2011 April Bulletin - Allegheny County Medical Society.pdf by lovemacromastia


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                                                                                                                                                                        April 2011
                                                                                                                                                                    Vol. 101 No. 4

 of the Allegheny County Medical Society

ARTICLES                                        PERSPECTIVES                                                    DEPARTMENTS
Legal Report ............................ 160   Editorial................................... 146                Society News ........................... 153
When Can Minors Consent to Their Own            Physician Reentry                                               ♦   Photo: Joint Surgical Society meeting
Medical Care?                                   Timothy Lesaca, MD
Elizabeth Metz, ESQ                                                                                             Community Notes ................... 153
                                                President’s Message .................. 149
Photo Feature .......................... 163    The ACMS Foundation: 50 Years                                   Activities & Accolades ............. 155
2011 ACMS Community Awards Gala                 Supporting the Community
                                                Leo R. McCafferty, MD                                           In Memoriam .......................... 157
Financial Health ...................... 170                                                                     Robert J. Carroll, MD
Read the Literature: Investing Lessons from     Academic Perspective ............... 150                        Rupert H. Friday, MD
Mark Twain                                      Academic Medicine and Pharma                                    Basil A. Marryshow, MD
Gary S. Weinstein, MD, FACS                     Partnership
                                                Arthur S. Levine, MD                                            Continuing Education ............. 158
Special Report.......................... 172
Free Resources for Physicians Help Cancer       Perspective ............................... 152                 Calendar .................................. 159
Patients & Families                             Reflections
Patricia T. Patterson, RN, MN                   George J. Pavlic, MD                                            Legal Summary ........................ 161
Special Report.......................... 174                                                                    Classifieds ................................ 178
Accountable Care Organizations: Western
Pennsylvania Physicians and Hospitals
Prepare for Reform
Patricia Raffaele

Special Report.......................... 177                                                                                page 163
Medical Records FAQs
                                                    Celebrate May 6-12                                                       Photo
                                                   National Nurses Week                                                     Feature

                                                                               Cover Art:
“    You can cut all the
     flowers but you
                                                                               Children’s Museum
     cannot keep spring                                                        Climbing Fun
                                                                               by Michael Shaughnessy, MD
     from coming.
             —Pablo Neruda
                              ”                                                 ○   ○   ○   ○   ○   ○   ○   ○

