September 2004
Physician
W A S H I N G T O N H O S P I TA L C E N T E R vol. 10, no. 7
News for Medical Staff, Residents, Fellows and Alumni
Inside…
The Aging
Athlete
A Golden
Moment
Joint Practice
Net Results
Justin Sullivan/Getty Images
Pool/Getty Images
John Kerry
Democrat,
Senator from
Bush and Kerry George W. Bush
Republican,
Massachusetts
on Health Issues incumbent
By Melanie Howard
F or many physicians this presidential election
will boil down to just one issue: tort reform.
One candidate — President George W. Bush — sup-
This is the elephant in the room whenever physicians
discuss politics these days, whether they support or
abhor the war, believe in tax cuts or dread deficits,
support oil drilling in Alaska or more environmental
ports it wholeheartedly, while another — challenger protections.
John Kerry — has hedged on the lynchpin issue of
limits on damages for pain and suffering. For stalwart Republicans Bush is a slam-dunk choice.
But for others, the concept of casting a vote for the
GOP is distressing. For one ob-gyn who came of age
in the feminist 1970s in liberal California, reproduc-
tive choice has always been a critical factor in deter-
HIPAA on My Mind mining her vote. But this year, as she told her
astounded life-long Democrat mother recently, “If I
Reality Check One Year Later don’t vote for the candidate who supports tort reform,
I may not be in business much longer to help women
By James Jelinek, MD make reproductive choices.” She remains one of the
T
he Health Insurance Portability and Accountability Act continued on page 10
of 1996 (HIPAA) was designed to protect patients on
how their personal health and information is to be used
and disclosed, particularly to third parties. Specifically, a
patient’s private health care information should not be given
to insurance companies, third-party people (friends), or third-
party vendors (pharmacies and drug companies). This task has
been an unfunded mandate thrust upon all health care
providers and, in particular, has been more onerous due to the
misconceptions about HIPAA.
continued on page 6
MedStar Health
Viewpoint
Taking Issue with
Malpractice Advice
T
his letter is in response to In the section, “Whom to The Physician Newsletter
“Malpractice Lawsuits: Prevention contact,” advising physicians article advises physicians
and Preparation” in the June 2004 to go the legal route first if concerned about a case to
Washington Hospital Center Physician they suspect there may be a suit “…remain aloof and
Newsletter. Not only do I disagree vehe- brewing against them, suggests that one can detached…” But the data
mently with the tone it sets, much of the predict which cases will go to court. This show that such behavior is precisely what
advice is outdated and antithetical to reduc- advice, however, doesn’t match up with the makes difficult situations become court
ing physician liability (Forster, Schwartz, facts. Many obviously actionable cases, e.g. cases. The first step down the path towards
DeRenzo, 2002). the wrong kidney was removed, never get to legal liability is for a patient or a patient’s
court. If an action is brought in such a case, family member to believe there has been
Telling physicians “Like a general, if you often the hospital just opens the checkbook harm and for an attorney to believe there
know you’re going to be attacked on the and asks, “How many zeros would you like was enough harm to achieve legal success.
western front, you can shore up your with this?” But such obviously actionable But for there to be a physician’s success, i.e.,
defenses” sends the wrong message and sets cases don’t always result in a claim. And that the situation calms down without the
physicians up for acting in ways that merely although data illuminating this issue are lawyers getting involved, the data show that
increase, not decrease, liability. Perhaps war hard to come by, evidence for the lack of the physician’s interpersonal competence
language motivates attorneys in ways that linkage between event and liability claim is and the strength of the physician-patient
bring attorneys success. Success for attor- beginning to surface. relationship are what matter most (Moore
neys means winning or advantageously set- et al, 2000).
tling cases. But success for attorneys is not The Wall Street Journal (May 18, 2004)
the same as success for physicians. Success reported the case of a 43-year-old female Rather than run to risk management and the
for physicians is never being involved with arresting during routine ankle surgery hospital attorneys at the first sign of a prob-
attorneys. And the way to keep attorneys because of an anesthesiology error. Angry, lem, it might be better to run to the chair of
out of the medical setting is to practice the patient sued. Against hospital legal that hospital’s ethics committee. Rather than
patient-centered medicine, not the kind of advice, the anesthesiologist contacted the the attorney who is trained to see everything
anachronistic defensive medicine advo- patient and apologized. The patient dropped as adversarial combat, the chair of a hospi-
cated in this article. the suit. tal’s ethics committee will approach the situ-
ation within the context of Hippocratic tra-
ditions. This is the approach that goes the
furthest in reducing liability, not the
Response From the Editor approach practiced by those whose success is
focused on battle readiness.
James Jelinek, MD
Evan G. DeRenzo, PhD
Everyone involved with patient care rec- the article specifically dealt with “How To Bioethics Consultant
ognizes that the most important facet of Avoid Lawsuits.” It states that “poor com- Bioethics
improving patient care and avoiding mal- munication with patients and families, June 24, 2004
practice issues is communication. A and failure to document gets doctors in
strong doctor-patient relationship is the trouble time and time again.” This was a
most important factor contributing to direct quote from Marilys Gilbert, direc- References
perceived quality of treatment by a tor of Risk Management.
Forster, HP, Schwartz, J, DeRenzo, EG. (2002).
patient. The stronger the patient-doctor
The article specifically dealt with physi- Reducing Legal Risk by Practicing Patient-
relationship, the less likely there will be Centered Medicine. Arch Intern Med.
malpractice activity no matter how bad cians who are confronted with a lawsuit,
after patient care has taken place. No one 162:1217-1219.
the actual health care delivered is.
would disagree with Dr. DeRenzo that Moore, PH, Adler, N, Robertson, P. (2000).
On the other hand, a superb physician excellent rapport with the patient would Medical malpractice: The effect of doctor-
who has a poor relationship with his likely have prevented the lawsuit but, patient relations on medical patient percep-
patients is more likely to be sued in the once the lawsuit happens, this is a com- tions and malpractice intentions. Western
event of a bad outcome, even if malprac- pletely different environment, which Journal of Medicine. 173:248.
tice was not involved. The article needs to be approached carefully. Zimmerman, Rachel. (2004). Medical contri-
“Malpractice Law Suits: Prevention and tion: Doctors’ new tool to fight lawsuits:
Preparation” focused on defending law- Saying ‘I’m sorry’sorry’. Wall Street Journal.
suits when they appear. One section of continued on page 7 May 18: A1.
–2–
Insider
Study Looks at Cholesterol-Lowering
Statin to Prevent Heart Attacks
Reducing Inflammation May Boost Coronary Health
T
he link between using a cholesterol-
lowering statin to reduce inflamma-
tion and preventing heart attacks in
people who currently do not have any car- DESIRED
diac or coronary disease but who may be at LEVELS
risk of heart attack is being studied by
Washington Hospital Center researchers. Total Cholesterol:
less than
The drug rosuvastatin manufactured by 200 milligrams
AstraZeneca Pharmaceuticals is being used
LDL 100-129
to reduce high-sensitivity CRP (hsCRP), an
(LDL 70 mg or less
indicator of inflammation, as part of a dou-
for people who have
ble blind, placebo-controlled study of par-
had heart attacks or
ticipants who have LDL-C cholesterol levels
are at high risk for
that currently do not require drug therapy.
heart disease)
Men who are older than 55 and post-
menopausal women age 65 or older who
have no history of heart attack or stroke are HDL 60 mg
being sought to participate in the study led or more
by primary investigator Wm. James Howard, Triglycerides
MD, the Hospital Center’s vice president for under 150 mg
Academic Affairs.
