
interaction is unknown, however it is recommended that patients ingesting 2-4 grams daily
be closely monitored for elevated INR levels (18).
32
Physicians Benefit More
from GLMS Disability Plans
MORE...Own-occupation coverage for
your premium dollar
MORE...Room to add coverage on top of
existing Group and Individual Disability plans
MORE...Flexibility. Simple application
For more information
without tax returns or exams
502-425-3232
800-928-6421
or visit us online at
www.NIAI.com
Medical
Society
Professional
Services
A Greater Louisville Medical Society Company
National Insurance Agency, Inc.
Professional Association Insurance Program Administration
11801 Brinley Avenue
•
Louisville, KY 40243
Is very pleased to announce
The “OPENING” of our
CHAMBERLAIN POINTE OFFICE
Conveniently located across from the Norton Brownsboro Hospital
Serving North Eastern Jefferson, Oldham, Henry, and Trimble Counties
&
SHIVELY OFFICE
Conveniently located in the newly renovated Shively Center on Dixie Highway
Serving PRP, Valley Station, Shively, Auburndale, River Port, Iroquois,
Beechmont & Fairdale
For appointment information please call (502)-426-1621 or (800)-548-6543
John G. Riehm, M.D.
Stuart W. White, M.D.
Adriana S. McCubbin, M.D.
Angela D. Thomas, M.S.N., A.R.N.P.
Daniel P. Garcia, M.D.
Derek A. Damin, M.D.
Jeremy D. Jones, M.D.
Tiffany L. Simpson, M.S.N., A.R.N.P.
The Brown Bag Assessment
Prescribers are increasingly utilizing this method of getting
a realistic view of their patients medication use. The Brown Bag
assessment was named as such because patients are asked to
bring in all their medications that they take in a grocery bag.
This is a very revealing assessment. It can be helpful to give
your patient a “homework” assignment if you suspect medication mismanagement. The assignment is to track the number
and frequency of OTC and herbal supplements used between
office visits. Your medical assistants can give medication tracking forms to patients or mail them out to be brought back at
clinic visits. Asking patients to bring a filled out log can serve as
documentation for the chart as well as be very revealing about
your patient’s ability to manage his medications appropriately
(Figure 3).
The Elderly: A special population vulnerable to
polypharmacy problems
The majority of the medications that are used in the elderly
were brought to market based on safety and efficacy studies
performed in either younger or healthier subjects than those
actually taking the medications. To participate in a safety and
efficacy drug trial, the exclusion criteria eliminate most frail
patients with multiple co-morbidities. Additionally, the frailest
of the frail cannot even make their way to clinic to participate in
studies. Be cautious using medications new to market.
Rofecoxib (Vioxx®) was introduced with claims of improved
safety but was found in post marketing data to cause adverse
cardiac effects and increased mortality. Impaired physiology is important to take into account
when prescribing for elders. Current science pertaining to our
understanding of the physiology of aging is changing daily,
thus our understanding of how drugs behave in elders is also
changing rapidly. Hepatic metabolism slows with age resulting
in impaired first pass effect. INCHIANTI, a 12,000 subject longi-
tudinal study measured biomarkers of frailty and illustrates a
principle of medication use in elders that is often unaddressed:
renal function impairment as a function of age. Many drugs
require renal dosage adjustment such as memantine and
quinolones, or are contraindicated in elders with renal impairment, for instance metformin. A deceiving feature of elderly
patients is that their serum creatinine level may seem normal
despite marked renal impairment. Most labs do report
Glomerular Filtration Rate however they calculate using the
MDRD which has not been validated in elderly subjects. The
Cockroft and Gault formula is recommended because it has
better validation in elders
(Figure 4).
Elderly
patients have
less physiological reserve
resulting in a decreased ability to adjust to neurotransmitter