                                                                               Dr. Shaughnessy is a urologist.
                                                                                                                ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○
                                                                                                                                OFFICES: Bulletin of the Allegheny
                                                                                                                                County Medical Society, 713 Ridge
                                                                                                       Bulletin                 Avenue, Pittsburgh, PA 15212; (412)
                                                                                                       Medical Editor           321-5030; fax (412) 321-5323. USPS
                                                                                                          Scott Miller          #072920. PUBLISHER: Allegheny
                Affiliated with Pennsylvania Medical Society and American Medical Association        (millers8@upmc.edu)        County Medical Society at above ad-
                                                                                                        Associate Editors
                                               PMS DISTRICT TRUSTEE                                                             The Bulletin of the Allegheny County
          2011                                                                                       Melinda M. Campopiano
                                                                                                                                Medical Society welcomes contribu-
Executive Committee and                             Paul W. Dishart                               (campopianomm@gmail.com)
                                                                                                                                tions from readers, physicians, medi-
   Board of Directors                                                                                       Fredric Jarrett
                                                                                                                                cal students, members of allied pro-
                                                      COMMITTEES                                       (jarrettf@upmc.edu)
                                                                                                                                fessions, spouses, etc. Items may be
       President                                           Bylaws                                         Timothy Lesaca        letters, informal clinical reports, edito-
   Leo R. McCafferty                                   Amelia A. Paré                                 (tlesaca@hotmail.com      rials, or articles. Contributions are
     President-elect                                  Communications                                       Deval Paranjpe       received with the understanding that
     Rajiv R. Varma                                    Amelia A. Paré                           (reshma_paranjpe@hotmail.com)   they are not under simultaneous con-
     Vice President                                       Finance                                        Stuart G. Tauberg      sideration by another publication.
     Amelia A. Paré                                   G. Alan Yeasted                                    (tlindsey@nb.net)
       Secretary                                        Membership                                        Frank Vertosick       Issued the third Saturday of each
                                                    Sharon L. Goldstein                                                         month. Deadline for submission of
    Kevin O. Garrett                                                                                  (vertosick@acms.org)
                                                        Nominating                                                              copy is the SECOND Wednesday
       Treasurer                                                                                         Gary S. Weinstein
                                                                                                                                preceding publication date. Periodi-
    John P. Williams                                 Christopher J. Daly                           (garyweinsteinmd@aol.com)
                                                                                                                                cal postage paid at Pittsburgh, PA.
      Board Chair                                  Occupational Medicine                                 Michael W. Weiss
   John F. Delaney Jr.                               Joseph J. Schwerha                             (mww@tririversortho.com)    Bulletin of the Allegheny County
                                                       Primary Care                                                             Medical Society reserves the right to
                                                                                                       Managing Editor          edit all reader contributions for brev-
     DIRECTORS                                         Lawrence John
                                                                                                         Linda L. Smith         ity, clarity, and length as well as to
          2011                                        Anthony Spinola
                                                                                                      (lsmith@acms.org)         reject any subject material submitted.
 Melinda M. Campopiano
      Doris K. Cope                           ADMINISTRATIVE STAFF                                  Contributing Editors        The opinions expressed in the Edi-
    David J. Deitrick                              Executive Director                               (bulletin@acms.org)         torials and other opinion pieces
  Donald B. Middleton                                   John G. Krah                                 Gregory B. Patrick         are those of the writer and do not
      Karl R. Olsen                                  (jkrah@acms.org)                                Heather A. Sakely          necessarily reflect the official
  Adriana M. Selvaggio                          Assistant to the Director                             Carey T. Vinson           policy of the Allegheny County
     G. Alan Yeasted                              Dorothy S. Hostovich                                                          Medical Society, the institution with
          2012                                   (dhostovich@acms.org)                                                          which the author is affiliated, or the
                                                         Bookkeeper                                                             opinion of the Editorial Board. Ad-
      Vijay K. Bahl
                                                      Susan L. Brown                                                            vertisements do not imply spon-
   Sharon L. Goldstein
                                                   (sbrown@acms.org)                                 ACMS ALLIANCE              sorship by or endorsement of the
    Adam J. Gordon
                                                     Communications                                        President            ACMS, except where noted.
    Lawrence R. John
    Anthony Spinola                             Bulletin Managing Editor                               Kathleen Reshmi          Publisher reserves the right to ex-
          2013                                         Linda L. Smith                                First Vice President       clude any advertisement which in its
   Robert W. Bragdon                                (lsmith@acms.org)                                    Patty Barnett          opinion does not conform to the stan-
   Douglas F. Clough                          Assistant Executive Director,                         Second Vice President       dards of the publication. The accep-
   Christopher J. Daly                         Membership/Information                                      Joyce Orr            tance of advertising in this publication
       Steve Evans                                        Services                                   Recording Secretary        in no way constitutes approval or
    Adele L. Towers                                   James D. Ireland                               Rose Kunkel Roarty         endorsement of products or services
                                                   (jireland@acms.org)                             Corresponding Secretary      by the Allegheny County Medical So-
                                                          Manager                                       Doris Delserone         ciety of any company or its products.
                                                    Dianne K. Meister                                     Treasurer             Subscriptions: $30 nonprofit organi-
          2011                                    (dmeister@acms.org)                                 Josephine Martinez        zations; $40 ACMS advertisers, and
    Krishnan A. Gopal
                                                   Field Representative                              Assistant Treasurer        $50 others. Single copy $5. Advertis-
    William M. Swartz
                                                   Nadine M. Popovich                                  Sandra Da Costa          ing rates and information sent upon
          2012                                                                                                                  request by calling (412) 321-5030.
     Dennis F. Stull                                                                                                            Visit www.acms.org.
     Bruce L. Wilder
     Judith S. Black                                                                                                            COPYRIGHT 2011:
  James E. Wilberger Jr.                                                         www.acms.org.                                  ALLEGHENY COUNTY
                                                                                                                                MEDICAL SOCIETY
                                                                                                                                POSTMASTER—Send address
                                                                                                                                changes to: Bulletin of the
                                                                                                                                Allegheny County Medical
                                                                                                                                Society, 713 Ridge Avenue,
 Leadership and Advocacy for Patients and Physicians                                                                            Pittsburgh, PA 15212.
                                                                                                                                ISSN: 0098-3772
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                                        Physician Reentry
○   ○   ○   ○   ○   ○   ○   ○   ○   ○
                                        TIMOTHY LESACA, MD
                                        ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○