Men who are older
than 55 and post- stroke. hsCRP is a substance that is produced
by inflammatory cells and is a marker that
will be followed for three years, including
follow up visits every six months during
menopausal women can be used to detect possible cardiac dis- which blood will be drawn and medications
age 65 or older who eases and other conditions such as rheuma-
toid arthritis or lupus.
will be reviewed and dispensed. A small
stipend is given to offset their travel costs.
have no history of “In previous clinical trials, when the LDL Anyone who is interested in participating in
heart attack or stroke has been lowered so has hsCRP,” said this study should call study coordinator
are being sought to Howard. “Patients who have high hsCRP
and who have high LDL cholesterol have a
Aynn Feller at (202) 877-6839.
participate in the study. very high risk of coronary disease. But of sig- — LeRoy Tillman
nificant interest to physicians is the fact that
individuals with relatively low LDL levels WASHINGTON HOSPITAL CENTER
“We’re hoping to learn whether there are but elevated hsCRP levels are also at
other actions of the statin above and beyond increased risk for a heart attack or stroke. We June Statistics
lowering LDL cholesterol that can con- want to determine whether lowering hsCRPs 2004 2003
tribute to the prevention of heart disease,” can be correlated with preventing heart dis-
said Howard. “And if that’s the case, we may ease and strokes.” Inpatient Admissions 3,988 3,781
be able to extend the drug’s benefits to peo-
ple whose LDL, or bad cholesterol, is cur- Individuals who know that their LDL level is Outpatient Clinic Visits 7,512 7,080
rently at a level that is currently not consid- less than 130, but who are concerned that
they may be at increased risk for a heart ED Visits 5,624 5,639
ered at high risk for a heart attack.”
attack of stroke can have their hsCRP level ED Admissions 1,374 1,374
Recent research has found that the hsCRP measured at no cost for possible participa-
blood test may be a marker for inflamma- tion in this study. Participants will be ran- Average Daily Census 675 673
tion of the arteries. The test may indicate a domized to receive either daily doses of 20
Births 345 354
higher risk for first-time heart attack or mg of rosuvastatin or a placebo. The patients
–3–
News & Notes
Four Seasons Hotel
TERRY FOX RUN
T he 2004 Terry Fox Run, along with an April golf tournament – both sponsored by the Four
Seasons Hotel — have raised $70,000 for the Washington Cancer Institute. Here, runners and
walkers stretch before the event. Hospital Center President James Caldas and his son Chris were
participants in this year’s 5K run, which included a Kid’s Dash and a Farmer’s Market that featured
fresh potted herbs, specially mixed rubs and dried herbs, flowers and baked goods. New this year
was a “Restaurant Grab,” in which participants took a chance that the envelope they selected
contained a certificate to The Palm, Galileo, Mendocino Grill or Ceiba restaurants. The third event
from the Four Seasons to benefit the hospital will be a jazz concert featuring Jonathan Butler and
a silent auction/raffle.
NEW ERA OF MEDICINE: DOCSLINK SURVEY RESULTS
“MEETING THE CHALLENGE” CME
T hank you to everyone who participated in the
first DocsLink survey to mark the two-year
FAMILIES
J oin your colleagues Dec. 5-8, 2004 at the new
Westin Casuarina Resort and Spa on Grand Cayman
Island. In this era of fast advancing medical technol-
anniversary of the e-newsletter. Here are the
results:
TEAMING UP
TO MEET THE
ogy and research, physicians are often challenged by • 96% of those responding read DocsLink. COUNT
the task of keeping up with the most current research
and knowledge in fields outside their own. This con-
ference will provide an opportunity to absorb this
• 83% read DocsLink regularly or every time
it is published.
• 80% find the information useful.
D avid Buck, MD, radiology,
and his daughter
Margaux, visited the Blood
knowledge in a peaceful and relaxed setting, away
Donor Center this summer
from the demands and pressures of clinical practice. • 64% of respondents are attendings; 35%
of respondents are staff. to help Washington Hospital
The conference is a four-and-a-half day event, with a
Center “Meet the Count.”
focus each morning on a specific clinical challenge in Each physician’s office should receive DocsLink. The Hospital Center’s goal
the areas of infectious disease, endocrinology, surgery It is one of the communication tools that the for the 2004 MedStar Health
and medicine. Discounted airfare, room rates and Hospital Center will use to notify the medical and blood donor campaign is 50
recreational packages are available. 20 category 1 dental staff in the event of emergencies. To sub- percent participation. Please
AMA-PRA credits. Micheal Pistole, MD, activity drec- mit or update your (or your office) e-mail address, call (202) 877-5250 and
tor. Contact Ramona Finch (202) 877 8201 or at e-mail Annamarie.G.DeCarlo@Medstar.net. make your appointment to
Ramona.Finch@MedStar.net to register or for more
donate today.
information.
–4–
W A S H I N G T O N H O S P I T A L C E N T E R
OFFICE OF CONTINUING MEDICAL EDUCATION
SEPTEMBER 2004 — HIGHLIGHTS
Upcoming CME Events Sponsored by Washington Hospital Center
FINANCIAL SEPTEMBER 18, 2004 DECEMBER 5 – 8, 2004 MARCH 5 – 12, 2005
UPDATE ASCO Highlights Conference
Presented by Washington Cancer Institute at
New Era of Medicine:
Meeting the Challenge
Controversies in Medicine
Conference
Washington Hospital Center Presented by Washington Hospital Center
I n early 2004 the Hospital Conference
Dennis A. Priebat, MD – Act. Dir. Presented by Washington Hospital Center Wm. James Howard, MD – Act. Dir.
Center began its initiative to Hilton McLean, Tyson’s Corner, Va. Michael Pistole, MD – Activity Director Vail, Colo.
streamline the patient reserva- (703) 683-1666 Grand Cayman Island (202) 877 - 8201
tion and registration processes to 7 “category 1” credits (202) 877-8201
make life easier for our patients SEPTEMBER 28 – OCTOBER 2, 2004 REGULARLY SCHEDULED CATEGORY 1 ACTIVITIES
and to get better control over Board Review in
Gastroenterology CARDIOLOGY/CARDIOVASCULAR NEONATOLOGY
collecting the revenue the hospi- Presented by Washington Hospital Center & Cardiac Catheterization Visiting Lecturer Series in
tal has earned for services. Here Capital Academics of Greater Washington, Conference Perinatology
are some recent accomplish- Inc. Weekly, Wednesdays, 7:30 a.m. 1st & 2nd Tues., 12:30 p.m.
William M. Steinberg, MD – Act. Dir. True Auditorium Room. 5B-03
ments, as of the end of June: Wyndham Baltimore Inner Harbor 1 “category 1” credit per lecture 1 “category 1” credit per lecture
Hotel – Baltimore, Md. (202) 877-8574 (202) 877-6527
■ As of June 30, only a few 1-800-283-1997
days after the process began, 40 “category 1” credits Interventional Vascular NEUROSURGERY
Conference Neurosurgery Conference
the Emergency Department had OCTOBER 15 – 16, 2004 Weekly, Thursdays, 7:00 a.m. Tuesdays, 7:30 a.m. — Room G2-70
collected $2,640 in co-pays in its Cutting Edge in Radiation CTEC Auditorium 1 “category 1” credit per lecture
acute care area. The dollar Oncology Symposium – 1 “category 1” credit credits (202) 877-5580
“Technology, Techniques and (202) 877-8050
amount reflects payments made Treatment Modalities” OBSTETRICS/GYNECOLOGY
Updates in Cardiovascular OB/GYN Grand Rounds
during the hours of 8 a.m. to 4 Sponsored by Washington Hospital Center & Medicine Lecture Series
MedStar Radiation Oncology Network Weekly, Tuesdays, 8 a.m.
p.m., Monday through Friday, Bi-weekly, Tuesdays, 6:30 p.m. 5B-3 Auditorium
Paul B. Fowler, MD – Activity Director Area DC, MD, and VA Restaurants
when the discharge desk is Princess Royale Conference Center 1 “category 1” credit per lecture
2 “category 1” credits per lecture (202) 877-6054
staffed. Evening hours will be Ocean City, Md. (202) 877-2994
added soon. (410) 682-6805
Echocardiography Conference ONCOLOGY
OCTOBER 29, 2004 Weekly, Thursdays, 7:45 a.m. Presented by the Washington Cancer
■ The GI Lab, Center for Breast Vocal Cord Dysfunction: Cath Lab Conference Room (5th Flr) Institute (WCI)
Health, and Medicine/Sub- An Overview of Diagnosis and 1 “category 1” credit per lecture Gastrointestinal Oncology Case
Specialty Clinics have collected Treatment Symposium (202) 877-7853 Presentations
Presented by Washington Hospital Center & Bi-Monthly, 2nd & Last Fridays,
$12,120 in fees since April 1 the Hearing and Speech Center EMERGENCY MEDICINE 8 – 10 a.m.
that patients are required to pay Ziad E. Deeb, MD – Activity Director Emergency Medicine Grand Surgical Classroom – Room G-270
Cardiovascular Research Institute and Rounds 2 “category 1” credits per lecture
at the time of service (co-pays or Third Thursdays, 7:00 a.m.
