LouisviLLe Medicine - Greater Louisville Medical Society
Transcription
LouisviLLe Medicine - Greater Louisville Medical Society
Louisville GREATER LOUISVILLE MEDICAL SOCIETY Medicine VOL. 60 NO. 9 February 2013 Ralena G. Heart Transplant 2007 More experience in organ transplants. More lives saved every year. Jewish Transplant Care leads Kentucky in both total procedures performed and survival rates for heart, kidney, liver, lung and pancreas transplants. For referral information, call 800-866-7539 or visit jhsmh.org/transplant. Scientific Registry of Transplant Recipient 1/1/08 - 6/30/11 February 2013 1 2 LOUISVILLE MEDICINE GLMS Board of Governors David E. Bybee, MD, board chair Russell A. Williams, MD, president James Patrick Murphy, MD, president-elect Bruce A. Scott, MD, vice president and AMA delegate Heather L. Harmon, MD, treasurer Robert A. Zaring, MD, MMM, secretary and AMA alternate delegate Robert H. Couch, MD, at-large Rosemary Ouseph, MD, at-large Tracy L. Ragland, MD, at-large Jeffrey L. Reynolds, MD, at-large John L. Roberts, MD, at-large Wayne B. Tuckson, MD, at-large Fred A. Williams Jr., MD, KMA president-elect Randy Schrodt Jr., MD, KMA 5th district trustee David R. Watkins, MD, KMA 5th district alternate trustee K. Thomas Reichard, MD, GLMS Foundation president Stephen S. Kirzinger, MD, Medical Society Professional Services president Toni M. Ganzel, MD, MBA, interim dean, U of L School of Medicine LaQuandra S. Nesbitt, MD, MPH, director, Louisville Metro Department of Public Health & Wellness Karyn Hascal, The Healing Place president Adele Murphy, GLMS Alliance president Louisville Medicine Editorial Board Editor: Mary G. Barry, MD Elizabeth A. Amin, MD Waqar C. Aziz, MD Deborah Ann Ballard, MD R. Caleb Buege, MD Arun K. Gadre, MD Stanley A. Gall, MD Larry P. Griffin, MD Kenneth C. Henderson, MD Jonathan E. Hodes, MD, MS Teresita Bacani-Oropilla, MD Tracy L. Ragland, MD M. Saleem Seyal, MD Dave Langdon, Louisville Metro Department of Public Health & Wellness David E. Bybee, MD, board chair Russell A. Williams, MD, president James Patrick Murphy, MD, president-elect Lelan K. Woodmansee, CAE, executive director Bert Guinn, MBA, chief communications officer Ellen R. Hale, communications associate Kate Allen, communications designer Advertising Cheri K. McGuire, director of marketing 736.6336, [email protected] Follow us on Linkedin, Facebook, Twitter and YouTube 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. Louisville Greater Louisville Medical Society Medicine Vol. 60 No. 9 FEbruary 2013 feature articles Integrative Medicine Can All-Too-Short Visit into 11 How 16 An Improve Patient Outcomes Obstetrics in Tanzania and Advance the Accountable Care Organization Model Deborah Ann Ballard, MD, MPH Can a Workplace History 12 What Reveal? Frank P. Vannier, MD Kuric Comes to Louisville 15 Dr. Ellen R. Hale Divya Cantor, MD, MBA Gigi Girard, MD of Louisville National 19 History Medical College and the Red Cross Hospital: African American Medicine in Louisville, Kentucky - 18721976 - Part 2 Morris Weiss, MD, FACC, FAHA, FACP departments 5 From the President Playing Defense Russell A. Williams, MD 24 Reflections Retreading the Retired 7 Alliance News Adele Murphy Lounge 27 Doctors’ Back to the Future 9 In Remembrance Kenneth Holtzapple, MD Steve Wheeler, MD 22 We Welcome You Review 23 Book The Long Walk Teresita Bacani-Oropilla, MD Mary G. Barry, MD How We Got to Where We Are Kenneth C. Henderson, MD 30 Physicians in Print by Judith C. Owens-Lalude Elizabeth A. Amin, MD 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: 4,000 On the cover: The country of Tanzania and its flag. Story on page 16. February 2013 3 Providers who contract with Humana - CareSource enjoy: • Quick Claims Payment and Electronic Fund Transfer (EFT) more than 96% of claims paid within 30 days • No waiting for newborn claim payments when born to an eligible Medicaid mother • Care Management and Care Transitions Programs • Secure 24/7 Provider Portal to Confirm Member Eligibility Humana - CareSource knows that providers are an integral part of meeting our Members’ needs. We are committed to forming strong partnerships with our providers to deliver quality, patient-focused health care. To learn more about how you can become a Humana - CareSource provider, call 1-855-852-7005 4 LOUISVILLE MEDICINE From the President Russell A. Williams, MD GLMS President Playing Defense S ince the presidential election, we have all become more familiar again with Obamacare – especially with the numerous newspaper spreads outlining its ramifications for patients, insurance companies, hospitals and physicians. Many organizations are gearing up to develop methods to reduce the cost of medical care in view of the fact that more of the population will be covered with a fixed pool of monies. We are seeing the development of ACOs, essentially capitated plans, and preventative care in order to have a healthy population, which will likely save some money. As an aside, my thought of preventative care is to slap a $5 tax on a pack of cigarettes and use that money in schools to teach healthy habits (i.e. eating well and exercise). Back to my point, however – a significant part of the fixed pool of money is being wasted. We the physicians are also wasters. I do not see any organizations (hospitals and insurance companies) trying to come up with a solution either. An occasional denial of service by an insurance company may help save money (i.e. when a breast MRI is denied in a patient I have clinical concerns about), but then I may not sleep as well because of the welfare of the patient and risk exposure. I’m talking about the practice of defensive medicine. In a week’s time, as a general surgeon, I’m sure I order several CT scans for abdominal pain that, based on clinical findings, will be of very low yield. It is what most patients expect and it has become knee-jerk to order diagnostics with little clinical basis to support them. If we want to stop wasting billions of dollars nationally, we need to have some effective malpractice reform. I’m not sure how you can have an effective ACO without it. If affiliated with a particular entity, now is a good time to discuss this with hospital administrators. Insurance companies and hospital associations may also be interested in the opinion of physicians on these matters. We should bring this topic back to the top of our agenda in Frankfort and Washington before we see a weeklong series of articles on how physicians waste medical dollars. I was told that, in Kentucky, malpractice reform would require a constitutional amendment that can only happen in even years. Regardless, we should apply a halfcourt press, steal the ball, and maybe next year we can get an alley-oop and a slam dunk. Let’s reopen that dialogue with our legislators, given that you may already be communicating with them regarding other issues. I’m going to the AMA National Advocacy Conference in Washington this month. National malpractice reform seems to have been buried during development of the new health care laws. When I have the opportunity to meet with our national legislators, this will be one of my chief agenda items as the current captain of the GLMS team. LM Note: Dr. Williams practices General Surgery with Associates in General Surgery. February 2013 5 6 LOUISVILLE MEDICINE Alliance News Adele Murphy GLMSA President “You can make more friends in two months by becoming interested in other people than you can in two years by trying to get other people interested in you.” –Dale Carnegie “D on’t criticize, condemn, or complain” is the first principle in Dale Carnegie’s famous book How to Win Friends and Influence People. In 2012, as Frankfort struggled to pass prescription drug laws and then dealt with the aftershock, there was plenty of criticism, condemnation and complaining to go around. These laws are due to be revisited in 2013. While this year may prove to be no less contentious, the GLMS Alliance is planning to take a positive approach. The KMA “Day at the Capitol” is Tuesday, February 12. The KMA and Alliance are teaming up this day to conduct “House Calls,” a health fair designed to promote health education and community service throughout the commonwealth. From 10 a.m. to 1 p.m., our dedicated white lab-coated company will be greeting lawmakers and their staff in the Capitol Annex building. We will be taking blood pressures, handing out healthy snacks and offering educational materials in a caring, friendly environment. This is a great opportunity to make new friends in Frankfort and show our appreciation for the hard work they do. Please try to attend and encourage as many of our members as possible to join in. Afterward, plan to stick around for some great fellowship at a group luncheon to follow our work at the Capitol. Dining in Frankfort is not the only tasty treat on our upcoming GLMS Alliance menu. Due to the popularity of last year’s lunch and cooking demonstration by “Top Chef ” contestant Edward Lee at 610 Magnolia, we will once again be dining and learning in 2013. Mark your calendars for 11 a.m. on Tuesday, Feb. 5, as we reprise our (Left to right) Millicent Evans, Barbara Cox and Dean Furman at the GLMS Alliance luncheon at the Science Hill Inn.; GLMS Alliance members learn about the Christopherson Gross Anatomy Lab in The Old Medical School Building during a tour. gustatory adventure, this time at the exquisite Corbett’s restaurant, 5050 Norton Healthcare Blvd., in northeastern Jefferson County. It might be an odd-numbered year, but we will keep an even keel supporting our medical community’s mission. In 2013, the GLMS Alliance will continue partnering with the Kentucky Science Center, the Greater Louisville Medical Society and Jewish Hospital to bring the highly acclaimed interactive educational program Pulse of Surgery to middle and high school students from all around Kentucky. The GLMS Alliance is also supporting the Center for Women and Families in Louisville by collecting and donating gently used OR scrubs, yoga pants and new men’s and ladies’ underwear. In addition, the GLMS Alliance Doctors’ Day committee is busy planning our lovely annual reception to honor our retired doctors. The luncheon will be March 22, once again at the elegant Audubon Country Club. January and February certainly come at a cold time of the year, but with warm hearts, we have the opportunity to win many friends. If you are interested in being interested in others, please come join us! LM Note: Contact