T     he American Medical
      Association (AMA)
defines physician reentry as the
                                                                                                                                                                                             or similar examinations may
                                                                                                                                                                                             be required. In 13 states,
                                                                                                                                                                                             completion of continuing
return to clinical practice in the                                                                                                                                                           medical education may be
discipline in which one has                                                                                                                                                                  required. Besides the lack of
been trained or certified after                                                                                                                                                              consistency in regulatory
an extended period of clinical                                                                                                                                                               and licensure guidelines,
inactivity not resulting from                                                                                                                                                                there are other barriers to
discipline or impairment.                                                                                                                                                                    reentry such as liability
     Physicians take leave of                                                                                                                                                                insurance and hospital
absence from clinical practice                                                                                                                                                               medical staff credentialing
for many reasons, including                                                                                                                                                                  issues, the lack of access to
family caretaking responsibili-                                                                                                                                                              and the cost of reentry
ties, personal health reasons,                                                                                                                                                               programs, and the overall
career dissatisfaction, pursuit of                                                                                                                                                           lack of information on the
alternative careers and retire-                                                                                                                                                              reentry process.
ment. The actual number of                                                                                                                                                                       The American Medical
reentering physicians is un-                                                                                                                                                                 Association has worked to
known due to lack of data, as                                                                                                                                                                develop recommendations
the majority of state medical                                                                                                                                                                on physician reentry. The
boards do not require that                                                                                                                                                                   AMA recently recommended
physicians see patients as a require-                                                       state medical boards actually have a                                                    the development of reentry guide-
ment for relicensure. It is nonethe-                                                        policy on physician reentry. The                                                        lines across state medical licensing
less estimated by the AMA that                                                              average length of time out of prac-                                                     jurisdictions that are consistent and
about 10,000 physicians could                                                               tice after which some state boards                                                      evidence based, including a consis-
reenter clinical practice in the U.S.                                                       require physicians to complete a                                                        tent length of time away from
each year.                                                                                  reentry program is three years, but                                                     clinical practice that necessitates
     Physicians wishing to return to                                                        the range is wide, from 18 months                                                       participation in a formal reentry
practice after a period of clinical                                                         to 10 years.                                                                            process, defining how much involve-
inactivity can experience difficulties                                                           Only 20 percent of medical                                                         ment in clinical care constitutes
due to the lack of a standardized                                                           boards require a physician to engage                                                    clinical practice, and studying the
reentry process. There is no continu-                                                       in a certain amount of patient care                                                     impact of loss of specialty board
ity among state medical boards                                                              for relicensure. In 16 states, passage                                                  certification on maintenance of
regarding reentry policy. Only 30                                                           of the special purpose examination                                                      licensure.
146                                                                                                                                                                                                     Bulletin :: April 2011
     Other recommendations include      dations to the board that are taken      be used to provide care. There is no
establishing mechanisms to permit       into consideration when acting on        government funding for physicians
reentering physicians the opportu-      an application for reactivation.         who want to participate in a reentry
nity to engage in clinical practice     There are costs involved in such         program, though such funding
under supervision as they participate   programs that are the responsibility     would be a relatively economical way
in a reentry program, the develop-      of the licensee. For example, the        to increase the physician workforce.
ment of a program completion            Oregon reentry program costs                 Returning a non-practicing
certificate that meets the need to      approximately $5,000 to $10,000.         physician to clinical medicine is
document physician readiness for        The Drexel program, which includes       appealing, as it is significantly less
clinical practice, increased consis-    a structured preceptorship, costs        expensive to retrain an inactive
tency among reentry programs and        about $20,000. These estimates do        physician than to train a new one.
the introduction of alternate licen-    not include the costs of temporary       Also, inactive physicians can be
sure tracks for reentering physicians   relocation for physicians who do not     retrained much faster than new ones
that allow a limited scope of prac-     live near their chosen program.          can be trained, so more physicians
tice. Also, to ensure that the physi-        The Pennsylvania State Board of     would be available in less time. It’s
cian reentry process is financially     Medicine does have a policy on           something to think about.
feasible, the AMA recommended           physician reentry to practice, and       ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○