Siegel Auditorium (202) 877-3908
co-insurances). (202) 877-5189 Emergency Dept. Conference Room
6 “category 1” credits 1 “category 1” credit per lecture Multidisciplinary Breast Cancer
■ The Central Financial (202) 877-9191 Treatment Conference
Clearance Department is now NOVEMBER 12, 2004 Weekly, Wednesdays, 7:30 a.m.
Emergency Medicine Continuous Seigel Auditorium
Maintenance of Vitality and Certification (EMCC) Literature
operative for inpatient and out- Quality of Life: Living with 1 “category 1” credit per lecture
Review (202) 877-7937
patient surgical services, mean- Cancer and Cancer Treatments Last Thurs. of each month, 7:30 a.m.
ing that financial clearance now Conference Emergency Dept. Conference Room
Jointly sponsored by Washington Hospital OPHTHALMOLOGY
is conducted using a centralized, 1 “category 1” credit per lecture Presented by Washington National Eye
Center & The National Rehabilitation (202) 877-9393
Hospital Center
real-time system.
Brendan Conroy, MD – Activity Director Emergency Medicine Faculty Saturday Morning Lecture Series
■ The hospital estimates that National Rehabilitation Hospital Development Series Weekly, Saturdays, 8:30 a.m.
denials for payment will be 1 Auditorium TBD True Auditorium
(202) 877-1952 Emergency Dept. Conference Room 2.5 “category 1” credits per lecture
percent of net revenue in FY 04, 6 “category 1” credits at Washington Hospital Center (202) 877-6159
down from 1.8 percent in FY 03. 1 “category 1” credit per lecture
DECEMBER 3, 2004 (202) 877-9393 SURGERY
Thyroid Disorders: General Surgery Orange Team
Recent Advances Conference GASTROENTEROLOGY Teaching Conference and Lecture
Presented by Washington Hospital Center & Gastroenterology Research Topic Weekly, Thursdays, 8 a.m.
the Department of Medicine/Division of Monthly, Wednesdays, 4:30 p.m. General Surgery Conference Room
U.S. NEWS & Endocrinology
Kenneth Burman, MD & Kathleen
2A50 Medicine Conference Room
1 “category 1” credit per lecture
2 “category 1” credits per lecture
(202) 877-9847
WORLD REPORT Prendergast, MD – Activity Director
Washington Hospital Center
(202) 877-2848 Surgery Grand Rounds
Weekly, Tuesdays, 8 a.m.
RANKINGS True Auditorium
MEDICINE
GRAND ROUNDS True Auditorium
(202) 877-6563 Weekly, Wednesdays, 12:30 p.m. 1 “category 1” credit per lecture
W ashington Hospital Center
placed 15th in the Heart
and Heart Surgery category and
8 “category 1” credits True Auditorium
1 “category 1” credit per lecture
(202) 877 3109 or (202) 877 6749
(202) 877-6426
UROLOGY
Urology Academic Series
30th in the Hormonal Disorders NRH Medical Grand Rounds Weekly, Tuesdays, 8 a.m.
category in the annual U.S. Fridays, Noon — NRH Auditorium Siegel Auditorium
1 “category 1” credit per lecture 1 “category 1” credit per lecture
News & World Report’s list of (202) 877-1660 (202) 877-3968
the top 50 hospitals.
–5–
Feature
HIPAA HIPAA was never designed to obstruct
patient health care. Unfortunately the zeal
Common Myths continued from page 1 with which HIPAA was pushed forward has
led to over-zealous enforcement of HIPAA
Regarding HIPAA I recently was shocked when employees of mandates. For example, it is explicitly stated
the Radiology Department refused to fax in the United States Department of Health
T he United States Department of Health
and Human Services Fact Sheet on
HIPAA states that “To promote the best
reports or send a copy of films to referring
physician offices. They did so under the mis-
and Human Services Fact Sheet on HIPAA
that “To promote the best quality care for
understanding that HIPAA prevented them patients, the rule does not restrict the ability
quality care for patients, the rule does not from sending the X-rays or results without of doctors, nurses, and other health care
restrict the ability of doctors, nurses, and having a specific signed release from the providers to share information needed to
other health care providers to share infor- patient. I was also appalled when trying to treat their patients.”
mation needed to treat their patients.” reach a physician regarding a significant
finding on an MRI to a physician. The refer- The disclosure of test results on a patient
•••
ring physician’s office refused to provide any from one physician’s office to another is a
MYTH: It is illegal for a physician to fax part of the health care process and HIPAA
or e-mail patient data to a consulting information about the patient, even though
the findings could jeopardize the patient’s does not ban the faxing of medical records
physician. and disclosure of the patient when one
health care. The gross misunderstanding of
TRUTH: HIPAA specifically allows HIPAA’s intent has prevented health care health care facility is sending results to
this. Customary safeguards should providers from taking good care of their another health care facility. No patient
apply when using e-mail and caution patients. It is time for all of us to recognize authorization is required for this. The send-
what HIPAA was intended to do and what ing party should, however, have in place
where patient records are being
HIPAA does not forbid. mechanisms that e-mails or faxes are indeed
faxed. being sent to a physician’s office involved
••• with the patient’s health care.
MYTH: It is illegal for departments to
fax reports or send a copy of films to It is time for all of us Patient Rights
referring physician offices without a to recognize what Other major misconceptions about HIPAA
signed release from the patient. are related to the patient’s rights. For exam-
HIPAA was intended ple, parents or guardians are permitted to
TRUTH: The use and disclosure of
health information from one covered to do and what HIPAA have access to their loved ones’ medical
records. HIPAA defers to state law regarding
health care provider to another for does not forbid. how a parent or guardian has access to a
the purpose of providing treatment is minor or dependent’s medical care data.
specifically covered and no authoriza- HIPAA does not supercede or pre-empt state
tion from a patient is required. There are several common myths that have law regarding minors. This means, in most
••• created obstacles to delivering patient health states, parents or guardians have access to
MYTH: It is illegal for health care work- care. For example, some physicians, physi- medical records of their children and loved
ers to share patient medical information cians’ office employees, and hospital ones without the minor’s or dependent per-
with family members.
employees believe that it is not legal to fax or son’s permission.
e-mail patient data. This is completely incor-
TRUTH: HIPAA requires only that rect. HIPAA specifically allows this.
physicians and nurses check with their Customary safeguards should apply when
patients prior to disclosing informa- using e-mail and caution where patient QUESTIONS?
records are being faxed.
tion, assuming the patient is mentally
competent. A minor or a patient who
HELP IS HERE
is a dependent of a family member Authorization
must have information shared.