Adele Murphy at [email protected] or 502-664-5925. February 2013 7 JEFFERSON MANOR HEALTH & REHABILITATION 1801 Lynn Way Louisville, KY 502.426.4513 JEFFERSON PLACE HEALTH & REHABILITATION 1705 Herr Lane Louisville, KY 502.426.5600 MEADOWVIEW HEALTH & REHABILITATION 9701 Whipps Mill Road Louisville, KY 502.426.2778 OAKLAWN HEALTH & REHABILITATION 300 Shelby Station Drive Louisville, KY 502.254.0009 ROCKFORD HEALTH & REHABILITATION 4700 Quinn Drive Louisville, KY 502.448.5850 SUMMERFIELD HEALTH & REHABILITATION 1877 Farnsley Road Louisville, KY 502.448.8622 Known for our nursing skills. Loved for our people skills. As skilled and dedicated as Elmcroft nurses are, what really sets them apart is their compassion for the patients they serve. The result: faster recoveries, shorter stays and better outcomes. Call any of our six Louisville communities to find out more. Elmcroft.com/skillednursing 8 LOUISVILLE MEDICINE In Remembrance Kenneth Holtzapple, MD (1931-2012) isville for residency training, and ultimately practice. In 1991, we were a special “couples match,” with me considering a faculty position and her a residency slot, when Dr. Pat asked Dr. H what really was the decisive question, “Will you still be chair while I’m training?” If he had said “no,” we would have considered it a deal breaker, because we found his leadership and his personal strength so valuable. K enneth Eugene Holtzapple, MD, 81, died on Sunday, September 23, 2012, in Steilacoom, Washington, surrounded by family. He was born on August 30, 1931, in Dallastown, Pennsylvania, the son of Curvin and Olive R. (Flinchbaugh) Holtzapple. Dr. H was a graduate of Gettysburg College and Temple University Medical School. After his medical internship at Presbyterian Hospital in Philadelphia, he entered the United States Army Medical Corps and completed his Internal Medicine residency at Madigan Army Medical Center. As a member of the Army Medical Corps from 1960 to 1980, he served in Washington state, Virginia, Germany, Washington, D.C. (in the Surgeon General’s Office), and Georgia. He was instrumental in starting the Army Medical Corps’ Department of Family Medicine and was chief of the first Family Medicine residency at Fort Benning, Georgia. His last Army Medical Corps assignment was chief of the Department of Family Medicine at Madigan Army Medical Center. He continued his teaching and medical career at the University of Louisville School of Medicine, where he was chairman of the Department of Family Medicine, the William Ray Moore Endowed Professor and, eventually, professor emeritus. He continued teaching, seeing patients and precepting in the department until age 79. Dr. Holtzapple was board-certified in Internal Medicine, Family Medicine and Geriatric Medicine. My wife, Dr. Pat Wheeler, and I consider Dr. H one of the key reasons we stayed in Lou- We loved his laugh. He would squint his eyes, rear back in his seat and laugh all over, so that his whole body would shake. Two times that he laughed like that were tied together. Jewish Hospital once gave a party at the Harley-Davidson retail store, where those willing could have their picture snapped dressed in leather astride a big Harley bike. Dr. and Mrs. H were always players, so they suited up and climbed on. The picture was wonderful, so what better place to clandestinely use it than at his gala retirement party, a few years later. Appropriately enlarged, mounted and elegantly framed, it was unveiled as his final gift of the celebration, with the Shangri-Las’ 1964 hit sounding over the loudspeakers, appropriately christening him “The Leader of the Pack!” Based on his many lifetime achievements, he was inducted into Alpha Omega Alpha, the national honor medical society, in 1996. When the School of Medicine needed to expose premed students every year to what it meant to be a doctor in the finest tradition and meaning of the word, we recruited Dr. H to come and interact with them. When Admissions at the School of Medicine needed someone who was respected, thoughtful and insightful (but NOT “dry” ... no, NEVER dry!) to help with interviews and decisions, Dr. H agreed. I’ve said many times, “Dr. H is who I want to be when I grow up.” This is still true. I used to claim that the high point of my career occurred once as I was walking down the back hallway at the Ambulatory Care Building while Dr. H was seeing his patients. “Come here,” he said. I came. “What would you do with this patient?” he asked. I blushed with the honor, quickly scanned the chart of a most difficult patient, looked up and honestly answered, “I’d ask you.” But then, what a privilege it was to be asked to be his doctor. Daunting and yet, with his laidback attitude, he made it possible, even easy. It was interesting to negotiate diagnostic and therapeutic decisions with him; he always had his opinion but respected mine as well. It was daunting, even easy ... until ... the cancer. Then the things I’d seen him model, learned from him about approaching hard issues and having hard conversations with patients, had to be applied to our relationship, to the heartfelt conversations we had. The parts about paying attention to the patient, not just to the disease, became even more important and personal. We loved Dr. H and miss him terribly. When you teach and model patient care for others, your knowledge, influence, ideas and approaches reach far beyond those relatively few patients you can personally touch. As a role model and mentor to thousands of students at all levels, Dr. Holtzapple’s life’s work and legacy will continue gently to improve the care of patients across the country for generations to come. As usual, Dr. H summarized his life and thoughts best in a September 2011 response to his nomination for an “Optimal Aging” award: “Why the hell does a grumpy grouchy old man get nominated for ‘Optimal Aging?’ What’s going on? At any rate, here are a few thoughts which I believe describe my path to so-called ‘optimal aging’ ... caring, supportive parents; good education; wonderful marriage, without question the most important factor; loving caring children, grandchildren and in-laws; very enjoyable fulfilling career in a profession I love; varied interests in areas outside my professional field; no desire to ever permanently retire; always looking ahead to the future.” Dr. Holtzapple is survived by his wife of 57 years, Patricia DeHoff Holtzapple; by his sisters, Yvonne R. and Mary E. Holtzapple, and Betty Amick (Allen); by his children, Ann Bender (Mark), Sue Bender (Matthew) and Samuel Holtzapple; and by his beloved grandchildren, Grace E. and Matthew A. Bender. If desired, memorial contributions can be made to: The Kenneth E. Holtzapple Award for Excellence in Humanistic Medicine University of Louisville Health Sciences Development Office 132 E. Gray St. Louisville, KY 40202 LM –Steve Wheeler, MD February 2013 9 LEAVE THE WORRIES TO US Call GLMS for Your Staffing Needs CLERICAL | CLINICAL | MANAGEMENT | ALLIED HEALTH Themes: Practicing/life physician category: “Challenges in Medical Practice” Physician-in-training/medical student category: “Medical Mentors” Length: 800 to 2,000 words. Format: Do not put your name on your essay, but include a separate cover letter with name, entry category, essay title and contact information. Medical Writing for the Public Award: In addition to the regular contest, GLMS offers a special award, Medical Writing for the Public. You may enter an article of any length, written on a medically related topic for readers in the general public, that was published in a printed newspaper, magazine or book anytime during 2012. The submission may not be a self-published work. Include a copy of the article along with a cover letter with the name and date of the publication and your contact information. WE PROVIDE: » Direct placement » Temporary placement » Temp to hire WE GUARANTEE: » Criminal background checks » Reference checks » Credit checks » Drug screening » Skills testing Deadline: Monday, April 1, 2013. Submission: Send via email as an attachment to Ellen Hale at [email protected]. Email submissions are highly preferred, but if not possible, send entry by fax to 502-736-6339 or by mail to 101 W. Chestnut St., Louisville, KY 40202. All entrants must be GLMS physician members or GLMS in-training members or University of Louisville medical students. 10 LOUISVILLE MEDICINE Serving greater Louisville and southern Indiana with a 60-year track record of quality and dedication. Call Ludmilla Plenty, employment director, at 502-736-6342 or visit us at www.glms.org. MedicaL Society Professional Services A Greater Louisville Medical Society Company How Integrative Medicine Can Improve Patient Outcomes and Advance the Accountable Care Organization Model Deborah Ann Ballard, MD, MPH A ccording to the Consortium of Academic Health Centers for Integrative Medicine (this includes such highly respected institutions as Harvard, Yale, the Cleveland Clinic, Boston University, the University of California, San Francisco, and Duke University): “Integrative Medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing.” Thus integrative medicine can achieve many of the objectives of an Accountable Care Organization. When combined with traditional medicine, it can complete the continuum of care to improve patient outcomes and reduce overall medical costs. Integrative medicine empowers people with knowledge and skills they can apply in their everyday lives to heal faster, control pain and anxiety, and reverse diseases caused by an unhealthy lifestyle. Integrative medicine activates the human body’s own natural healing mechanisms, provides techniques for self-management of pain and anxiety, and teaches coping skills that empower people to overcome illness and injury. It is a powerful means to reduce human suffering. According to the Centers for Disease Control and Prevention, 85 percent of chronic diseases and 40 percent of all cancers are preventable through proper diet, exercise and avoidance of tobacco. Optimal nutrition, physical fitness and stress management are the foundations of integrative medicine and have immense potential to prevent illness as well as treat conditions already present. Furthermore, integrative medicine is not an episodic approach to disease or injury management. It provides a means to change one’s lifestyle permanently and maintain health after the illness or injury is treated. The passage of House Bill 1 by the Kentucky legislature last year has left physicians looking for