pursuing multiple funding streams       the length of time out of practice       Dr. Lesaca is a psychiatrist specializing in
to support the development and          after which a reentry program            children and adolescents, and he serves as
implementation of a national physi-     completion is required is four years.    associate editor of the ACMS Bulletin. He can
                                                                                 be reached at tlesaca@hotmail.com.
cian reentry system.                    Pennsylvania physicians who need a
     I was able to identify only nine   reentry program can be referred to
physician reentry programs in the       the LifeGuard Program that is                The opinion expressed in this column
United States. They are the Center      administered by PAMED.                       is that of the writer and does not
                                                                                     necessarily reflect the opinion of the
for Personalized Education for               Participants in the LifeGuard           Editorial Board, the Bulletin, or the
Physicians in Denver, Cedars-Sinai      Program undergo a cognitive and              Allegheny County Medical Society.
Medical Center Physician Reentry        psychiatric screening, followed by a
Program in Los Angeles, Drexel          clinical skill assessment. If the need
Medicine Physician Refresher/
Reentry Course in Philadelphia,
                                        for advanced training is identified,
                                        the LifeGuard Program develops an            Physician Referrals
Oregon Health and Science Univer-       individual remediation plan to
sity Physician Reentry Program,         refresh knowledge and skills in a            Did you know we get
                                                                                     calls daily asking for
University of California San Diego      protected practice setting. The
                                                                                     referrals to physicians?
School of Medicine Physician            program then makes recommenda-               Be sure your
Assessment and Clinical Education       tions to the physician and the board         membership information
Program, University of Wisconsin        of medicine regarding the physician’s        is up to date so that
School of Medicine and Public           return to practice, modification of          you get connected,
Health Physician Assessment Center,     practice and continuing educational          including:
                                                                                     √ Hospital Affiliations
Upstate New York Clinical Compe-        needs.
                                                                                     √ E-mail address
tency Center at Albany Medical               From my perspective, one of the         √ Correct phone/fax/
College, Texas A & M Health             greatest potential benefits of stan-           address/e-mail
Science Center KSTAR Program,           dardizing and certifying the physi-
and the LifeGuard Program created       cian reentry process is the opportu-                     ALLEGHENY COUNTY
                                                                                                  MEDICAL SOCIETY
by the Pennsylvania Medical Society     nity to address the looming physi-
                                                                                             E-mail acms@acms.org or
(PAMED).                                cian shortage. While medical schools
                                                                                         call (412) 321-5030 and ask for
     Reentry programs generally         are trying to expand enrollment and               Nadine Popovich (ext. 110) or
provide clinical skill evaluations,     educate new doctors, a big pool of                     Jim Ireland (ext. 101)
retraining programs and recommen-       already-trained physicians could also
April 2011 :: Bulletin                                                                                                                                       147
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148                                                                                                                            Bulletin :: April 2011

                                        The ACMS Foundation: 50 Years of
                                        Supporting the Community
○   ○   ○   ○   ○   ○   ○   ○   ○   ○
                                        LEO R. MCCAFFERTY, MD
                                        ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○

T     he Allegheny County Medical
      Society Foundation—created,
funded and administered by physi-
                                                                                        WTAE-TV news anchor, served as
                                                                                        the master of ceremonies during the
                                                                                        live auction and the awards cer-
                                                                                                                                                                                    ates had debt of at least $150,000.
                                                                                                                                                                                         If you were unable to attend the
                                                                                                                                                                                    gala, or have never contributed to
cians—holds an honored place in                                                         emony. It is no surprise that this                                                          the ACMS Foundation, you can still
Pittsburgh’s health care history. Since                                                 annual event has grown in popular-                                                          make a tax-deductible donation.
1960 the ACMS Foundation has                                                            ity over the years. I strongly encour-                                                      Please make your checks payable to
given back more than $2.1 million                                                       age you to attend next year’s event,                                                        the ACMS Foundation and mail
to the community and continues to                                                       especially if you have never done so                                                        them to 713 Ridge Avenue, Pitts-
be guided by its original mission: to                                                   before.                                                                                     burgh, PA 15212. If you prefer, you
alleviate suffering by helping people                                                        What makes the gala so special is                                                      can also call the medical society at
of all backgrounds live better,                                                         that all of the proceeds directly                                                           (412) 321-5030 and contribute
healthier lives through access to                                                       benefit the foundation. Funds raised                                                        using a Visa or MasterCard. Visit the
health care, education and related                                                      at this event specifically provide                                                          medical society’s website at www.
services.                                                                               medical student scholarships and, in                                                        acms.org and click the foundation
     On March 19 the ACMS Foun-                                                         collaboration with the Community                                                            link to view a list of individuals who
dation hosted “Pittsburgh Proud,”                                                       College of Allegheny County, health                                                         have already benefited from grants
its annual community awards and                                                         career scholarships. The ACMS                                                               presented by the foundation.
fundraising gala. Taking place at                                                       Foundation raised nearly $45,000                                                                 Are you willing to help the
Heinz Field, East Club Lounge,                                                          during this year’s gala for these                                                           ACMS Foundation continue to
Pittsburgh Proud was an evening                                                         scholarships.                                                                               fulfill its mission of supporting
that celebrated many reasons to be                                                           Several medical and health career                                                      charitable and educational projects
proud of the Pittsburgh region,                                                         students will receive financial assis-                                                      in our community? Would you like
including the 2010 ACMS award                                                           tance this year through scholarships                                                        to help lighten the financial burden
winners. A color photo feature in                                                       granted by the foundation because                                                           of worthy medical students—our
this month’s Bulletin (page 163)                                                        of the generous support of gala                                                             future physicians? Please donate
highlights all of the award recipients                                                  sponsors, as well as those who                                                              today to help the ACMS Founda-
and captures the fun-filled evening                                                     attended the gala or simply donated                                                         tion continue its good work provid-
enjoyed by nearly 400 guests.                                                           to the foundation. What a worth-                                                            ing support for students on track for
     The event featured lively enter-                                                   while cause, considering the extreme                                                        careers in medicine and health care.
tainment by The Cadillac Jazz Trio                                                      debt that many medical school
and delicious food, and it provided                                                     students face after graduation.                                                                 ○       ○       ○       ○       ○