•••
Another myth that has been pushed forward
and prevents health care is that physicians’
W ashington Hospital Center’s Media
Relations team, in the Department
of Marketing and Public Affairs, is avail-
offices are being denied access to patient able to help physicians and health care
DOs and DON’Ts records that have been referred on the workers handle media inquiries regard-
DO NOT discuss patient information in grounds that the patient has not specifically ing patient information.
the elevators and hallways. authorized their results to be sent to a refer-
Reporters often call during a breaking
ring physician’s consult office. The use and news event to ask for a patient’s name
DO NOT give patient information to the disclosure of health information from one or condition. Or a reporter may call for
media. covered health care provider to another for information regarding a local official’s
DO call a media relations representative if the purpose of providing treatment is specif- procedure you performed to ask the
you have questions about a media query. ically covered and no authorization from a extent of the official’s illness, diagnosis,
patient is required. treatment or prognosis. All of this infor-
(See box at right.)
–6–
Feature Viewpoint
Response From
the Editor
continued from page 2
Physicians usually have no experience
dealing with malpractice issues.
Physicians need immediate help and
should find their best resources.
Physicians who have already been
named in a potential suit should contact
their malpractice attorney and, for those
who are associated with a hospital,
should contact the hospital’s risk man-
agement staff. Washington Hospital
Center’s risk management service is
excellent. They know the importance of
immediately meeting the patient to dis-
cuss the issue. They are experts at how to
avoid unnecessary lawsuits by approach-
ing the patient with care and compassion
and attempting to meet their needs.
Patient Confusion Lower the Chatter Most physicians are stunned by their first
Finally, patients in hospitals are confused It is equally appalling to observe friends of lawsuit. Many talk openly about this
about the meaning of HIPAA. In some cases, friends or even friends of doctors freely (perhaps one of the worst things they
patients and family members may be chatting about a recent surgery that Dr. X could do) because they feel “no malprac-
extremely disturbed when they have been had and what the implications are. A tice occurred.” Their discussions about
informed that they are no longer allowed patient’s results or another physician’s the case could be admissible in court.
information regarding their family mem- health should never be discussed in an ele- Some physicians inappropriately go back
ber’s medical information. Some physicians vator but more important, should not be to the patients after a suit has been filed.
and nurses categorically refuse to give any part of the lunch-time conversation. This, without appropriate counsel or
information to family members. Physicians, in their intent to do well, must advisement from Risk Management,
never give results of their patients, in par- almost never benefits either the patient
However, HIPAA requires only that physi- ticular if they are VIP, when called by news or the physician being sued. As was
cians and nurses check with their patients media. If a health care worker or physician stated in the article, correction of fact
prior to disclosing information, assuming provides information about a patient’s care after the matter is certainly one of the
the patient is mentally competent. A minor in response to a call from the media it is a worst things possible.
or a patient who is a dependent of a family clear and gross violation of the HIPAA
member must have information shared. mandate. Any such questions should be All physicians should recognize the most
handled by a skilled media relations expert. important way to avoid a malpractice
Media relations is always available to help suit is by practicing and establishing an
with consults 24/7. (See box at left.) excellent rapport with the patient and
mation is HIPAA-protected and should family members.
be referred to Media Relations. HIPAA was put in place to protect patients
You can reach a member of the Media from inappropriate release of their data, in
Relations team at any time by calling: particular to insurance companies or third-
party pharmacies/marketing vendors or
Paula Faria, director, (202) 877-7594,
pager 1-866-474-0805
media who might have economic benefit
from understanding and discussing a
LeRoy Tillman, associate director, patient’s condition. HIPAA was never
(202) 877-7072, pager 1-866-474-1779 intended to obstruct patient health care.
So Young Pak, senior media relations
specialist, (202) 877-2748,
pager 1-866-474-0901
James Jelinek, MD, is chairman of the
For HIPAA questions and requirements, Department of Radiology and editor of
contact MedStar Health’s corporate Washington Hospital Center Physician
privacy officer, Diane H. Meyers
Newsletter.
(410) 772-6535.
–7–
Feature
Providing Innovative Services
to the Elderly
2 New Outpatient Behavior Health Programs
T
wo new outpatient behavioral health ered to do a little more,” home watching television
programs reach further into the com- she notes. She strives to and sleeping. Samuel tries
munity to offer services to elderly encourage her patients to to motivate them to expand
patients who have not been served by other get out and be with others. their horizons. “I try to
programs. One program provides in-home recharge their minds,” he
psychiatric care for elderly patients who are “I had one woman in her explains.
homebound. The other program brings eld- 90s,” she remembers. “She
erly patients to Washington Hospital resumed going to her At the center, Samuel gets
Center’s outpatient behavioral health center weekly church service. She participants talking about
at Trinity Square for lunch, therapy and said, ‘I’m getting back to things that are important to
socialization from noon to 3 p.m., Monday my life!’” them.“The other day I asked
through Friday. a group what was their life
Another patient had like in D.C. when they were
become housebound be- teenagers,” he says. “Their
In-Home Program cause her wheelchair was
The in-home program sends social workers faces just lit up and they
broken and she could not started smiling. They
to the homes of elderly people who need manage to get it repaired.
psychiatric services as an extension of remembered their successes
After a few therapy ses- and it reminds them they
Washington Hospital Center’s House Call sions, the patient was less
Program. can still have fun.”
depressed. She had her
“Dr. (Eric) DeJonge shared with me that wheelchair fixed, and then He has many success stories
many homebound elderly had psychiatric was able to get out of her Karen Van Allen, LICSW — In- to share. “There was one
home. home program “is wonderful.” woman who was psychotic.
issues,” explains Desi Griffin, PhD, adminis-
trator for the Hospital Center’s Outpatient She was very confused and
Behavioral Health Services. “He wondered if
Day Break confrontational. Now she’s communicating
we would be able to provide psychiatric sup- The need to break social isolation led to the better, letting others finish their conversa-
port services for these homebound patients.” establishment of the second new behavioral tions and has reduced psychotic symptomo-
health program, called Day Break. This pro- tology.”
Accordingly, the in-home behavioral health gram provides a place for elderly residents to
service started in September 2003. One part- gather and receive treatment from their psy- Samuel also works with participants to keep
time social worker traveled to patients’ chiatrist and participate in group psy- their minds alert. He initiates games that
homes to provide behavioral health services. chotherapy. require simple addition and subtraction, for
The program quickly grew; the third part- example. He also favors games that require
time social worker began in March 2004. Established in the fall of 2003, this program interaction and stimulate conversation. “The
provides a van to pick up participants from point is to help people recognize that even
“It’s really quite a wonderful program,” says their homes and bring them to Trinity Square though they’re getting older, they’re not
Karen Van Allen, LICSW, who was the first at noon. Participants eat lunch, see their psy- worthless. Age has nothing to do with a per-
social worker to make house calls. “It’s like chiatrist and/or mental health clinician and son’s ability to feel good about themselves.”
an old-fashioned model of health care, with attend individual or group therapy sessions.
people being seen where they live.” The van then returns them home at 3 p.m. Length of stay is based on patient need, with
The program operates Monday through most participants spending about three
Some elderly residents cannot leave home Friday. Family involvement is encouraged. months in the Day Break program. The goal
for physical reasons. Other patients are so is to stabilize their symptoms, improve their
depressed that they lack the motivation to Frank Samuel, LICSW, is one of two clinical level of functioning and connect them to
leave home. Still others are so frail that they social workers who work with the Day Break other Behavioral Health Services programs
fear leaving home. In any case, at-home serv- program. “Most patients are pretty or community resources prior to discharge.
ices provide a necessary link to behavioral depressed, withdrawn and isolated,” Samuel
health. notes.“This is due largely to the fact that they “These programs are part of our effort to
have gotten older, their friends and family provide a comprehensive web of behavioral
Van Allen works on a variety of issues with have died, they have physical disabilities and health services to the community,” Griffin
her patients, using traditional psychotherapy their ability to get around is hampered.” concludes. For more information or to refer
techniques. “Our hope is that people can a patient, call the Outpatient Service Intake
begin to feel a little better, and feel empow- As a consequence, they spend a lot of time at Line at (202) 877-6339.