alternatives to narcotics and other controlled substances to treat pain and anxiety. Integrative medicine can offer evidence-based therapies such as acupuncture and healing touch to meet this acute need. Integrative medicine includes therapies formerly labeled as complementary and alternative medicine. There is a growing body of evidence on the effectiveness of many integrative therapies. The Consortium of Academic Health Centers for Integrative Medicine is dedicated to applying the same rigorous evidence-based standards to integrative therapies as have been applied to traditional therapies. In February 2012, the Bravewell Collaborative released a landmark study, “Integrative Medicine in America: How Integrative Medicine Is Being Practiced in Clinical Centers Across the United States,” which provides current data on the patient populations and health conditions most commonly treated with integrative strategies. and knowledge as well as a professional commitment to adhere to the American Board of Physician Specialties (ABPS) Medical Code of Ethics. The ABPS anticipates accepting ABOIM® applications starting in July 2013. Certified physicians can be located on the ABOIM website: http://www.abihm.org/search-doctors. The Kentucky Board of Medical Licensure has authority over acupuncturists. Integrative medicine is an evolving field. It is important to make sure integrative physicians and other practitioners have shown a dedication to a high standard of evidence-based care and professional ethics by training at a reputable institution, obtaining board certification and obtaining continuing medical education on the specialty. Integrative medicine’s time has come. Integrative medicine does not replace traditional evidence-based therapies. It provides a means to assure their success, promote optimal healing, reduce suffering and prevent future illnesses. LM Note: Dr. Ballard is with Holiwell Health Consultation. According to the CDC, in 2007, approximately 38 percent of adults aged >18 years reported using complementary and alternative medicine (CAM) during the preceding 12 months. Women (43 percent) were more likely than men (34 percent) to use CAM. In 2007, adults in the United States spent $33.9 billion out of pocket on visits to CAM practitioners and purchases of CAM products, classes and materials. The Consortium of Academic Health Centers for Integrative Medicine has training opportunities for integrative physicians and other practitioners. If an integrative practitioner trained at one of the consortium members or affiliates, he or she has completed an evidencebased curriculum. Physicians completing the Integrative Medicine board certification (ABOIM) demonstrate mastery of the specialty experience February 2013 11 What Can a Workplace History Reveal? Frank P. Vannier, MD T he histor y of a patient’s workplace activities is an obvious and essential component of the care provided in an Occupational Medicine practice. This workplace history, however, at times can play a role in delineating causes of symptoms and clinical issues in the primary care practice. Therefore, when the primary care physician encounters patients it is helpful to consider a workplace origin of the clinical problem. Taking an occupational history can make the difference between a complete versus an incomplete diagnostic and treatment plan. If you are caring for someone whose asthma has proved difficult to manage, and may have been associated with exacerbations at work, the occupational history is meaningful. Someone who works in the auto repair industry can be exposed to the isocyanate compounds, which are often a component in spray-on polyurethane products. These compounds are a significant irritant and also a potent sensitizing agent. This can cause asthma that is difficult to treat without addressing exposure in the workplace. At times, smaller companies may not be aware of all the characteristics of products that they employ and may not provide the ideal personal protective equipment for their workers. The primary care physician can here play a valuable role in identifying this etiology. The isocyanate compounds are also used in building-insulation materials. Spray-on polyurethane chemicals have been used to protect cement, fiberglass, steel and aluminum products, so ask questions about what your patient is working with and how he or she might be exposed. For example, a young man of 25 presented to our office with a history of transferring to a 12 LOUISVILLE MEDICINE work area where a coating was being applied to manufactured product. He presented with a non-productive cough associated with his work station and a tendency to feel short of breath. He did not have a previous history of asthma or respiratory dysfunction. The fact he had recently transferred to the area where the industrial coating was applied appeared to suggest the possibility of occupational asthma. On physical examination, he had bilateral scattered end expiratory wheezing. Exhalation also tended to precipitate a cough. The chest X-ray was clear. The pulmonary function testing was consistent with mild obstructive disease. The bronchodilator albuterol was prescribed to use as needed. A call was made to the plant requesting MSDS information (material safety data sheets) for the polyurethane coating that was being utilized. It then became clear that an isocyanate component was used in this product, and that a negative pressure respirator as personal protective equipment was indicated for this work process. After our patient began using the negative pressure respirator, his shortness of breath and cough resolved. If symptoms persist in spite of personal protective equipment (e.g. this respirator), transfer of the individual to an area free of exposure to the specific entity is recommended. Cobalt is often combined with tungsten in the workplace to form an alloy called carbide that has significant resistance to wear. Cobalt can serve as a sensitizing entity and can cause contact dermatitis. Occupational asthma can also occur with exposure to cobalt, and a pneumoconiosis called “Hard Metal Lung Disease,” a chronic lung disease developing over an extended period, is associated with long-term cobalt exposure. For patients with respiratory symptoms, the occupational history should include questions about cobalt exposure. As doctors, we are aware of latex allergy and realize that the existence of dermatologic, respiratory and in certain circumstances even anaphylactic reactions can occur with latex, which is omnipresent in patient care. Ask food service workers, transporters, and maintenance and housekeeping workers about latex exposure, not just nursing and pharmacy staff. Pre-work shift and post-work shift pulmonary function testing or peak expiratory flow testing with an individual peak flow monitor can be utilized to assist in the diagnosis of occupational asthma. In addition, heat, cold, dust, co-workers’ cigarette smoke or perfumes, and environmental allergens including molds and grasses all can play a part. Think about what your patient faces in his or her work day to help you make a diagnosis and guide evaluation and treatment. As we can see, determining the occupational history in our patients can serve to aid the process of determining the etiology of the symptoms associated with the clinical problem for which the patient has sought medical care. LM Note: Dr. Vannier is a member of the new GLMS Environmental Medicine Committee. He practices Occupational Medicine with Occupational Physician Services of Louisville. NIA, ExcEllENcE IN SErvIcE. With over $50,000,000 in group life and disability insurance plan benefits paid to Kentucky professionals and their families since 1957, National Insurance Agency is proud to introduce New York Life Insurance Company as the new underwriter beginning July 1, 2012. Underwritten by new york Life insUrance company, 51 madison avenUe, new york, ny on poLicy forms Gmr and sip-di-1ky www.niai.com • Phone 502-425-3232 • w r l @n i a i . c o m February 2013 13 14 LOUISVILLE MEDICINE job number: date: client: 52218_B7_C1-1 06/06/12 RLX Dr. Kuric Comes to Louisville Ellen R. Hale K atie Kuric was the goalkeeper for the University of Louisville soccer team. Kyle Kuric was a star on the U of L basketball team that went to the Final Four last year. Now, Steven and Judi Kuric, the proud parents, have come to Louisville with their own special talents – treating neurosurgery patients. Steven Kuric, MD, joined Michael Doyle, MD, in practice last fall after 20 years practicing in Evansville, Indiana. Judi Kuric is an APRN. Though Kyle graduated in 2012 and is currently playing professionally in Spain, Katie remains in Louisville as a first-year dental student at U of L. The Kurics decided to give up the two-hour drives and embrace Louisville as their new home. Both Indiana natives, Steven was a medical student at Indiana University and Judi was a nursing student when the two met in anatomy class. Dr. Kuric graduated from medical school in 1982 and completed his neurosurgery residency at Wayne State University in Detroit. With her husband working all the time, Judi said, she went ahead and earned her master’s degree. (Above left) Kyle Kuric in the “infrared” uniform worn during the Cardinals’ unexpected postseason run.; (above right) The Kuric family celebrates on the court after Louisville’s victory over Florida to go to the Final Four: (left to right) Judi, Kyle, Steven and Katie. for the Asefa Estudiantes on a two-year contract. The Kurics visited for the first time in late December. “He likes playing basketball, and he’s getting paid to do it,” Dr. Kuric said. The proposal story made its way to Spain, where a magazine article billed Kyle as “El Ultimo Romantico.” Fans have already requested Louisville T-shirts. “It’s just incredible fan support,” Judi said. The Kurics continue to marvel at Kyle’s fan support in Louisville as well. “Louisville adopted him,” Judi said. She recalls how Kyle, before his senior year began, wanted to find a way to give back to Louisville. He brought children with cancer who attended Indian Summer The Kurics on graduation day at the Camp to a U of L scrimmage, then organized a University of Louisville. drive for Halloween costumes for children at the Home of the Innocents. The charity was named Kyle’s Korner for Kids. At Both of their children played sports from an early age and displayed a Christmas, fans donated more than 2,000 toys that the Kurics distributed competitive spirit. “We did