                                                                                                                                                                                    Dr. McCafferty is a plastic surgeon and 2011
                                                                                                                                                                                                                                ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○

the perfect opportunity and setting                                                     According to the Association of                                                             ACMS president. He can be reached at
to socialize with friends and col-                                                      American Medical Colleges, the                                                              mccafferty@acms.org.
leagues. An array of fabulous items                                                     average medical student in 2010
                                                                                                                                                                                            The opinion expressed in this column
were available to the highest bidder                                                    graduated with $157,944 in student                                                                  is that of the writer and does not
at a silent auction and, for the first                                                  loans. Seventy-eight percent of these                                                               necessarily reflect the opinion of the
time, a live auction took place for                                                     graduates had debt of at least                                                                      Editorial Board, the Bulletin, or the
                                                                                                                                                                                            Allegheny County Medical Society.
more exclusive items. Mike Clark,                                                       $100,000, and 42 percent of gradu-
April 2011 :: Bulletin                                                                                                                                                                                                                                                                                                                      149
                                        Academic Medicine and Pharma
                                        Dancing with the (new) stars
○   ○   ○   ○   ○   ○   ○   ○   ○   ○
                                        ARTHUR S. LEVINE, MD
                                        ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○

I  t’s no secret that this is a difficult
   time to be working in biomedical
research. Not that being a scientist
                                                                                            since 1998 and, for more than a
                                                                                            decade, has ranked among the
                                                                                            nation’s top 10 educational institu-
                                                                                                                                                                                    sively pursuing alternative funding
                                                                                                                                                                                    sources for medical research. The
                                                                                                                                                                                    pharmaceutical industry is quickly
has ever been a particularly lucrative                                                      tions in annual NIH support. In                                                         emerging as a promising partner. As
profession, but in this hard-hitting                                                        2010 the university spent nearly                                                        NIH struggles with its budget crisis,
recession era, the shrinking pool of                                                        $754 million on research, more than                                                     the pharmaceutical industry is facing
grant monies has made the job of                                                            80 percent of which went to the                                                         its own difficulties maintaining the
starting and maintaining a research                                                         health sciences. Among the hottest                                                      pipeline for new drugs and therapeu-
laboratory especially difficult.                                                            areas of funded research at the                                                         tics. For decades, “pharma” has taken
     Even the National Institutes of                                                        School of Medicine now are drug                                                         a “soup-to-nuts” approach to drug
Health (NIH), which—thanks to                                                               discovery and design; vaccine devel-                                                    discovery, development and com-
your tax dollars and mine—is the                                                            opment and biodefense; stem cell                                                        mercialization. Pharmaceutical
largest source of funding for medical                                                       therapy, tissue engineering, and                                                        companies built huge centers,
research in the world, has experi-                                                          artificial organ and medical device                                                     invested in state-of-the-art technolo-
enced stagnant funding levels since                                                         development; and comparative                                                            gies and hired thousands of their
2003. In 2006, the NIH appropria-                                                           effectiveness research.                                                                 own scientists in a brutally expensive
tion from Congress was reduced by                                                                We can’t afford to rest on our                                                     strategy that worked as long as there
$81 million over the previous year’s                                                        laurels, though, and we are aggres-                                                     was a constant stream of new drugs
allocation, the agency’s first budget                                                                                                                                               coming out of the pipeline. How-
cut since 1970. Since then, NIH’s                                                                                                                                                   ever, that stream has become a
budget essentially has stayed flat,                                                                                                                                                 trickle, not because the science isn’t
failing even to keep pace with                                                                                                                                                      good, but because all the “low-
inflation. Although the 2009 Ameri-                                                                                                                                                 hanging fruit”—the easy-to-develop
can Recovery and Reinvestment Act                                                                                                                                                   drugs and targets—have already
provided a two-year bolus of $8                                                                                                                                                     been found. What we are left with
billion in vital stimulus funds for                                                                                                                                                 are the most complex biological
extramural research, that legislation                                                                                                                                               problems: the intracellular networks,
will expire in 2011, and the govern-                                                                                                                                                genomic-level effects and proteomic
ment has no plans to compensate for                                                                                                                                                 pathways, riddles that will take
the impending shortfall.                                                                                                                                                            increased and continued investment
     Despite the austere financial                                                                                                                                                  in scientific research to solve.
climate and fierce competition, the                                                                                                                                                      The University of Pittsburgh is
University of Pittsburgh has still                                                                                                                                                  well poised to form strategic and
managed to fare quite well. Pitt has                                                                                                                                                collaborative partnerships with the
more than doubled its NIH funding                                                                                                                                                   pharmaceutical industry. Pfizer has
150                                                                                                                                                                                                    Bulletin :: April 2011
                                                                                           ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○