— Catherine Avery
–8–
Feature
Preventing Injury in
Ryan McVay/Getty Images
the Aging Athlete
Wiemi A. Douoguih, MD
P
rofessional athletes often perform the rate of muscle fiber regimen that consists of
amazing feats on the playing field. loss increases to 10 per- 30-60 minutes of exer-
Despite their tremendous condition- cent per decade. Rates cise at 60-90 percent of
ing, they often experience significant mus- of loss have been the age-adjusted maxi-
culoskeletal injuries that can have long- reported to be as high mum heart rate, three
term effects on their bodies. If highly as 35 percent per to five days per week.
trained young athletes can sustain serious decade in certain sub- For resistance training it
injuries, it is easy to understand how the sets of the aging popula- is recommended that an
“weekend warrior” attempting to mimic tion. As a result, by the individual engage in two
their favorite television sports hero can also age of 80, individuals sessions per week in
sustain significant injuries. may lose as much as 60 which one set of 8-10
percent of their peak exercises are performed,
Professional athletes are young, for the most strength. targeting the major muscle
part, and their bodies are able to recover groups.
quickly from most injuries. The older one Tendons and ligaments
gets, the more difficult it becomes to physio- undergo similar changes with For people under the age of
logically recover from injury. Therefore, it is age. One study showed a pro- 50 a weight that can be lifted 8-
important to understand the risk factors for gressive decline, with age, in the 12 times is appropriate. For
athletic related injuries so that one can pre- stiffness and ultimate load to fail- individuals over the age of 50,
vent them from occurring. ure (maximum force that a struc- weights that can be lifted 10-15
ture can withstand) of human anterior times are more appropriate. Resistance
The human body undergoes predictable, cruciate ligaments. The decrease in load to programs have been shown to both improve
age-related changes that can increase the risk failure was most rapid between the third and muscle strength and maintain bone density.
of injuries and affect its ability to heal. The fifth decades of life. In subjects older than 60 In all, a moderate resistance exercise pro-
average person reaches his or her peak bone years, the anterior cruciate ligament was gram combined with a regular cardiovascu-
mass by the age of 30 years. After 30, both found to fail with only one-third the force lar fitness program can significantly enhance
men and women experience a steady decline applied in younger patients. Decrease in strength, flexibility and joint mobility. This
in their bone mass until they die. Women blood supply and cellular function also prescription for health reduces the risk of
experience a greater decrement in their bone occurs with age in these tissues contributing injury, and improves the body’s ability to
mass around menopause. After menopause to their increased susceptibility to injury and heal in the aging athlete.
the rate of decrease returns to levels equiva- inferior ability to heal.
lent to men. Decreasing bone mass increases
the likelihood that an aging individual will Benefits Outweigh Risks
sustain a fracture. Not only does bone mass Wiemi Douoguih, MD, is an orthopedic sur-
Despite age-related changes that can geon and has served as assistant team physi-
decrease with age, but the process by which increase the risk of injury and decrease heal-
old or injured bone is removed and new cian for several professional sports teams,
ing rates, the benefits of regular exercise sig- including the Los Angeles Dodgers, Anaheim
bone is formed decreases significantly with nificantly outweigh the risks posed by a
age. This process, referred to as bone Angels, and Washington Redskins.
sedentary lifestyle. Exercise has long been
turnover, helps heal broken or injured bone. known to reduce the risk of premature mor-
Decrease in the rate of bone turnover means tality, strokes, coronary artery disease and
increased time to heal fractures in older References:
hypertension. It also has been shown to pre-
individuals. vent age-related degradation of bones, joints
1. Woo SL, Hollis JM, Adams DJ, Lyon RM, Takai S.
Tensile properties of the human femur-anterior cru-
Muscles, tendons and ligaments also experi- and muscles. However, prior to beginning a ciate ligament-tibia complex. The effects of speci-
ence age related changes, which render them new exercise program an individual should men age and orientation. Am J Sports Med, 1991;19:
determine his or her physical limitations and 217-25.
more susceptible to injury and less likely to
heal. Just as with peak bone mass, men and set specific exercise goals. Determining phys- 2. Galloway MT; Jokl P. Aging Successfully: the
women reach their peak muscle mass at ical limitations should be done objectively Importance of Physical Activity in Maintaining
with the aid of a physician. Health and Function. J Am Acad Orthop Surg 2000;
around 30 years of age. After 30, muscle 8:37-44
fibers decrease in both size and overall num- Setting realistic exercise goals is also critical. 3. Buckwalter JA; Heckman JD; Petrie DP. An AOA
bers. Skeletal muscle mass has been found to The American Academy of Orthopaedic Critical Issue: Aging of the North American
decrease at rate of four percent per decade Surgeons endorses a cardiovascular exercise Population: New Challenges for Orthopaedics. J
between the ages of 25 and 50. Thereafter, Bone Joint Surg Am 2003 85: 748-758
–9–
Election 2004
Election
continued from page 1 HEALTH CARE REFORM ket system, and the low reimburse-
FAST FACTS: There are currently ments and heavy administrative bur-
truly undecided voters, and in all like- more than 43 million Americans dens posed by Medicare haven’t been
lihood there are other physicians in without health insurance, four mil- exactly a great advertisement for what
her situation. lion more than four years ago. the government could accomplish on
a wider scale. Although the AMA
The American Medical Association PERSPECTIVE: Physicians dedicated remains steadfastly silent on candi-
and most other major medical associ- to patient care are deeply distressed dates, the keywords in their policy
ations do not endorse political candi- about this issue (and can certainly statements remain “tax credits” and
dates but, based on their policy state- empathize, since they face skyrocket- “consumer choice.” The AMA would
ments as well as information from the ing insurance rates and limited avail- limit the role of government, avoid-
candidates position papers, Physician ability in their own sphere). But the ing a one-size-fits-all approach to
Newsletter has prepared a point-by- medical community historically has coverage.
point analysis of where Bush and been resistant to any plan that repre-
Kerry stand on issues of concern to sents what they view as excessive gov- John Kerry
the medical community. We’ll begin ernment intrusion into our free mar- Under Kerry’s plan the existing health
with tort reform. insurance system for federal employ-
ees would be expanded to private citi-
zens through tax credits and subsidies,
and the unemployed would get a 75
MEDICAL MALPRACTICE John Kerry percent tax credit to help pay for
REFORM According to his campaign literature, insurance. Tax credits would also help
FAST FACTS: One in seven ACOG Kerry “strongly opposes capping small businesses cover their employ-
(American College of Obstetricians damages in medical malpractice ees. Citizens aged 55 to 64 could buy
and Gynecologists) Fellows has suits.” Kerry’s plan to reduce liability into the federal employees’ health
stopped practicing obstetrics because insurance costs would have “qualified plan. The government would step in
of the risk of liability claims. Over 76 specialists” analyze cases and deter-
percent of ACOG Fellows reported mine if they have enough merit to end
they had been sued at least once; 57 up in court, require states to offer
percent had two or more claims filed non-binding mediation and eliminate
against them, and 41.5 percent had the award of punitive damages except REPRODUCTIVE CHOICE
three or more claims. in cases of intentional misconduct, AND RELATED ISSUES
gross negligence or reckless indiffer- FAST FACTS: Earlier this year the
PERSPECTIVE: For doctors this ence to life. FDA ruled to keep emergency contra-
remains the most critical issue on the ception a prescription-only drug. And
political horizon. With an aggressive George W. Bush although enforcement of the Partial
tort reform plan already before Bush claims his tort reform play Birth Abortion act is enjoined by the
Congress and backed by the president, would reduce health care costs for all courts, the Justice Department issued
they are unlikely to throw support Americans by $60 billion. The Bush multiple subpoenas to hospitals
behind any watered-down version of plan would limit non-economic dam- demanding medical records of
reform. Possibly driving more physi- ages to $250,000, reserve punitive women who had undergone second-
cians to the Bush camp is Kerry’s damages for “where they are justified,” and third-trimester abortions. Under
selection of John Edwards, a noted provide for payments of judgments Bush, government-funded stem cell
plaintiffs’ attorney, as his running over time rather than in a lump sum, research has been limited to a number
mate. prevent cases from being brought of existing lines and adult stem cells.