alterations, changes in blood pressure, glucose and other
parameters. These cardiovascular, renal, neural hormonal,
endocrine and other
changes result in the
elderly patients being less
able to recover from hypoglycemia, hypotension,
confusion and delirium. It
is useful to recognize that
the goals of care may be
quite different in elders.
Tight glucose control may
not be the goal of treatment in elders due to their
increased risk of falls, decreased ability to survive hypoglycemic
events and decreased need to prevent end organ damage with
respect to their expected survivability (19). The same approach
is useful with respect to blood pressure control in elders.
Reaching JNC7 guideline recommendations in elderly patients
may be a recipe for disaster if the patient falls due to hypotensive events or experiences marked orthostasis (20). At the age
of 80 or earlier with weaker patients or anyone with Parkinson’s
Disease, a standing blood pressure should be the measure of
safety, not a seated one.
Safe Prescribing in Frail Patients
The Beers Criteria is a comprehensive reference addressing
medication use in frail elderly patients. There’s an updated
version: Updating the Beers Criteria for Potentially
Inappropriate Medication Use in Older Adults: ARCH INTERN
MED/VOL 163, DEC 8/22, 2003, and can be found at www.archinternmed.com. The Beers Criteria lists medications that should
be avoided in the elderly, as well as listing alternatives that are
safer. Polypharmacy as a morbidity however, is difficult to quantify and predict because each individual patient has her own
mix of diseases, altered physiology, drugs (OTCs too), and cognition. Thus a seemingly very frail patient may do well on a
J U LY 20 09
35
Beers drug while a robust-appearing younger patient may suffer
adverse consequences on the same medication. So, the Beers
Criteria attempts to lessen adverse events by avoiding certain
drugs but is not an absolute mandate. The mixing of multiple medications in any given patient is
an experiment that has not been studied and verified through
the scientific literature because it is impossible to control for all
the confounders in clinical trials. Prescribers can through good
history taking, accurate diagnosis, understanding of frailty and
drug behavior (utilizing drug data bases such as Lexicomp®,
Micromedex ®, Epocrates®) anticipate drug related problems
and minimize their impact. An approach that emphasizes drug reduction and asking
“What medication can I discontinue today?” can markedly
impact morbidity and mortality beyond the level of today’s
current practices (21). Awareness of the risk factors for adverse
drug events (Figure 5) can assist prescribers with recognition of
patients likely to have poor outcomes with their medications.
The Beers Criteria, discovery of unreported medication use, detailed history
taking (even using ancillary health care professionals and the patient
themselves to assist),
awareness of physiological
compromise, using elder
appropriate goals of care
and overcoming literacy barriers can move us closer to reducing
the polypharmacy risk.
Figure 5.
Demetra Antimisiaris, PharmD, and James G. O’Brien, MD, are
members of the faculty of the U of L Department of Family and
Geriatric Medicine. The department’s Polypharmacy Initiative
was funded by Jean Frazier to support research on polypharmacy and to combat its potential for patient harm. References
1.
2.
3.
4.
5.
6.
U.S. Census Data AGS: Underrepresentation of Older Adults in Clinical Trials. http://www.americangeriatrics.org/policy/
clinical_trials.shtml Hanlon JT, et al. Epidemiology of over-the-counter drug use in community dwelling elderly: United States perspective. Drugs Aging. 2001;18:123-131
Slone Survey, Boston College. Patterns of Medication Use in
the United States. http://www.bu.edu/slone/SloneSurvey/AnnualRpt/
SloneSurveyWebReport2005.pdf Denham MJ, Adverse Drug Reactions. Brit Med Bull 1990 (46): 53-62