taken a lead in forming such rela-        that intellectual property and corpo- Dr. Levine is senior vice chancellor for the
tionships, having already closed          rate contract policies are in align-         health sciences and dean of the School of
several deals with major academic         ment with each other.                        Medicine at the University of Pittsburgh. He
                                                                                       can be reached at alevine@hs.pitt.edu.
medical centers in the U.S. (includ-           Fortunately, partnering with
ing an $85 million commitment to          industry is neither without prece-
                                                                                         The opinion expressed in this column
the University of California at San       dent nor an entirely foreign concept           is that of the writer and does not
Francisco) and also looking overseas      to Pitt. For example, since 2006 the           necessarily reflect the opinion of the
to Europe and China. From the             University of Pittsburgh Drug                  Editorial Board, the Bulletin, or the
                                                                                         Allegheny County Medical Society.
industry’s standpoint, it gains access    Discovery Institute (DDI) has had a
to the best and most current science      number of researchers engaged in
and technology, funded by NIH et
al., without the high costs of main-
                                          collaborative work with industry.                   www.acms.org
                                          However, most of these projects have
taining physical infrastructure like      been individually contracted with no
                                                                                                      If you haven’t
laboratories and buildings. From the      formalized institutional support.
                                                                                                      visited the medical
university standpoint, we gain a          DDI Director and Allegheny Foun-
                                                                                                      society’s web site
stable source of research funding and     dation Professor D. Lansing Taylor,
a significant stake in any drug that                                                                  recently, log on and
                                          himself a serial entrepreneur as well
reaches commercialization. It’s a         as an academician, has coined a                             see what you’re
win-win situation, and I expect           motto for the institute’s future focus:                     missing!
other pharmaceutical companies to         “Novel chemistries and systems                                  ALLEGHENY COUNTY
follow suit in the near future.           biologies to accelerate drug discov-                              MEDICAL SOCIETY
     Some have raised questions           ery.” Moving
about potential conflict-of-interest      forward, I intend
issues for an academic-industry           for the DDI to
partnership. It’s certainly true that     serve as an
a for-profit company has different        institutional
drivers than a government-funded
entity. For more than 25 years, our
                                          model and
                                          incubator for
                                                                      Does it
focus has been on federal funding
sources. The university and NIH
                                          industry collabo-
                                          ration, providing
have well-developed policies and
guidelines around every aspect of
                                          and training for            when I
research conduct, and I myself came       researchers across
to Pitt from the National Institutes      campus to learn             push
of Health in the late 1990s. So we as     drug discovery,
a university have grown to be and         design and                  here?
are very comfortable dealing with         development.
the government. Yet now we are            We’ve weathered
likely to have a new partner, a           the recession,
corporate entity with a different         and I am once
motive and culture.                       again optimistic
     Just like us, pharma wants to        for the future of          More and more doctors are reporting a feeling of
                                                                     “pressure and discomfort” in their bottom lines.
have the best science. It is willing to   academic medi-
invest significant amounts of re-         cal research and           Get some relief...
sources to get it, but only if such       excited at the             Call the Kell Group 412-381-5160.
investment improves its pipeline and      prospect of new                                      KELL GROUP, LLC

the bottom line. A large part of our      and fruitful               www.kellgroup.com                      Medical billing and consulting
work together will involve ensuring       partnerships.
April 2011 :: Bulletin                                                                                                               151
○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○    ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○