years after an alleged event and reduce
doctors’ payments to plaintiffs that PERSPECTIVE: The FDA decision
have been compensated by insurance. and the Justice Department actions
Bush’s plan, strongly backed by the came as a blow to medical organiza-
AMA and other medical organiza- tions that have had a remarkably
tions has passed the House and strong relationship with this admin-
remained stalled in the Senate. But the istration. Willingness to ignore med-
president, who considered tort reform ical recommendations in the FDA
important enough to include in his case drew criticism from physicians
State of the Union speech, has vowed as did the attempted record search.
to see it pass if reelected. Many articles appeared quoting doc-
– 10 –
Election 2004
to help companies and insurers pay rumor mill has it that key Bush offi- GUN CONTROL
catastrophic medical costs for cials knew and suppressed the higher FAST FACTS: In 2001, 11,348 of the
employees if firms hold down premi- cost estimates during legislative nation’s 20,308 homicides were com-
ums. The federal government would debate. Critics have also said the bill is mitted with firearms. In 2002, more
also expand access to insurance for a windfall for pharmaceutical compa- than 13,000 children were injured by a
children who are currently covered by nies rather than seniors. The president firearm. During the decade of 1992 -
state programs. Estimated cost: $895 has also signed legislation allowing 2001 an average of 1,273 children a
billion over 10 years to cover 27 mil- medical savings accounts and health year committed suicide with guns.
lion people. While the Kerry plan is far care tax credits to make insurance
from the dread Canadian single-payer more affordable, both measures sup- PERSPECTIVE: The AMA sees
model, it might be too much govern- ported by the AMA. In addition he gun violence as a public health
ment for some wary physicians. supports plans that allow small busi- issue and largely supports
(Kerry also vows to expand and nesses to pool together for health care plans, such as a national wait-
reform the troubled health care sys- options, and the president’s plan also ing period and background
tem for veterans.) offers federal matching funds to state check, to restrict access to
health insurance programs for poor handguns. The AMA also
George Bush children. favors collection of firearm
The cornerstone of Bush’s health death and injury data by the
reform strategy, a prescription drug While these plans have met with AMA CDC. Ultimately, however, this
benefit for seniors, has already passed approval and have more modest cost issue may break along personal
Congress with the support of the estimates than the Kerry proposal, lines: country docs who grew up
AMA and America’s most powerful critics doubt their ability to seriously hunting versus urban ER docs who
senior organization, AARP. But the reduce the vast numbers of uninsured treat 15-year-olds with gunshot
bill has not been without controversy. in the country. Under Bush the num- wounds. Unlike reproductive issues,
First, the cost is now estimated at $534 ber of uninsured Americans has there have been no direct conflicts
billion rather than $395 and the steadily increased from 39 million. with the medical community and the
administration on gun control.
John Kerry
tors who feared they could be investi- Kerry is a gun owner and hunter as
John Kerry well as a combat veteran, but he sup-
gated for performing or referring Kerry is a longtime abortion-rights
patients for procedures that remain ports gun control legislation outlined
supporter and a stalwart on issues in the Brady Bill and supported by the
legal. ACOG and the AMA protested important to women’s groups, which
this intrusion into confidential med- AMA.
would include emergency contracep-
ical records in writing. tion. He voted against the Partial George W. Bush
In terms of stem cell Birth Abortion Bill and has As Vice President Dick Cheney said to
research, many feel that vowed to appoint only a supportive crowd of NRA members
Bush — as in the case of Supreme Court judges in Pennsylvania in April, “The
emergency contracep- who support reproduc- Republican ticket this year, once
tion — has allowed the tive choice. (As a pro- again, is two Westerners who are life-
voices of the religious choice politician, Kerry long gun owners, hunters, and anglers
right to out-shout has no problem with — and strong believers in the Bill of
those with medical using embryos for Rights of the Constitution.” No fan of
knowledge. Many pro- stem cell research.) gun control measures or lawsuits,
minent GOP figures, Bush has also brought his passion for
including Nancy Reagan George W. Bush tort reform to the firearms arena, sup-
on the eve of her hus- Bush is out front in his porting a bill that would immunize
band’s death, have urged opposition to abortion gun manufacturers from lawsuits by
Bush to reconsider his posi- and has pushed programs victims of gun violence.
tion, but he has been unmove- such as abstinence-only edu-
able. The question is, will these issues cation. He supports abortion only
matter enough to some physicians — in cases of rape, incest and life of the Melanie Howard, a long-time writer
particularly ob-gyns — to put them mother, and does not believe in for Physician Newsletter, is a former
in the Kerry camp despite his tort exceptions to preserve the health of staff writer for The Washington
reform stand. the mother. Times. She currently writes on health-
related issues for American Health,
Family Circle, and Glamour, among
Note: Washington Hospital Center Physician Newsletter does not endorse a particular party or candidate. other publications.
– 11 –
Feature
‘Lifted Spirits,’ Improved Patient Care
Joint Practice Initiative Nets Results
A
consolidated effort to promote qual- a very strong camaraderie and collegiality,” First and foremost, he makes himself avail-
ity clinical outcomes and improve she says.“The medical director serves as ‘unit able as an ongoing resource. Every week he
the working environment at champion.’” She also points to objective participates in discharge rounds and then
Washington Hospital Center has achieved proof that the practice model is effective. On conducts a didactic session that serves as a
solid results, report physicians and nurses unit 2C, for example, the March 2004 patient forum for discussing that week’s patients
involved with the Joint Practice initiative. satisfaction data showed an increase of 19 and resolving issues. Pessagno adds that lec-
points in overall nursing care. ture topics may include information about
The Joint Practice Committee was estab- technology, equipment or flow processes.
lished in December 2002 to foster collabora- DeJonge adds that his unit, 1C, also has a
tion among physicians and nurses to collaborative and supportive team of staff “It’s like being the coach of a football team,”
improve clinical care and provider satisfac- and physicians with “superb morale and Pistole explains. “The head nurse is the cap-
tion. Two goals of the group are to recom- patient service.” He describes how the tain. Your job [as a physician] is to be avail-
mend appointment of medical directors for process works.“Elderly and disabled patients able. Be a confidante to the nurses, be an
each nursing unit and to formalize the receive caring and compassionate care from information conduit, offer another forum
nurse-physician rounding process. all the staff on 1C. Frail elders need to get out for getting answers. It gives nurses a sense of
of bed, receive help with feeding and stay as connection with the rest of the hospital; it’s
Two units already had medical directors — little time in the hospital as possible, all of total empowerment.”
Micheal Pistole, MD, gastroenterology, a pri- which the 1C team accomplishes. The best
vate practice physician, is medical director of part of working on that unit as a Unit 2C consists of general medical patients,
unit 2C, and Eric DeJonge, section director, physician is our practice of bed- many with chronic illnesses. Still, the team
geriatrics, is medical director of unit 1C. side rounds with the primary approach has been able to reduce length of
Efforts are underway to identify medical nurses and aides that care for stay through ongoing communication and
directors for additional units. our elderly patients.” effective discharge planning.
“There’s been a lot of support [for the Pistole describes what Pistole sees ways that the Joint Practice ini-
Joint Practice initiative] from Mr. Caldas goes into serving as med- tiative can have additional positive impact.