not play board games in our household,” Judi to several charities, including at Kosair Children’s Hospital on Christmas said, laughing. “They do not like to lose.” Day. Teammates Peyton Siva and Elisha Justice joined Kyle in visiting the Fast-forward to 2010 and the Cardinals’ final game in Freedom Hall. ICU and oncology unit. All patients were invited to the lobby to select a Kyle, a sophomore who had been averaging just three points, scored 22 in gift. “The people of Louisville made it happen,” Judi said. the second half to lead Louisville over top-ranked Syracuse. She recalled meeting a mother of five children, one of whom had been “Still, to this day, I can’t believe it happened,” Dr. Kuric said. readmitted to the hospital two days before Christmas due to chemotherapy complications. “We were just getting ready to tell our kids we didn’t have any Capping his career with a Big East championship and trip to the Final Christmas for them,” the woman told Judi. “This is an answer to our prayers.” Four “was almost like a dream – no one was expecting it,” Dr. Kuric added. The Kurics were able to travel to Portland, Phoenix and New Orleans for all the games during the Cards’ NCAA tournament run, returning to catch up on work in Evansville between trips. Even with its founder overseas, Kyle’s Korner for Kids held a second Christmas toy drive at a home game this December. Judi said she kept wondering if each game would be Kyle’s last for U of L, particularly when the Cards were down late to Florida in the Elite Eight. “When they pulled that out, we couldn’t believe it. We knew how hard he and the team had worked for it,” Judi said. “It was something he had wanted so badly. He wanted to do the Final Four.” Note: Ellen R. Hale is the communications associate for the Greater Louisville Medical Society. “Certainly, we’re happy for what he’s accomplished on the court but also for what he’s accomplished off the court,” Dr. Kuric said. LM Kyle’s notoriety didn’t end with the basketball season, however. He generated headlines when he proposed to his girlfriend, Taraneh, on stage as she received her diploma from the U of L dental school in May. They’re planning a July 2013 wedding from Madrid, Spain, where Kyle is playing February 2013 15 An All-Too-Short Visit into Obstetrics in Tanzania Divya Cantor, MD, MBA, Gigi Girard, MD T anzania is a country known for its rich culture, spectacular landscape and wildlife wonders. Despite this great beauty, most Tanzanians live with very limited resources. On a recent trip there, we wanted to explore the obstetrical services available to women in this country and also look at some of the cultural differences and practices in regards to circumcision. We interviewed a private practice obstetrician in the city of Arusha, and we also got to interview the Maasai about their traditions as well. Dr. Amal Nur is a solo OB-GYN who practices in her private, freestanding birthing center. She is originally from Somalia and trained in Kiev, Ukraine. Although this facility is relatively new, her clinic has the ability to provide vaginal deliveries and postpartum care to those patients seeking her care. She currently performs 10-15 deliveries per month; if her patient needs a C-section, she will transport her in the clinic’s ambulance to the nearby hospital. Indications for Dr. Nur’s C-sections are the same as U.S. OB doctors are familiar with: breech, fetal distress and obstructed labor. Her unofficial rate of “switch to section” is 25 percent. When describing antepartum care, Dr. Nur states she will often see patients after just one missed period. In these cases, patients will generally be seen seven to eight times during the gestation of the pregnancy. She has two ultrasound machines in the clinic, one located in the office and the other in the L&D area (an ultrasound will cost $25 to the patient). Ultrasounds are performed for dating on her patients, and she will draw a panel of blood work at 13 weeks. She states she has approximately five HIV positive patients per year. She is able to treat them with basic medications with PMTC and ARV but if they are in need of further treatment, she refers them to the public hospital that provides the treatment for free. At 20 weeks, a fetal survey US will be performed and a two-hour GTT is standard at 28 weeks. Despite carbohydrates being a dietary staple for Tanzanians, diabetes is not very 16 LOUISVILLE MEDICINE (Clockwise from left) Dr. Divya Cantor (left) and Dr. Gigi Girard outside the clinic entrance; The Mother Medical Care clinic’s private ambulance, which takes patients with emergency needs to the hospital where additional care can be provided; Dr. Amal Nur. common, probably because their society does not appear to be sedentary. Everyone walks as their primary mode of transportation. Infants born after 28 weeks will have the greatest chance of survival in Tanzania. If a patient of Dr. Nur is at risk for pre-term delivery, she will hospitalize her and is able to augment labor with IV oxytocin. For postpartum hemorrhage management, she has only oxytocin to help. Patients in labor preparing for a vaginal delivery do not receive any analgesics other than local anesthesia for episiotomy repair. On occasion, a pudendal block will be administered during the second stage of labor. Patients will stay 24 hours after an uncomplicated vaginal delivery. A routine vaginal delivery costs approximately $250; many expatriates rely on her service, as this cost can be prohibitive to the locals. In Tanzania, most nontribal males are circumcised at the hospital between the ages of 5 and 6. Of note, Tanzania has approximately 1.8 million births per year, with an infant mortality rate of 46 deaths per 1,000 live births, according to the 2012 estimate in the CIA World Factbook. The U.S. rate, for comparison, is 6 per 1,000 live births. For mothers, Tanzania’s 2010 maternal mortality rate was 460 per 100,000 deliveries, compared to the U.S. rate of 21 per 100,000. Using the CIA World Factbook definition, the maternal mortality rate in Kentucky has dropped from 17 in 1995 to 7.6 in 2004. The factbook defines MMR as the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes). The MMR includes deaths during pregnancy, childbirth, or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, for a specified year. HIV remains a pandemic in the sub-Saharan countries such as Tanzania. According to UNICEF, in 2010, the prevalence of the population living with HIV is 5.9 percent for all ages; this is equal to 44 million people in Tanzania living with HIV. Services for HIV/AIDS are available, especially in the urban areas of the country. According to a 2011 United Nation AIDS report, HIV prevalence has declined among pregnant women attending antenatal clinics and young people ages 15-24. This is great news for a country where almost one-half of the population is less than 15 years old. Dr. Nur spoke very highly of the Benjamin William Mkapa HIV/AIDS Foundation. This is a nonprofit organization established in 2006 to provide supplemental support to the government of Tanzania. It promotes an equitable delivery of treatment to those in need and includes a reproductive and child health component. More information for those interested can be found online at www.mkapahivfoundation.org. The other part of our journey in Tanzania included a drive through a Maasai village on the way to Tarangire National Park. We noticed an adolescent male with his face painted white. He was also wearing the traditional robe of brightly colored beautiful fabric in red, blue and purple. We were able to learn that there is a group circumcision between the ages of 15 and 18, without anesthesia, as part of the ritual for entering into manhood. These young men are now known as the young warriors, maroni in Swahili. They paint their faces white as evidence of the procedure having been performed. Years ago, the tradition for the maroni was to fight a lion while living in the desert for two months. With the numbers of lions dwindling due to human impact, conservation groups over the past five years have approached the Maasai elders to try and eliminate this aspect of the tradition. These traditions have been slow to change, according to our guide. However, one tradition that has changed is that female circumcisions are rarely performed these days in Arusha, thankfully. While in the Serengeti National Park, we had a Maasai guide who was happy to share with us that both of his children had been born in a hospital, despite the fact that he lives in a very remote community. The Maasai women are encouraged to seek prenatal care and to deliver in a hospital. Some Maasai have greater access due to their proximity to the hospital, but they still may have to walk or, if lucky, get a motorbike to take them to the hospital when in labor. Our guide told us what a wonderful celebration the village had when his son returned home from the hospital, where all the women came to sing to the baby, and a calf was slaughtered in honor of his son. Lab on the premises that can perform many routine lab requests. Despite the fact that 80 percent of the population lives in a rural area, 50 percent of pregnant women have a skilled attendant at birth and 50 percent of pregnant women do an “institutional delivery,” according to UNICEF. Geography, costs and cultural differences may have been barriers to health care for people in Tanzania years ago. However, today there are increasing resources with access to health care reaching into even the most remote areas of this large nation. We enjoyed learning about different aspects of obstetrical care and women’s health in this country. We would invite our colleagues also to go and experience the richness of Tanzania! LM Note: Dr. Cantor is senior physician consultant with Healthgrades and Kentucky Section chair of the American Congress of Obstetricians and Gynecologists. Dr. Girard practices Obstetrics and Gynecology with Associates in Obstetrics and Gynecology, a part of Norton Women’s Care. References www.unicef.org www.indexmundi.com www.cia.gov/library/publications/the-world-factbook/geos/tz.html www.mkapahivfoundation.org The delivery suite with two birthing beds and screens for privacy. February 2013 17 18 LOUISVILLE MEDICINE History of Louisville National Medical College and the Red Cross Hospital: African American Medicine in Louisville, Kentucky – 1872 to 1976 Part 2 Morris M. Weiss, MD, FACC, FAHA, FACP I n the saga of Henry Fitzbutler and Louisville National Medical