I  t is difficult to imagine that
   55 years have passed since we
in the Class of 1956 received                                                                                Class of
                                                                                                                                                                                       more a physician mastered these
                                                                                                                                                                                          techniques, the better diagnosti-
                                                                                                                                                                                          cian he or she became. Time
those coveted diplomas from the                                                                                                                                                          spent with patients established
University of Pittsburgh School                                                                               1956                                                                   relationships that allowed patients to
of Medicine. We too were                                                                                                                                                             know and trust their physicians.
bursting with energy and eager                                                                                                                                                       Today, advanced technology mini-
to use our knowledge in the                                                                                                                                                          mizes the necessity for extensive
noble profession of caring for the                                                                                                                                                   physical diagnosis. For some doctors,
sick and dying. That future is now                                                                                                                                                   the stethoscope around the neck is
our past, but I’ve thought about                                                            our classes know the present; and                                                        more of a status symbol than a
what words of experience might be                                                           new doctors will live medicine of the                                                    diagnostic tool. Economic circum-
meaningful to the new medical                                                               future. You are entering an exciting                                                     stances make medicine more of a
graduates of 2011.                                                                          chapter in the history of medicine.                                                      business than it was for us 55 years
     Our 1956 class witnessed and                                                               In my own field of hematology/                                                       ago. More intermediaries now come
has been part of the marvelous, if                                                          oncology, the first cures of cancer by                                                   between the doctor and patient. The
not meteoric, advances in diagnostic                                                        chemotherapy were just being                                                             downside of these factors is that
and therapeutic medical technology.                                                         reported for the rare cases of chorio-                                                   doctors spend less time with pa-
New physicians likely never or rarely                                                       carcinoma and Burkitt’s lymphoma                                                         tients, leading to a depersonalization
saw a patient with polio in an iron                                                         55 years ago. What followed was a                                                        of medicine.
lung, or rheumatic fever and rheu-                                                          series of discoveries and innovative                                                          Even in retirement, I hear stories
matic heart disease, or tuberculosis,                                                       therapies that give many of today’s                                                      that some doctors are inaccessible,
or tertiary syphilis, or complications                                                      cancer patients hope for cures,                                                          do not return phone calls or notify
of childhood infectious diseases.                                                           prolonged remissions, better control                                                     patients of test results in a timely
Patients such as these occupied many                                                        of adverse side effects from chemo-                                                      fashion, and that they do not spend
hospital beds during our medical                                                            therapy and better relief of pain and                                                    adequate time with patients, even
school years, internships and resi-                                                         suffering—all resulting in a much                                                        though patients may wait hours to
dencies.                                                                                    better quality of life than could be                                                     be seen. Patients will always need
     Renal dialysis, CPR, open heart                                                        offered 55 years ago. Similar spec-                                                      personal attention, reassurance and
surgery, organ transplantation,                                                             tacular progress has been made in all                                                    compassionate care. Patients have
chemotherapy, potent new antibiot-                                                          branches of medicine.                                                                    human emotions that need your
ics and vaccines, specialty care units                                                          Advanced technology has                                                              attention. Look into the faces and
and microsurgery techniques were all                                                        changed the face of medicine over                                                        eyes of your patients. Don’t just look
in their infancy or not even on the                                                         the past 55 years. Our medical                                                           into your computers searching for
radar screen. If such progress contin-                                                      school professors emphasized the                                                         data while talking to patients. Don’t
ues at the same exponential pace,                                                           hands-on approach to patients. We                                                        treat a disease, but a patient with a
new physicians will witness endless                                                         spent many hours developing basic                                                        disease.
possibilities for improved quality of                                                       diagnostic skills of physical examina-                                                        Graduates of 2011 are highly
health care. Our 1956 medical                                                               tion by inspection, palpation,                                                           trained, highly skilled and have
school class knows the past; both of                                                        percussion and auscultation. The                                                         exciting futures. But I would caution
152                                                                                                                                                                                                                          Bulletin :: April 2011
                                                                                     SOCIETY NEWS
that it isn’t the prestige, it isn’t the
power, it isn’t the money. Medicine
is all about your patients. They
entrust their very lives to your care
and deserve your time and under-
standing. Sir William Osler, MD,
world renowned clinician and
teacher, said, “The practice of
medicine is an art, not a trade; a
calling, not a business; a calling in
which your heart will be exercised
equally with your brain.”
     And finally, don’t neglect your-
self or your family. Medicine will
consume your time, but don’t let it
devour you. Pay attention to your
own body, mind and spirit. The
profession of medicine is challenging
enough without the distractions of
avoidable personal and family
problems. I hope that in 55 years                                                    The Joint Surgical Society met on February 28 at the Fairmont Pittsburgh Hotel, carrying
you can return to the University of                                                  on the Pittsburgh Surgical Society’s long-time tradition of presenting the previous year’s
Pittsburgh and look back on your                                                     Most Interesting Cases. Nine residents presented cases from 2010. Pictured here with Dr.
medical careers with pride in your                                                   Bernard J. Costello are: (foreground) Dr. Leah Burnett, UPMC Mercy; and (l. to r.) Jon
accomplishments, just as our class                                                   Cardinal, MD, UPMC Presbyterian/Shadyside; Matt Pavlick, DDS, MD, UPMC; Erik
                                                                                     Svensson, MD, WPAHS, Allegheny General; Dr. Costello; Betsy Dovec, MD, WPAHS,
will be reflecting during our reunion                                                Allegheny General; Zachary Peckler, MD, WPAHS, Forbes Regional; and Roman
weekend.                                                                             Grinberg, MD, Conemaugh Memorial Medical Center. Not pictured: Drs. Vivek Sharma,
○    ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○
                                                                                     UPMC Presbyterian/Shadyside, and Ricardo Patton Po, Conemaugh Memorial Medical
Dr. Pavlic is a member of the class of 1956.                                         Center.
He can be reached at docpavlic@verizon.net