[Washington Hospital Center President ical director for a unit. He would like to encourage the concept of
James Caldas],” said Anthony Watkins, ‘geographical residents’, in which groups of
MD, co-chair of the Joint Practice residents would be assigned to units, so they
Committee. “There’s been a signifi- would work as part of patient care teams. He
cant degree of collaboration among also would like to see the educational com-
head nurses and physicians that has ponent of the nurse-physician rounding
improved communications and process become more formalized so nurses
lifted spirits, and that’s improved could earn continuing education credits.
patient care. We’re continuing to
look for more physicians who Watkins has a few plans of his own. “I’d
have the time to devote and can like to find way to support our nurses
serve as medical directors for while the Hospital Center is attempt-
units.” ing to achieve Magnet status,” he
says. Magnet status is awarded by
Pistole is enthusiastic about the the American Nurses Credentialing
program. “It’s been a very posi- Center (ANCC) in recognition of
tive experience for all of us,” he excellence in all aspects of nursing,
said. “We’ve established better from management to patient care.
relationships among those who
work on the unit so we work But the team approach to patient
together better. That improves care is an end in itself. “It makes us
patient care and expedites effec- a family,” Pistole concludes. “It
tive discharges. As a team, we establishes better relationships.
come together in the right way.” Problems are easier to handle when
they are shared. It’s very positive
Ann Marie Pessagno, RN, direc- for all of us. I’ve learned a lot
tor of oncology and ambulatory myself. I’ve been empowered. It
services and co-chair of the Joint works!”
Practice Committee, agrees that Ann Marie Pessagno, director of oncology and ambulatory
the program works well. “There’s services, and Eric DeJonge, MD, section director, geriatrics, —Catherine Avery
medical director of Unit 1C
– 12 –
Foundation
A Pathway to a “Golden Moment”
By Bob Levey, Senior Vice President for Development
T he laminated card is now a fact of life.
de and who
By the time you read this, every physician s express gratitu
For doctors whose patient pital Center:
(and every nurse) who works at Washington Washington Hos
Hospital Center will have a way to refer may wan t to contribute to
grateful patients to the Washington Hospital ppreciation
show your a
Center Foundation. you'd like to
Information on how to do that is contained “ If
in a more sub
stantive way,
I'd like to giv
y in the Wash
e
ington Hospit
al
on a laminated blue-and-yellow card, Bob Leve members
approximately four inches by three inches. your name to ne of his staff
a tion. He or o
The Foundation distributed approximately Center Found days, when y
ou're
3,000 cards in late June and early July. a call in a few
will give you
On one side of the card, physicians will find
language that they can use if a patient says
he’d like to make a gift in honor of good
feeling bette
r.
”
treatment or a good outcome.
oundation
On the other side are my phone number
Hospital Center F
(202-877-7983) and the main phone num- Washington 202-877-6558
ber of the Foundation (202-877-6558).
lopment
The card fits very neatly into the breast es ident for Deve
Senior Vice Pr
Bob Levey, d st a r. n e t
pocket of a physician’s white coat. The idea is
983 or b o b .l e v e y @ m e
that physicians will always carry it, and 202-877-7
always have it on hand if a patient asks where
and how he can contribute. undation an
also send the Fo
Doctors should on any such conversation, so .
Let me stress that no laminated card has ever e-mail to report has a record and can follow up
raised a nickel, and no laminated card ever the Foundation
will. MedStar Health
Thank you!
People give to people. People give in honor
of top-notch care. People will give to the
hospital only if the Foundation can get con-
nected to them at the time when they feel
most generous.
Physicians are almost always the pathway to results that make Washington Hospital Please bear in mind that gifts to the
that “golden moment.” After all, it’s physi- Center so well-respected. Foundation do not float quietly onto some
cians whose training and talent produce the profit-and-loss sheet, never to be seen again.
Physicians can produce another kind of Donations always go — and only go for
result, too: More contributions to help bal- equipment, training, research and new ini-
ance the Hospital Center’s budget. tiatives. By helping steer prospects to the
Bob Levey Foundation, physicians can help assure a sol-
You doubt that it will work? It already has.
Senior Vice President for vent future for this wonderful institution.
Development This summer, a patient was being seen by Dr.
Arnold Kwart. The patient mentioned that So please keep your laminated card handy,
Washington Hospital Center
he was very grateful for great urological care. and please use it. You can be the difference
Foundation
Dr. Kwart whipped out the laminated card between a gift that’s given, and a gift that the
202-877-7983 PHONE Foundation never hears about.
and rattled off the language on it.
202-877-5148 FAX
The patient wrote a $10,000 check on the Many thanks!
bob.levey@medstar.net
spot!
– 13 –
Spotlight On…
Frank Spellman, MD —
Physician With a Clear Vision
was devastated when my grandmother died of uncon-
I
t’s no wonder that Frank Spellman, MD, has chosen
to specialize in retinal surgery, a highly challenging trolled hypertension in a leaky basement hallway
subspecialty of ophthalmology that employs intri- because African-Americans couldn’t be admitted to
cate surgical techniques to combat vision loss. regular rooms in the hospital,” the younger Dr.
Spellman notes.
After all, he’s spent his life keeping a vision
alive. His vision — and that of his father and To no one’s surprise, the next generation produced
grandfather — is of a color-blind society, another physician. Mitchell Spellman, MD, graduated
where each person succeeds based on his or from Howard Medical School in 1944, and earned a
her efforts. And he has lived that belief in doctorate during his thoracic surgery residency at the
singular fashion. University of Minnesota. He was the first thoracic sur-
geon at Howard and was head of Howard’s surgery
Dr. Spellman was born and raised in service. He left Washington in 1969 to be the founding
Washington, D.C., the oldest of eight chil- dean of the Charles Drew Medical School in Los
dren. “I was programmed from birth to be a Angeles. Then in 1979 he became a professor of sur-
physician,” he remembers, with a chuckle. gery and dean of medical services at Harvard Medical
“My mother brainwashed me from the age of School in Boston. Today he is dean emeritus and is
five. I thought it was my own idea.” It didn’t involved in Harvard Medical International, an
hurt that his father was a respected local sur- exchange program that helps third-world countries
geon. His mother, too, had been admitted to send students to Harvard for training.
medical school, but she decided to attend
nursing school so she could fulfill her larger
ambition of raising a large family. “I was made to understand
Dr. Frank Spellman —
“Education is the
But his medical roots go back even further. His pater- that if I did not become
nal grandfather, Frank, was orphaned at the age of 12
key.”
or 13 in Louisiana, and couldn’t start first grade until successful, the only person I
age 16. “He was teased without mercy by his 6- and 7- could blame was myself.”
year-old classmates,” his grandson says now. But his
parents had impressed on him the impor-
tance of education, so he soldiered on until It’s no wonder that our Dr. Spellman professed an
he graduated from high school. early interest in medicine. But he knew education was
the key. “I was told that if I worked hard, I could be the
The family myth is that grandfather Frank
first African-American graduate of Georgetown Prep,”
walked from Louisiana to Washington, D.C.
he recalls. So he enrolled there as a seventh grader in
carrying his only pair of shoes so he would-
1962, where he was the only African-American stu-
n’t wear them out. When he arrived, he
dent until he was joined by John McKnight, who now
enrolled at Howard University Medical
is on oncologist on the medical staff at Washington
School and got a job at the Government
Hospital Center.
Printing Office, working his way through
medical school. He graduated in 1909, and “There were certainly some painful moments,” he
returned to Alexandria, Louisiana to set up recalls, “but there were some wonderful ones as well.
practice several years later, where he prac- Those were different times.” He had an agreement
ticed from 1915 to 1953. “He wanted to be a with his father that he would pay half his tuition, so he
big fish in a small pond,” his grandson dutifully rose each morning at 4 to deliver the
explains. Washington Post before school.