College, other important characters include Fitzbutler’s wife, Sarah Helen McCurdy Fitzbutler (Fig. 1). Sarah Fitzbutler was a supportive spouse and an intellectual force in her own right. Clearly, she helped Henry succeed in all his diverse endeavors. They married in 1866 and after Sarah arrived in Louisville with three young children, three more offspring were born. Three of their children became physicians, and one died during childhood. After the children grew up and began to leave home, Sarah entered her husband’s Louisville National Medical College and became the first African American female in Kentucky to receive a medical degree. Sarah practiced medicine and treated people free of charge in the tenements and back alleys of West Louisville for years after her husband’s death in 1901. Obstetrics and pediatrics were her forte, and she enjoyed a fine reputation. In addition, Sarah supervised the nursing program at Louisville National Medical College, which at that time was the only institution training African American girls for a career in medicine. Among her other duties, she was superintendent of the Auxiliary Hospital in the 1000 block of Madison Street. In 1907, the 19th Bulletin of the medical college lists her as one of the five directors. She continued to practice in Louisville until her health deteriorated; eventually, she moved to Chicago to be near a daughter, where she remained until her death in 1922. Sarah deserves to be better known among Louisville’s famous citizens because of her great courage, which her grandchildren remarked was her hallmark. Prima, a daughter born in Canada in 1868, graduated from Central High School in Louisville in 1885 and graduated from Louisville National Medical College the year her father died, 1901. Daughter Mary Fitzbutler Waring, born in Canada in 1871, graduated from Central High School in Louisville in 1888 and LNMC in 1898 (Fig. 2). In 1919, during World War I, she was chairman of the Colonel Denison Red Cross Auxiliary; she also was chairman of the Red Cross Colored Women’s Club of the U.S. and president of the National Association of Colored Women from 1933 to 1937. The Fitzbutlers’ son, James H. (some references say “John H.”), was Fig. 1 Dr. Sarah McCurdy Fitzbutler, wife of Dr. William Henry Fitzbutler, a graduate of Louisville National Medical College who supervised and directed the nurses training program in addition to practicing medicine. born in 1873 in Louisville, the year after his parents arrived. He graduated from Central High School in 1890 and Louisville National Medical College in 1893. He first practiced medicine in the Philippine Islands and later in Chicago, Illinois, where he married Mae Hamilton on August 25, 1905. James served for a short period as secretary to the Louisville National Medical College and was professor of surgery, demonstrator in anatomy and surgeon in the Auxiliary Hospital. A daughter Sarah was born in Canada in 1872, just prior to the family’s moving to Louisville, and Myra was born in 1874 in Louisville. Details of their lives are not known. The Caron 1911 City Directory of Louisville, Kentucky, lists Prima Fitzbutler as a teacher at Central Colored School, living at 1027 W. Green, and Sarah H., physician, also living at 1027 W. Green. This was in 1911, 10 years after the death of Henry Fitzbutler. Although Henry Fitzbutler was the driving force behind the medical school, two colleagues were of tremendous help and key role players for him. The most important was Dr. W.A. Burney of New Albany, Indiana. Dr. Burney, a remarkable man in his own right, was born May 11, 1846, in Dublin, Indiana, the son of John Henderson Burney and Elizabeth Mitchell, originally from Guilford County, North Carolina, but raised in Indiana. In 1864, in the Union Army at Indianapolis, he was listed in the 28th U.S.C. Volunteers Co. F as a private. He continued in service until June 24, 1865, and was honorably discharged. Dr. Burney was present at Lee’s surrender to Grant at Appomattox. After his discharge, he moved to Canada, where he worked in a grocery store and continued his education. In 1867, he returned to New Albany and practiced his trade as a plasterer. In early 1868, Burney moved to Kansas (Continued on page 20) February 2013 19 Appendix I Church of Our Merciful Saviour (Fig. 3) This is the Episcopal church at 473 S. 11th St., on the northeast corner of Muhammad Ali Boulevard (Walnut Street). The Fitzbutlers were one of four families that supported this church in its early years. On the east wall is a bronze plaque with Drs. Henry and Sarah Fitzbutler’s names, honoring their endowment of the church. There also is a large stained glass window above the altar on the south wall. The original window was donated by Dr. Prima Fitzbutler in honor of her parents at the time of their deaths. The current window has replaced the original window. When the Fitzbutlers moved to Louisville in 1872, construction had begun on the church and they were early contributors. An endowment fund given long ago by Prima and others honors the Doctors Fitzbutler and still furnishes money for the church’s operating expenses. Fig. 2 Mary Fitzbutler Waring (middle first row), Fitzbutler’s daughter. From Scott’s Official History of American Negro in WWI, Emmet J. Scott, Chapter 28, photo 13. (Continued from page 19) City to practice his trade and to further his education. Later that year, he graduated from Central School in Buffalo, New York, only to return to Indiana to study medicine with his preceptor, Dr. S.S. Boyd of Dublin, Indiana, eventually graduating in 1879 from the Long Island Hospital School of Medicine. Appendix II The Fitzbutler Humanitarian Award at the University of Louisville This is an annual award funded by the Student Government and the Dean’s Office, whose recipient is decided by medical students. Dr. Bart Spurling, a medical student in 2001, and Dr. Leah Dickstein, a retired medical school professor, initiated the Fitzbutler award. The award honors a physician who has contributed most to the humanitarian aspects of the medical profession. Finally, following these sojourns, Dr. Burney returned to New Albany in the fall of 1877 to begin a very large and profitable practice as a consultant surgeon in the surrounding area. In 1880, he joined the Floyd County Medical Society and was elected vice president in 1884 and became president the same year due to the death of the elected president. In 1886, he was elected a member of the New Albany City Board of Health. In addition to all these duties, he and William Octah Vance published a newspaper, The Weekly Review, for the local African American community from 1881 to 1883. He also was a contributor to the Ohio Falls Express, the newspaper published by William Henry Fitzbutler across the Ohio River in Louisville. Over the years, many awards and honors came his way. His office and residence was at 111 E. Elm St. in New Albany until 1906, when he retired and moved to San Diego, California, where he died in 1911. His offices in the Louisville National Medical College included trustee, professor and dean, 1901-1906 (after the death of Fitzbutler). The other physician who worked with Drs. Burney and Fitzbutler was Dr. Rufus Conrad, a Louisville osteopath who went with Drs. Burney and Fitzbutler to petition the Kentucky State Legislature for the right to open a medical school. No other biographical data is available on Dr. Conrad. Fig. 3 Church of Our Merciful Savior, endowed by the Fitzbutler family, 473 S. 11th St. 20 LOUISVILLE MEDICINE Appendix III The Fitzbutler Jones Medical Society Award, University of Michigan The Fitzbutler Jones Society is an organization of African American University of Michigan medical students. The group honors African American students and raises scholarship funds. Sofia Bethena Jones was the first female African American graduate of the University of Michigan College of Medicine. She devoted her life to promoting the health of African American women. After her graduation from UM College of Medicine in 1985, she joined the faculty at Spelman College in Atlanta and initiated a nurse training course. She practiced medicine in St. Louis, Philadelphia and Kansas City during her professional career. Appendix IV A Few Bits of Ephemera to Help Better Refine Henry Fitzbutler’s Extraordinary Vitality and Existence In 1875, Fitzbutler backed two black men who attempted to buy theater tickets to watch a play. They were blocked from purchasing tickets. Fitzbutler said the Civil Rights Act gave them this right. This was possibly Louisville’s earliest theater sit-in; a trolley car sit-in took place in 1871. Fitzbutler ran for the school board and “other elected positions” over a 20-year period – and lost. He formed the R.B. Elliott Club, a black political organization, and was very active in all Louisville elections in the 1890s. But he never was elected to any office – not even the school board. The “Marse Henry” story: Fitzbutler took on the powerful patriarch Henry Watterson, the owner, publisher and editor of The Courier-Journal (Fig. 4). This episode occurred during Fitzbutler’s civil rights activities. In an article in his (Fitzbutler’s) paper, he refers to a gentleman by the name of “Marse Henry.” Fitzbutler wrote of him in a derogatory sense, presumably because of Watterson’s racist attitude. Watterson filed suit against Fitzbutler and his newspaper, the Ohio Falls Express, demanding $5,000. “Marse Henry” is a derogatory term for a Southern plantation owner of slaves. In his newspaper article, Fitzbutler never mentioned Henry Watterson by name. In a rather clever court defense, Fitzbutler said, “If Henry Watterson considers himself ‘Marse Henry,’ that’s his problem, not mine.” Fitzbutler won the lawsuit. Unfortunately, there are no records in the courthouse or in the newspaper of this event. Whether it was purged after the trial or this is an apocryphal story is unknown. In any case, it beautifully defines Fitzbutler’s personality and lifestyle. Fig. 4 Henry Watterson, owner and publisher, The Courier-Journal, circa 1895. Appendix V Key Sites in the Fitzbutler Saga 1891: William Henry Fitzbutler’s home – 1110 W. Madison. Other members of the Fitzbutler family in Louisville between 1891 and 1909: • James H. Fitzbutler, son. Clerk at Post Office. • Home: 1110 W. Madison. • Marie H. Fitzbutler, daughter. Teacher, Eastern Colored High School. • Home: 1110 W. Madison. • Prima Fitzbutler, daughter. Teacher, Western Colored High School. • Home: 1110 W. Madison. • Sarah Fitzbutler, wife, MD. • Home: 1110 W. Madison. 