Bath, PA et al. Identification of Risk Factors for 15-year Mortality Among Community-Dwelling Older People Using Cox Regression and a Genetic Algorithm. Journal of Gerontology, 2005. (60A) 8, 1052-1058.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Woodford H, Walker R. Emergency hospital admissions in idiopathic Parkinson's disease. Mov Disord. 2005;20:11041108. Hanlon JT, Schmader KE, Ruby CM, Weinberger M. Suboptimal prescribing in older inpatients and outpatients. J Am Geriatr Soc. 2001;49:200-209.
Alzheimer’s Disease Foundation and Referral Center, National Cancer Institute, Am Diabetes Assoc, Arthritis Foundation, National Center for Health Statistics, National Parkinsons Foundation, National Stroke Foundation.
Express Scripts: http://expressscripts.com/ourcompany/news/outcomesresearch/
Novartis, Pharmacy Benefits Report, Facts and Figures, 2007
Edition Gurwitz, Jerry MD(quotation): Meyers Primary Care Institute Fallon Foundation and University of Massachusetts Medical School
Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older
adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163:2716-2724.
Nourjah, P et al. (2002, September). Safety analysis of acetaminophen (APAP)-associated hepatotoxicity. Presentation at the meeting of the U.S. Food and Drug Administration’s Nonprescription Drugs Advisory Committee, Rockville, MD
Temple AR, et al. Clinical Therapeutics. Multicenter, randomized, double-blind, active-controlled, parallel-group trial of the long-term (6-12 months) safety of acetaminophen in adult patients with osteoarthritis 28(2):222-35, 2006. Oberhauser V, et al. Acetylcholine release in human heart atrium: influence of muscarinic autoreceptors, diabetes, and
age Circulation 2001; 103:1638-1643
Tayabati SK, et al. Age-related changes of muscarinic cholinergic receptor subtypes in the striatum of Fisher 344 rats. Exp Gerontol. 2004; 39: 217-223.
Parra, D et al. The Effect of Acetaminophen on the International Normalized Ratio in Patients Stabilized on Warfarin Therapy. Pharmacotherapy 2007 27 (5): 675-83
The Action to Control Cardiovascular Risk in Diabetes Study Group (ACCORD) Effects fo Intensive Glucose Lowering in Type 2 Diabetes NEJM 358;24 www.nejm.org june 12, 2008
Oates, D et al. Blood Pressure and Survival in the Oldest Old.
JAGS 2007 55 :383-388
Garfinkel D, et al. The war against Polypharmacy: A New Cost-Effective Geriatric-Palliative Approach for Improving Drug Therapy in Disabled Elderly People IMAJ 2007;9:430–
434. LM
J U LY 20 09
37
Medaling In Mettle
By Matthew Ralph
W
hen second-year medical student Jenny Bland
finally reached the home stretch of the Kentucky
Derby Festival Marathon, she had given just about
all she could give on a scorching hot day were
even the most experienced marathoners were pressing to the
finish. With her knees threatening to buckle beneath her, Ms.
Bland looked up and saw a four-year-old boy in his mother’s arms
waiting to run the last 15 yards with her. The boy was Aiden Johnson, of Sellersburg, a kid who for two
years has shown the kind of mettle and courage battling acute
lymphocytic leukemia that pales in comparison to the four-hour
struggle and test of will Ms. Bland experienced on April 25. Wearing the yellow bracelet Aiden had given her before the
race, Ms. Bland greeted the boy she would give her medal to in
the Red Cross tent, mustering up the strength to smile at a child
whose own courage made the running of the 13.1 and 26.2-mile
half marathon and marathon for Ms. Bland and a dozen of her
classmates all the more significant. “To tell the truth, thinking about seeing Aiden at the finish is
what got me there,” Ms. Bland said after the race. “I desperately
wanted to stop running the race several times, especially when
the course passed within a couple blocks of my house. But I kept
thinking about little Aiden at the finish and told myself that I had
to get there for him.”
Coordinated through an Indianapolis-based program known
as Medals4Mettle, the idea for a local exchange of medals from 13
medical student marathoners to cancer patients came to med
student Riley Jones when he says he should have been studying
for a Gross Anatomy test.
“I wanted to donate my medal but keep it here in Louisville,”
said Mr. Jones, who e-mailed Medals4Mettle founder Steven