But times were different then. He was the He graduated from Georgetown Prep in 1968, and
Father, Dr. Mitchell only African-American physician in town went on to Johns Hopkins University with a National
Spellman — First and was not allowed to have hospital privileges. He Achievement Scholarship to study pre-med. “I got my
thoracic surgeon at had to transfer care to Caucasian physicians when most meaningful medical experience during my jun-
Howard University. patients needed to be admitted to the hospital. “He ior year, when I was hospitalized for six weeks with
Spotlight
viral pericarditis,” Dr. Spellman said. The experience
was invaluable in preparing him for his medical career.
“I found that all doctors are well-educated, and some
are even brilliant. But some are far better doctors than
others,” he says.
After graduating from college in 1973, he went on to
medical school at the University of California in San
Francisco. He then did an internship in the Bay Area
and a fellowship in ocular pathology, before moving to
Boston for a residency in ophthalmology at Harvard’s
prestigious Massachusetts Eye and Ear Hospital.
The choice of ophthalmology came about from setting
a stringent goal for himself. “While I was in med
school, a fellow student told me that his research indi-
cated that ophthalmology was the best specialty. The
only negative factor was that it was the most difficult
specialty to get into,” he recalls. “I thought that would
give me a great goal. If I could do that, I would have
my pick of specialties.”
But after several electives in ophthalmology, he dis-
covered that was what he really wanted to do. While at
Mass Eye and Ear, he decided to specialize in retinal
surgery, thanks to the encouragement of a professor.
Again, the challenge appealed to him. “I think retinal
surgery is the most challenging area in ophthalmol-
ogy,” he says. “You’re working on the inside of the back
of the eye, dealing with vascular and degenerative con- generation. He mentors young people interested in
ditions, tumors and trauma. There are any number of pursuing a career in medicine, and teaches residents at
extremely challenging conditions that you have to the Hospital Center and medical students at Howard
manage. Retinal conditions are the leading cause of and George Washington.
vision loss.” He and his wife Beverly Brown Spellman, a retired
His particular area of interest is diabetic retinopathy, attorney, live on the Montgomery County line, with
which he notes has a 60 percent higher prevalence in their 13-year-old son and 11-year-old daughter. He
the African-American community. In fact, his mater- and his wife will celebrate their 27th wedding anniver-
nal grandfather was a diabetic. “Dating back to my sary in September, he proudly notes.
childhood, I wanted to take care of the folks,” he In his spare time, he and his wife play golf, and he has
explains. coached his son’s basketball and baseball teams since
Accordingly, when he finished his fellowship in retinal pre-kindergarten. He also has restored a 1963
surgery as the Bascom Palmer Eye Institute in Miami, Mercedes, which puts him in mind of Martin Luther
where he was the first African-American retinal fellow, King’s “I Have a Dream” speech. “I wanted to go to the
he came home. He joined the staff of the Hospital March on Washington, but my mother was afraid
Center in 1983 and also served as director of the reti- there would be rioting, so she wouldn’t let me go. She
nal service at Howard University Hospital for 13 years. went, and told me about the ‘I Have a Dream’ speech.
She said, ‘The only way you can make your dreams
“There’s no way to overestimate how satisfying it is to come true is to pursue your education. That’s how
practice in this community,” Dr. Spellman says. “There you’ll be able to buy one of those cars you like!’”
were many African-American physicians who were
role models for me as a child, and some have become So he did just that, and has no regrets. “Not a day goes
my patients over the years.” Recently, he even treated a by that I’m not grateful for the educational opportu-
patient who lived on his old newspaper route. He also nities given to me by my parents, teachers and role
feels fortunate to have many family members living in models,” he says. “I was never denied opportunity. I
the area. was made to understand that if I did not become suc-
cessful, the only person I could blame was myself.”
Today he works hard to pass his vision on to the next
—Catherine Avery
– 15 –
Research Update CONTACT INFORMATION
James S. Jelinek, MD
Editor • (202) 877-6088
James.S.Jelinek@MedStar.net
Margo Smith, MD
Associate Editor • (202) 877-7164
Lombardi-MedStar Oncology Margo.A.Smith@MedStar.net
Annamarie G. DeCarlo
Managing Editor • (202) 877-3118
Research Network Created Annamarie.G.DeCarlo@MedStar.net
Washington Hospital Center Physician is an
A
new MedStar Health system-wide with representation of diverse patient informative monthly publication for all the members of the
initiative for cancer research has groups.” Washington Hospital Center Medical and Dental Staff. It is a forum
to report news of interest to the medical staff, disseminate informa-
been formed with the goal to tion about what is going on in the hospital, introduce new providers
The new research network is chaired by and profile current ones, exchange ideas and opinions about subjects
involve more than 1,000 patients in oncol-
John Marshall, MD, of the Lombardi of interest and controversy, and recognize the professional and per-
ogy clinical trials within the next three sonal accomplishments of our practitioners. Its overall goal is to
Institute. Perry is in charge of the system- help foster and celebrate a sense of community among the broad
years.
wide Oncology Institutional Review Board. diversity of the Hospital Center physician membership. The newslet-
ter is published by the editorial services division of Public Affairs for
The MedStar Research Institute (MRI), In addition to Lessin, senior advisors the Office of Medical Affairs.
established by Washington Cancer Institute include William McGuire, MD, Franklin MISSION—Washington Hospital Center, a valued member of
MedStar Health, is dedicated to delivering exceptional patient first
at Washington Hospital Center in1999, and Square Hospital, and Barbara Howard, health care. We provide the region with the highest quality and
the Lombardi Research PhD, president of MedStar Research latest medical advances through excellence in patient care, educa-
tion and research.
Network at Georgetown Institute. Washington Hospital Center, a private, not-for-profit hospital, does
University Hospital, not discriminate on grounds of race, religion, color, gender, physical
While oversight of trials handicap, national origin or sexual preference.
have merged to become Visit the hospital’s web page at: www.WHCenter.org. This newsletter
being conducted in this
the Lombardi-MedStar is printed by Washington Hospital Center Printing Services.
new network is limited
Oncology Research Net- James F. Caldas, President, Washington Hospital Center
to MedStar physicians,
work. This new initiative The Honorable Togo D. West, Jr.
all trials are open to Chairman of the Board, Washington Hospital Center
will provide more
patients referred by any John P. McDaniel, CEO, MedStar Health
patients with access to
physician. The coordinated effort with
new clinical trials than any other regional James Jelinek, MD Editorial Board
large numbers of investigators and poten- Editor Members
cancer center.
tial participants strongly positions MedStar Margo Smith, MD David Downing, MD
Health to competitively attract cutting- Associate Editor Roy Flood, MD
The MedStar Oncology Network has been Annamarie G. DeCarlo
edge clinical research studies – including Cheryl Iglesia, MD
led by David Perry, MD, medical director of Managing Editor Stephen Peterson, MD
research at the Cancer Institute, and Becky those that previously may have been Ann Lesnik
Micheal Pistole, MD
Sr. Graphic Designer
Montalvo, administrative director. awarded elsewhere because of the need for Mark Smith, MD Kevin Reed, MD
larger numbers of patients. It also gives the Editor Emeritus Marc Schlosberg, MD
David Shocket, MD
“In its most recent year, the MON accrued system leverage with leading organizations Frederick C. Finelli, MD
Thomas Stahl, MD
President,
more than 300 patients to clinical trials, like the National Cancer Institute. Most Medical and Dental Staff Larry White, MD
with greater than 30 percent minority par- important, it provides MedStar’s oncology Janis Orlowski, MD
Contributing Writers
ticipants,” said Lawrence Lessin, MD, med- Senior Vice President
patients with access to the latest targeted and Medical Director Catherine Avery
ical director at Washington Cancer cancer therapies. Lisa Wyatt Carol Casey
Institute, and a senior advisor. “Our goal is Vice President, Public Affairs Melanie Howard
Physicians who want more information Christine Vinh Deborah Schwartz
to involve more than 1,000 patients in Asst. Vice President
should call (202) 444-4000. LeRoy Tillman
oncology clinical trials within three years, Medical Affairs/Quality Resources
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