1891: William Henry Fitzbutler. 503 Center (apparently his office). Church of Our Merciful Saviour, 11th and Muhammad Ali (formerly Walnut Street). The Fitzbutler family church, which they helped endow. LM Note: Dr. Weiss practices Cardiovascular Diseases with Medical Center Cardiologists. He is a member of the Innominate Society, Louisville’s medical history society. February 2013 21 WE WELCOME YOU 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 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. LM Candidates Elected to Provisional Active Membership Honaker, Joshua Travis (4233) Michelle 1930 Bishop Ln Ste 1600 40218 272-5005 Pediatrics 01,09 U of Louisville 98 22 LOUISVILLE MEDICINE Pratt, Jonathan William (31368) 220 Abraham Flexner Way Ste 1100 40202 584-3377 Physical Med. & Rehab. Pain Management West Virginia U 07 Book review The Long Walk: Slavery to Freedom Judith C. Owens-Lalude Anike Press, Louisville, 2012 Reviewed by Elizabeth A. Amin, MD J udith C. Owens-Lalude is a Kentuckian by birth and grew up in Louisville. She is a nationally and internationally recognized educator. She has traveled widely, researching the impact of language and writing on childhood development. She has taught on the staff of the University of Louisville’s Delphi Center, the JCPS Life Learning Program and Bellarmine University’s Continuing and Professional Studies Program. In 2002, she established the j. camille cultural academy that primarily focuses on encouraging women and girls to pursue their writing interests. Ms. Owens-Lalude lives in Louisville with her physician husband, A. O’tayo Lalude, MD, a longtime member of the Greater Louisville Medical Society. The Long Walk: Slavery to Freedom, Ms. Owens-Lalude’s first novel, is the culmination of a very personal search for her ancestors in Kentucky. The novel centers on Clarissa, a young enslaved woman, and her young son George Henry. The novel opens as Clarissa and George Henry are being loaded onto a dirty oxcart by their new owner, Ben Mullins. The date is stated as January 16, 1846. Ben has just purchased the mother and young son at the auction in the Jefferson County courtyard in downtown Louisville, and he is now headed back to his farm in Spencer County along the turnpike. The weather and the journey are miserable in the extreme, as is Clarissa’s state of mind. Only briefly have we been told that Clarissa is thinking of her man, Jake, her big boy Toby and her twin girls Mary and Molly, sold off to different owners at that fateful auction. Not until chapter 15 will we learn more about Clarissa’s family and her heritage. What we will have learned, though, by reading about the author and the introductory notes, is that George Henry – whose age is given as somewhere between 2 and 3 years old at the time of the auction – is in fact Ms. Owens-Lalude’s great-grandfather and Clarissa is her great-great-grandmother. Ben Mullins’ 600-acre farm in Spencer County is where George Henry grew up. Using this factual information, Ms. Owens-Lalude has created a work of historical fiction set in the Kentucky of the mid-19th century. She has peopled her novel with characters so finely drawn that one can see them in the mind’s eye. Her visits to what was the Mullins property have allowed her to recreate for the reader the farm and its buildings. The ruts and trails are evidence of the to-ing and fro-ing of slaves and masters. Life on the farm is minutely described, the smells, the sounds, the daily tasks, the nightly woes. For most, escape seems like a dream. The idea of freedom is pushed to the edges of minds and hearts too full of cares and too aware of the high price it demands. When Clarissa and her son arrive at the farm, they are delivered by Ben to Effie’s cabin. Effie is the oldest female slave and raised Ben from infancy. Ben maintains a measure of respect for Effie and during her lifetime there is wood for her fire and adequate food. With Effie’s care, Clarissa and George Henry slowly recover from their terrible journey. The two of them are allowed to continue to live in Effie’s cabin along with Little Bo, the young son of Ben Mullins’ blacksmith. Clarissa takes up her duties at the big house with the other female slaves. George Henry thrives under Effie’s care and learns the secrets of her healing potions as he observes the ways of the menfolk and the duties he will be expected to perform as he grows older. Life is hard, though everyone tries to stay out of trouble, and all the hurts and travails flow through Effie’s cabin. It is the only place where solace can be found – if any exists at all. With advancing age, Effie’s health declines and Clarissa and George Henry become her caretakers. Effie has no fears for herself and her one wish – to be buried under the big old red oak behind her cabin – is known to everyone. Ben will guarantee it. Clarissa aches to be free. For the 10 years she has been at the farm, she has thought about it. She has to wait for George Henry to grow strong enough and old enough to make the walk with her. She, too, needs time to recover from a serious leg injury inflicted upon her by her mistress in a fit of rage. During this time, Clarissa’s one possession, an old ragged, bloodied and repeatedly mended quilt, has been her constant inspiration. We are told that Clarissa inherited the quilt from her Grandma Alice who took care of her as a child. Alice had inherited the quilt from her mother, Mary, who, Alice understood, had been brought from Africa. On one side are the remembrances of the many women who have added to the quilt over the years. On the other side is the road to freedom. Clarissa knows by heart the significance of the north star, the dipper, the drinking gourd, the river that can only be crossed in winter and other signs to look for along the way. Clarissa adds her own story to the quilt with scraps of fabric torn from old clothes. Effie understands Clarissa’s yearning and explains to her the significance of the clanging of the blacksmith’s hammer — the sounds she must listen for on those dark winter nights when the conditions, for those who are prepared, might be such that escape can be risked. After Effie’s death, Clarissa starts her preparations with a single-mindedness spurred on by the fear that another January auction could see her separated from George Henry and by the fact that George Henry is beginning to question where (Continued on page 24) February 2013 23 REFLECTIONS Teresita Bacani-Oropilla, MD RETREADING THE RETIRED B elonging to the generation of the “young old,” a still-youthful psychiatrist retired to join her husband who had just been piped out in style from active naval medical service. There followed three years of R and R (rest and recreation), learning to dance the tango in Argentina, visiting old civilizations like China in the East, making pilgrimages in Europe, doing charity works for the church, helping to write a book and enjoying what many envision as the ideal retired life. But, they were too young. There is so much unharnessed potential that is lost among our retirees. Not only physicians, but nurses, social workers and other therapists who have made helping people their line of work, miss their calling. They would still like to use their talents but are hindered by too many rules and bureaucracy if they attempt to use them at hours that suit their schedules. So, at the peak of their experience and expertise, they are let go, or electively leave because of set rules and regulations that individually are difficult to surmount at their stage in life. Her psychiatric clinic co-workers missed her. Besides, the powers-thatbe needed someone to organize a program to gather, treat and house the chronically mentally ill. These poor souls roamed the streets, inhabited cubbyholes under the bridge or any place that provided shelter from the cold and rain, were non-compliant with treatment, and showed up like bad coins at hospital emergency rooms, or the jail in times of crisis. It was fortunate that this particular health department recognized the talents and services that they could squeeze out of their retired doctor and were personal and flexible enough to make arrangements to have these accomplished for everyone’s benefit. These powers-that-be lassoed her back with a grant, giving her a free hand to run such a program. Two years later, 80 almost-hopeless cases were permanently housed, being treated regularly at clinics or at home, being helped by case managers to apply for benefits and some even capable of holding jobs. Having a home base had turned these patients’ lives around. It is hoped that some enterprising genius will have the patience to figure out and make it simpler to retread the retired. They are unmined veins of gold or just precious nuggets lying around for the picking. L M Note: Dr. Oropilla is a retired psychiatrist. The program continues to hunt for more of these “lost” people, weeding out the non-mentally ill incorrigibles who make their homes a den of drug distribution or a fence for thieves. Having accomplished her mission, the still youngish psychiatrist is back to being retired. (Continued from page 23) they are from. This awakens too many memories for Clarissa to ignore. Mother and son do make their escape, but it is not a given that they will succeed. The skill of the author and the realism of her storytelling are such that until Clarissa and George Henry are washed up and rescued on the Indiana shore of the Ohio River we are not sure what will happen to 24 LOUISVILLE MEDICINE them. Ms. Owens-Lalude has painstakingly researched her material not only locally but also spending time in Nigeria, her husband’s home country. I found her novel to be a compelling read for many reasons. L M Note: Dr. Amin is a retired diagnostic radiologist. “When it comes to Meaningful Use, athenahealth did all the legwork… and then they made it easy for me to do.” –Dr. Reavis Eubanks This is how Dr. Eubanks got paid for Meaningful Use. A fter practicing medicine 35 years, Dr. Reavis Eubanks knew it was time for an EHR. As a solo physician, he needed an easy transition and an effective way to begin earning up to $44,000 in Medicare incentive payments. athenahealth helped Dr. Eubanks go from paper to payment in just six months. With guidance every step of the way and proven, cloud-based services. Best in KLAS EHR* Free coaching and attestation Seamless clinical workflow Guaranteed Medicare payments** 85% of