Isenberg, MD, about his idea and started recruiting other med students to participate. Normally, participants in the Medals4Mettle
program mail their medals in and the organization then presents
them to patients. But thanks to Mr. Jones’ inspired study break
and a joint effort between students and faculty, the student
runners were able to meet the recipients before the race and
present their medals in person a day after the race. Mr. Jones, like
Ms. Bland, was even able to run the last few yards to the finish line
with the medal recipient. Approaching the finish line of the half marathon, Mr. Jones
38
Photos: (top right) Carter Dewitt & Riley Jones (photo by Kate Eldridge),
(bottom left to right) Med students Joshua Yuen, Joel Lanceta & Riley
Jones. Jenny Bland & Riley Jones. Jason & Gena Johnson wait with their
son Aiden near the finish line. Riley Jones, Jenny Bland, Gena & Aiden
Johnson.
spotted 10-year-old Carter Dewitt and knowing his leg had been
bothering him asked if he wanted to walk the rest of the way to
the finish line. Carter’s response: “No, I want to run.”
Mr. Jones said knowing that Carter would be there waiting
near the finish line gave him “an extra spring” in his step and an
appreciation for the little things he can do as an aspiring physician
with an already full schedule to make a difference. Salvatore Bertolone, MD, chief of the U of L Division of
Hematology, Oncology, Blood and Marrow Transplant, said participation in a program like Medals4Mettle will make the students
better doctors. “It’s one thing to read about a disease and another to see the
impact that disease has on patients and their families,” Dr.
Bertolone said. “This makes it real.”
Ms. Bland echoed Dr. Bertolone’s statement in her own
description of the experience.
“We learn so much in school about different diseases and illnesses, but medicine is more than that,” Ms. Bland said. “It’s about
the people who have to live with the diagnoses we make and the
treatments we offer.”
Running along with Ms. Bland and Mr. Jones were students
Elizabeth Doll, Sarah Todd, Alex Sweet, Martin McKinney, Joshua
Yuen, Marc Ettensohn, Wes Brown, Brent Road, Stevie Carraro,
Jennifer Wrubel and Mark Noll. The medal recipients ranged in
age from three to 17 and all but two are undergoing treatment
for acute lymphocytic leukemia or brain, bone and ovarian
cancers. They were chosen in consultation with the child psychologist and nursing staff of the U of L faculty-operated Pediatric
Hermatology/Oncology Specialists.
Aiden’s mother, Gena Johnson, said the marathoners’
Kentucky Derby Festival sacrifice was an inspiration.
“The one thing she’s earned for all her hard work she’s giving
to Aiden,” Ms. Johnson said. “That’s just selfless.” L
M
BUSINESS CARD GALLERY
Jackie Lovett, CPC
Sr.MedicalBillingAdministrator
4010DupontCircle,Suite418
Louisville,KY40207
p:502.217.5309
p2:502.714.1410
Ken Reutlinger
DIRECT 502.271.2724
OFFICE 502.425.0225
TOLL FREE 800.837.5696
FAX 502.425.7793
www.WRrealtors.com
e:[email protected]
www.RemoteAccessBillingLLC.com
“AroundTheClockServices”
[email protected]
Simply an extension of your office
following HIPAA guidelines, providing quality,
expeditious and confidential services.
Specializing in
medicalcoding,pre-auditing,chargeentry,
secondaryclaimprocessing,insuranceverification,follow-up,paymentposting,creditbalances,
correspondence,scanningandqualityassurance.
Practice Administrative Systems
“ Outsource your billing problems,
increase your collection income. “
(502) 371-9700
Lindsay A. Hudson, C.P.C.
WALKER COUNSELING SERVICES, INC.
• 20 Years Private Practice
• Specializing in Bowen Systems Theory
• Individual • Couple • Marital & Divorce
• Family • Group
Maureen A. Walker, M.A.
KY Board Licensed, Clinical, Marriage and Family
Systems Psychotherapist
Office (502) 425-5482
Direct (502) 553-5482
YOUR REFERRALS ARE ALWAYS APPRECIATED
East End Location: Lynnhurst Office Centre, 8009 LaGrange Road, Suite 4, Louisville, KY 40222
Do you have a
physician who will be
joining your practice?
Do you plan
an office
relocation?
We Offer A Professional
Announcement Package Service
Call or email for more information