eligible athenhealth providers attested to Stage 1 Meaningful Use. And we’re ready for Stage 2. Visit athenahealth.com/LLS or call 800.981.5085 *ambulatory segment for practices with 11-75 physicians ** If you don’t receive the Federal Stimulus reimbursement dollars for the first year you qualify, we will credit you 100% of your EHR service fees for up to six months until you do. This offer applies to HITECH Act Medicare reimbursement payments only. Additional terms, conditions, and limitations apply. Cloud-based practice management, EHR and care coordination services February 2013 25 announces new phone and fax numbers for the solo practice of Rare Offering! $550,000 Log Cabin with Rustic Charm in a Bucolic Setting • One floor home with an open floor plan • 4 BR/3BA • Vaulted ceilings and skylights • Brick and pine floors • Updated kitchen and bathrooms • Lots of outdoor living spaces • Barn with carport • 1.6 acres Navin Kilambi, MD at 200 Abraham Flexner Way, Suite 403, 40202 502.587.5055; FAX 502.589.7573 7926 Preston Highway, Suite 103, 40219 502.587.5055; FAX 502.969.2628 5129 Dixie Highway, Suite 100, 40216 502.587.5055; FAX 502.589.7573 • For GLMS members only • Download to EHR system • One year license agreement •Access select GLMS member information online 24/7 • Reduces staff time •Affordable tiered-pricing based on practice size For more information contact: Cheri K. McGuire, Director of Marketing 502.736.6336 [email protected] 26 LOUISVILLE MEDICINE 914 North Dixie Highway, Elizabethtown, Ky 42701 502.587.5055; FAX 502.589.7573 Please update your new GLMS roster! Back to the Future Mary G. Barry, MD T Louisville Medicine Editor [email protected] he price of denial is failure. When individuals do it, “I’ve got to smoke” produces lung cancer, and “I don’t feel like exercising” becomes diabetes. “It’s just heartburn” turns angina into acute MI. “Just one more” translates into bad news of all kinds, from 30 more pounds to 30 more vodkas to 30 more days of desperately seeking drugs. Preventable misery dogs the lives of those in daily denial. When Congress does it, large parts of the country suffer. On both sides of the aisle, senators and representatives deny that they are choosing power, partisan politics and lobbyist loot over what we, their constituents, actually need. They deny that their decisions will be harmful and instead argue that what should properly be called “loss of medical care” can be euphemized to “fiscal responsibility.” By March 1, the president and our Congress must decide together if they can come up with any agreement to target specific spending cuts to multiple federal programs. If not, then a mandatory 2 percent cut to these programs will wreak havoc in many forms. We face this second fiscal cliff because in August 2011 the polarized Congress, facing an election year to come, settled in the Budget Control Act for pushing important decisions to 2013, when a new Congress could be tasked. Both sides hoped that they would win in November 2012 and that some sort of electoral mandate would simplify not only their choices, but also the logistics of fighting such choices through the legislative labyrinth. Wishful thinking remains a handy, though equally destructive, form of denial. By December 2012 nothing had changed. Only the last-gasp intercession of Vice President Joe Biden, after weeks of private negotiations between the president and House Speaker John Boehner, saved the nation from falling off the fiscal cliff. The same talks delayed, for the 10th year in a row, the automatic 27 percent cut in Medicare’s pay to doctors, the cut mandated by the hopelessly unfair, ill-designed and outdated Sustainable Growth Rate formula. The SGR is a classic case of government double-speak, in which payments to physicians have been frozen for a decade, while the cost of providing care to patients has risen by more than 20 percent. If there were no large hospital systems employing doctors, the number of specialists and generalists who accept Medicare would long ago have dropped below 50 percent, and the citizens who have served this country the longest would be the ones most injured. As it now stands, the SGR cut has been delayed again for a year, and the monies to pay for it will come from cuts to hospitals’ inpatient service reimbursement, payments for medical imaging, payments to dialysis providers and payments to Medicare private plans. But the March 1 cuts, called budget sequestration (automatic cuts to meet the gap between budgeted money and actual spending), amount to annual cuts ranging from $10 billion to $16 billion to Medicare. According to the AMA, the American Hospital Association estimates that would cause a net loss in 2013 alone of almost 500,000 jobs. Defense spending would fall by 10 percent, and more than 1,200 federal accounts would face sudden drops, including health care for the active duty military and for the VA, research losses at the NIH and a $66 million loss for health insurance exchange grants. Economic researcher Dr. Stephen Fuller, PhD at George Mason University, said that the sequester could cost the country overall 2.1 million jobs, cut the GNP by more than $200 billion, and send the country back into recession. If that fails to worry you, think about Social Security. In The New York Times of January 6, professors Gary King and Samir Soneji dissected the current database that Social Security uses to estimate its costs and revenues, and our mortality. You’d think the Three Stooges had made up the formulae – they’re that bad. For instance, their chart predicts that in 2028, everyone 55-58 years old will up and die, while their relatives who are over 95 will keep on living. Multiple errors here pointed out would result in an additional $801 billion of cost to Social Security by 2031, a cost completely and utterly not anticipated or budgeted for by our government. If these guys are as much into denial as our Congress, then there will be a rapidly shrinking safety net for the old, the infirm and the disabled. We will become a country of unpaid medical bills for the vast majority, as opposed to merely a huge slice of the population (although naturally members of Congress will continue to vote themselves the best health coverage in the land). The only way through this minefield is straight talk and stark honesty about why, how much and which cuts our members of Congress will inflict on us, because cuts seem inevitable in the current climate. Doing the least amount of medical damage is my priority, but who knows theirs? If the members of the Congress of 2013 allow their denial to exceed both their courage and their judgment, then patients, doctors, hospitals, nurses, nursing homes, veterans, the serving military and the patients who won’t be helped by research will pay the initial price. If we plunge back into recession, then the whole country, in every business sector, will pay the price. “Failure is not an option,” said Sir Winston Churchill. “Leadership is solving problems,” said General Colin Powell. “Failure is not fatal, but failure to change might be,” said Coach John Wooden. “It’s time Congress got its priorities straight,” said Sen. Mitch McConnell. I may be in denial, but I sure hope Congress can change. LM Note: Dr. Barry practices Internal Medicine with Norton Community Medical Associates-Barret. She is a clinical associate professor at the University of Louisville School of Medicine, Department of Medicine. Speak Your Mind The views expressed in Doctors’ Lounge 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 in this issue, please submit an article or letter to the editor. Contributions may be sent to [email protected] or may be submitted online at www.glms.org. The GLMS Editorial Board reserves the right to choose what will be published. February 2013 27 “ I can take care of myself. With a little help from ResCare.” If you or a loved one have physical limitations and could benefit from help in the home, call ResCare today. A ResCare Home Help caregiver can be scheduled for help in the home anytime, 24/7, including holidays. And the services are more economical than you might think… including assistance with medications, housekeeping, cooking, transportation, companionship and more. Call 866.ResCare (866.737.2273) or go online at ResCareHelpCare.com to schedule a ResCare in-home assessment. ResCare is help care for seniors. “ResCare to the rescue.” 28 LOUISVILLE MEDICINE Doctors’ Lounge How We Got to Where We Are Kenneth C. Henderson, MD T he changes that have occurred in the private practice of medicine in my lifetime have created the future in which we find ourselves. I would like to briefly touch on what I consider the operative events. In my view, these events include third-party payment for medical services, the operation and management of hospitals by non-physicians, the subspecialization of medicine post-World War II, Medicare and Medicaid, DRG reimbursement, cost shifting of governmental programs to the private sector and Obamacare. The best way to approach this complex task may be to reduce these multifaceted issues to their simplest form. Form usually follows function in most complex systems. It turns out that many form issues in the private practice of medicine in this country are financial, and therefore follow funding. In my opinion, the end of the private practice in this country began and continues to end with third-party reimbursement. In the 1930s, the reimbursement concept arose in this country to separate the payment for medical services from the person who receives the services to another responsible party. The third-party insurance company was placed at primary financial risk instead of the patient or the recipient of medical services. The consumer of medical services was no longer obligated to pay directly for the charges or the cost of medical care. Unfortunately, this third-party system of payment for health care did not produce a responsible consumer or guarantee a responsible physician or provider of services. Physicians and surgeons in great numbers volunteered or were drafted into military service during WWII. In their absence, a new group of providers of health care called hospital administrators filled their vacant hospital ownership and management roles. Public and private hospitals became a business as opposed to the previous charity provider of health care services. Church denominational and physician hospital ownership began to decline. All for-profit and not-for-profit institutions were required to make a profit margin to both support their mission and to survive in this new marketplace. All hospitals became fiscally the same except for the form in which they distributed their earned margins to their shareholders. The demands for medical and surgical care during WWII supported the development of specialty practice. When the military doctors came home to this new health care environment, the available reimbursement opportunities supported the growth of subspecialty care as well. Subspecialty care and its reimbursement not only insulated the patient from direct payment for services rendered, but in some cases from the provider as well. Based primarily on both hospital and physician reimbursement issues, hospital medical care later became separated from private clinical office practice. The private doctor-patient relationship no longer related directly to the continuity of diagnosis, treatment and follow-up. The growing complexities of medical care in the office setting and the cost of solo practice led to its decline and eventual extinction in this country. In 1965, Medicare and Medicaid became a reality. This new concept of an infinite demand placed upon a finite resource was now the law of the land. Citizens for the first time became entitled to health care based on age, means tested economic status or disability. The full impact of these two measures is yet to be determined. Dual eligibility without the provider’s ability to balance-bill Medicaid is the current health care financing dilemma related to a growing number of seniors and disabled persons. Patients, who are entitled to health care related to age, financial status or medical disability, may also currently have a right to health care. Soon all of our patients, citizens or not, may enjoy the right to health care. The advent of Medicare and Medicaid changed the business model of health care by reversing the supply and demand relationship. There is substantial evidence that the demand for health care services is directly related to the supply of physicians in that geographic location. Therefore, it is no surprise that there is currently a demand for more physician providers. I suggest that the acquiescence of physicians to being called “providers” has come full circle. In my opinion, medical care providers have a much higher medical-legal risk than do physicians who are acquainted with their patients. Physicians who blatantly advertise likely represent themselves as providers. The original objective of DRGs was to develop a classification system that identified the “product” that an inpatient received in the hospital. DRGs also served to identify the “products” that a hospital provides. Since 1983, DRGs have been used to determine the amount Medicare and later Medicaid would pay the hospital for each “product.” The end game was to replace the “cost-based” reimbursement of hospitals that had been used up to that point in time. Patients became products purchased by the government from vendor providers. The open-ended use plus under-funding of Medicare and Medicaid created massive cost shifting in hospitals and in private medical practice billing. In the current environment, hospitals do not bill charges but instead most must rely on a negotiated percentage of cost. All payers and providers strive to follow the lead of the federal government by cost shifting in a financial environment currently containing no charge or cost payers. The end result is a loss of revenue and increased debt for all concerned. The cost and benefit of “The Patient Protection and Affordable Care Act” is unknown and yet to be determined. A preliminary study done in the Northwest on small numbers of patients indicates that there will be a 25 percent increase in utilization of health care services when this act is in force. However, recipients of Obamacare did not utilize emergency services at a higher rate than did individuals with other types of insurance. Members with this new type of financing system were less depressed in general and were reported to be more satisfied with their health care provision than were their controls. This comprehensive law was passed in the same grand tradition as Medicare and Medicaid without knowing what the law really says, what the provisions will mean when the regulations are written, or what it may cost now, and in the future. This massive new entitlement may be the final governmental intrusion into health care provision and financing before the more formal program of single-payer is put into place. It is clear that we are following the time-honored practice of our European neighbors of socializing medicine at a time when we can least afford it. It seems to this observer that the private practice of medicine has been essentially forced to ride the (Continued on page 30) February 2013 29 Doctors’ Lounge (Continued from page 29) governmental tiger’s back of reimbursement for almost 50 years, and as a result has wound up in his stomach. Did private practicing physicians really have, or do they presently have, any real choices? In my opinion, the majority of practicing physicians may have simply followed, or gone along with, the pervasive mood of the country that is based on taking more and giving back less. The current political and socioeconomic climate in America, demonstrated by the reelection of President Obama, will create for the first time a new middle class in this country that is dependent upon the federal government. Physicians and their families have become the upper middle class members of that rapidly developing group. LM Note: Dr. Henderson is a clinical professor at the University of Louisville School of Medicine, Department of Pediatrics. Physicians in Print Downard CD, Renaud E, St Peter SD, Abdullah F, Islam S, Saito JM, Blakely ML, Huang EY, Arca MJ, Cassidy L, Aspelund G; For the 2012 American Pediatric Surgical Association Outcomes Clinical Trials Committee. Treatment of necrotizing enterocolitis: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. J Pediatr Surg. 2012 Nov;47(11):2111-2122. PubMed PMID: 23164007. Scheker LR, Martineau DW. Distal radioulnar joint constrained arthroplasty. Hand Clin. 2013 Feb;29(1):113-21. PubMed PMID: 23168033. Weaver JL, Bradley CT, Brasel KJ. Family engagement regarding the critically ill patient. Surg Clin North Am. 2012 Dec;92(6):1637-47. PubMed PMID: 23153887. NOTE: GLMS members’ names appear in boldface type. Most of the references have been obtained through the use of a MEDLINE computer search which is provided by Norton Healthcare Medical Library. If you have a recent reference that did not appear and would like to have it published in our next issue, please send it to Ellen Hale by fax (502-736-6339) or email ([email protected]). LM JANUARY 20 - MAY 19 727 West Main Street, Louisville, KY 40202 • KYScienceCenter.org • 1-800-591-2203 SPONSORED BY 30 LOUISVILLE MEDICINE WITH SUPPORT FROM IN PARTNERSHIP WITH The Kentucky Department for Public Health YMCA of Greater Louisville Greater Louisville Medical Society © 2013 Baptist Healthcare System, Inc. / Member, Baptist Healthcare System WHEN IT COMES TO BEATING HEARTS, WE’RE BEATING THE STANDARDS. REGULARLY BEATING NATIONAL STANDARDS FOR CARDIAC RESPONSE. In the event of a cardiac emergency, the cardiac team of Baptist Health responds with a speed that regularly exceeds national standards. From the moment you experience symptoms or for ongoing therapies and advanced surgical procedures, Baptist Health is the place for hearts. For more information, visit baptisthealthky.com or call (502) 897-8131 for a physician referral. BAPTIST HOSPITAL EAST | BAPTIST HOSPITAL NORTHEAST | BAPTIST EASTPOINT BAPTIST URGENT CARE | BAPTIST MEDICAL ASSOCIATES BH 529 heart print (8.125x10.875)_beat standard_FNL.indd 1 baptisthealthky.com 12/31/12 February 2013 2:05 PM 31 Advertisers’ Index Athena Health www.athenahealth.com 25 Kentuckiana Pain Specialists www.painstopshere.org 18 ResCare www.rescare.com 28 Baptist Hospital East www.baptisteast.com 31 Kentucky Science Center www.kysciencecenter.org 30 Semonin (Joyce St. Clair) www.joycestclair.semonin.com 32 Canfield Development www.canfielddevelopment.com 1 Medical Society Employment Services www.glms.org 10 State Volunteer Mutual Insurance Co www.svmic.com Elmcroft www.elmcroftseniorliving.com 8 Merkley Kendrick Jewelers www.mkjewelers.com The Pain Institute www.thepaininstitute.com Humana CareSource www.caresource.com 4 Murphy Pain Center www.murphypaincenter.com Jewish Hospital & St. Mary’s HealthCareIFC www.jhsmh.org Jewish Physician Group www. jhsmh.org 26 National Insurance Agency www.niai.com 14 6 13 Norton Healthcare PhysiciansIBC www.nortonhealthcare.com 2 OBC The Physicians Billing Group www.thephysiciansbilling.com 32 Van Zandt, Emrich & Cary www.vzecins.com 22 Wakefield Reutlinger Realtors www.wrrealtors.com 26 business card gallery 32 LOUISVILLE MEDICINE BreAktHrougH LuNg CANCer surgery As one of the first sites in the country — and the only one in Louisville — to perform breakthrough lung brachytherapy surgery, Norton Healthcare is offering new hope to patients with lung cancer. Cesium-131 brachytherapy is a revolutionary new treatment that employs the use of minimally invasive surgical techniques along with targeted direct beam radiation therapy for patients who previously were not surgical candidates, including the elderly and those with severe emphysema. For more information, call (502) 629-LUNG (5864). George J. Mikos, M.D., Cardiothoracic Surgery Cardiothoracic surgery of Louisville Michael J. Hahl, M.D., Radiation Oncology Norton Cancer Institute February 2013 33 Greater Louisville Medical Society 101 WEST CHESTNUT STREET LOUISVILLE, KY 40202 PRSRT STD U.S. POSTAGE PAID LOUISVILLE, KY PERMIT NO. 6 EXPERTISE. As a Board-Certified Anesthesiologist Fellowship-Trained in Pain Management, Dr. Michael Cronen has over 20 years of experience in his field. He's also Board-Certified in Headache Management and respected by Pain Management experts nationwide. In 1991, Dr. Cronen founded The Pain Institute, the region's premier resource for pain management. Together with his colleagues, he uses knowledge, experience and state-of-the-art medical technology to provide relief for debilitating pain. Trust your patients to the skill of Dr. Cronen and The Pain Institute. Where relief is reality. For more information, visit our Web site at www.thepaininstitute.com or for immediate, personal response, call us at 502.423.7246. 252 Whittington Pkwy • Louisville, KY 40222