Cheri K McGuire
Director of Marketing
502.736.6336 or [email protected]
A service provided by Medical Society Professional Services
J U LY 20 09
39
ADVE RTI SERS’ INDEX
Baptist Hospital East
IBC
MAG Mutual Insurance Co
12
CB Richard Ellis Louisville
14
Medical Protective Co
19
Concentra
17
Hospital Internal
Medicine Associates
29
www.himassociates.com
Jewish Hospital
St Mary's Healthcare
IFC
Keller Williams Realty
Louisville East
(Karen Kraft)
39
Kentuckiana Allergy
Asthma & Immunology
34
Kentuckiana Pain Specialists
25
www.kentuckianaallergy.com
www.painstopshere.com
KMA Insurance Agency
www.kmainsurance.com
9
www.medicalprotective.com
Medical Society
Employment Services
24
Murphy Pain Center
4
www.glms.org
www.murphypaincenter.com
National City (John Allen)
23
National Insurance Agency
33
Passport Advantage
1
Practice Administration Services
39
Prudential Parks Weisberg
(Dave Parks)
36
www.nationalcity.com
www.niai.com
Remote Access Billing
(Jackie Lovett)
39
Republic Bank & Trust Co
9
State Volunteer Mutual
Insurance Co
2
The Pain Institute
OBC
Wakefield Reutlinger
(Ken Reutlinger)
17 &
39
Walker Counseling Services
39
www.republicbank.com
www.svmic.com
www.thepaininstitute.com
[email protected]
CLASSIFIEDS
MedicAl Office cOndO fOr SAle Or leASe
Located at 1005 DuPont Square North, between Norton Suburban Hospital and Jewish Hospital Medical Center East. 2980 Sq. Ft. Call 502-348-9888.
eXecUTiVe HOMe – AliA circle
Luxury freestanding home in maintenance free gated community. Located off Brownsboro Road. Priced BELOW
APPRAISAL. 6700 square feet of beauty. Ebrenz custom built.
Call Karen Kraft / Keller Williams Realty 502-727-1070
HeArTS in MOTiOn
Looking for an unconventional gift for the person who has
everything? Buy a "cinderblock" and help Hearts in Motion, a
501(c)3 organization, build a daycare center for impoverished
children in Gualan, Guatemala. Your $25 tax deductible donation will help us provide for children, whose parents to work in
the fields. All contributors’ names will appear on a plaque
above the door of the daycare center. For more information
contact Lauren or Anne Vaughan at 253-4313.
40
OldHAM cOUnTy PcP-iMMediATe OPPOrTUniTy
Well established, solo practice, seeking full-time or part-time
Certified Internal Medicine & Pediatrics Physician. No routine
hospital rounds, no nights/weekends, call share. CVs to [email protected] subject: 40031-10464.
STOnecreST cOndO: 750 ZOrn AVe UniT #41 $169,900
1600 square feet with 2 bedrooms/baths, bright kitchen,
great/dining room, sunroom/den, laundry, pantry, lots of closet
space and covered porch. Ground Floor. Detached garage.
Insight of VA hospital and approximately 9 minutes to downtown. Sandy Gulick (502)-271-5142 Kentucky Select Properties
TiMeSHAre AVAilABle at Norton Old Brownsboro Crossing:
Great opportunity for part-time lease of a fully equipped physician office including 6 exam rooms. Available in August when
the “new” Norton hospital opens. Please call 587-8000 for more
details.
lOUiSVille HOSPiTAliST PrAcTice
Looking for part time and full time physicians to provide patient
care at Norton Suburban Hospital. CVs to [email protected].
PRSRT STD
U.S. POSTAGE PAID
LOUISVILLE, KY
PERMIT NO. 6
101 WEST CHESTNUT STREET
LOUISVILLE, KY 40202
location
Madison
Hanover
New Albany
Louisville
Shelbyville
Frankfort
The Pain Institute was the first non-hospital pain management facility in this area.
And now, The Pain Institute has expanded to include six locations in Kentucky and
Southern Indiana.
252 Whittington Pkwy. • Louisville Ky 40222
502-423-7246 in Louisville
800-599-7246 toll free in Kentucky
800-788-7549 toll free in Indiana
www.thepaininstitute.com

July 2009 - Greater Louisville Medical Society

Transcription

Similar documents

SHOW PASS

Eric`s Eateries

Seasonal Allergies

mission Vision VaLue - Big Brothers Big Sisters

the collection - The Kentucky Center for the Arts

the lumberyard - Typecast Publishing

LouisviLLe Medicine - Greater Louisville Medical Society

9/10/15 Press Release

gh8224 aba profile sheet_gh8224

LOUISVILLE MEDICINE GREATER LOUISVILLE MEDICAL SOCIETY VOL. 55 NO. 12 MAY 2008