                                                                                     ACMS Medical Student
    Got Something to Say?
    If you’re an ACMS member                                                                                                       The AMD3Foundation, Renaissance
                                                                                        $2,000 will be awarded annually
                                                                                                                                   Orthopaedics and the orthopaedic
    and would like to write a                                                           to each of two qualified medical
                                                                                                                                   program at Magee-Womens
                                                                                        students. For information on
    Perspective, e-mail Linda                                                                                                      Hospital at UPMC are
                                                                                        how to apply for the scholarship           jointly sponsoring the
    Smith at lsmith@acms.org.                                                           or how to contribute to the                2011 Bone and Joint
                                                                                        scholarship fund, e-mail                   Health Series at Magee-
    or call (412) 321-5030,
                                                                                        studentservicesfoundation@                 Womens Hospital on
    x105.                                                                                pamedsoc.org or call                      April 30, with registration/
                                                                                         (717) 558-7854. The                       check-in and exhibits to
    The opinion expressed in this column
                                                                                         PaMedSoc Foundation                       begin at 9:15 a.m. The program,
    is that of the writer and does not                                                   administers the                           which will end at noon, is free, but
    necessarily reflect the opinion of the                                               scholarship.                              advance registration is required at
    Editorial Board, the Bulletin, or the                                                                                          (412) 641-1924 or online at
    Allegheny County Medical Society.
April 2011 :: Bulletin                                                                                                                                                153
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154                                                               Bulletin :: April 2011
Donald L. Fisher, MD, recently           James Luketich,                                                                         William R. Poller,
received the Peter J. Safar Pulse of     MD, has been                                                                            MD, FACR, recently
Pittsburgh Award from the Ameri-         named founding                                                                          joined the Susan G.
can Heart Association. The award is      chair of the Univer-                                                                    Komen Board of
named for the late professor of          sity of Pittsburgh                                                                      Directors, Pittsburgh
resuscitation medicine at the Univer-    School of Medicine’s                                                                    Affiliate, for a two-
sity of Pittsburgh, who became                                     Dr. Luketich                                                  year term. He is the          Dr. Poller
                                         new Department of
known as the father of CPR.              Cardiothoracic Surgery. Dr.                                                             first physician locally to sit on a
Dr. Fisher was named director of         Luketich, who pioneered minimally                                                       Komen board. Dr. Poller is associate
Allegheny General Hospital’s Cath-       invasive surgical techniques for                                                        director of the Breast Cancer Center
eterization Laboratory in 1960 and       esophageal and lung operations, is                                                      and Division of Breast Imaging,
chief of the department of cardiovas-    the Henry T. Bahnson Professor of                                                       West Penn Allegheny Health Sys-
cular diseases in 1964, a position he    Cardiothoracic Surgery.                                                                 tem.
held until 1984. He continues to
report to work daily, serving as a       George                                                                                  Edward J. Zivic, MD, CFAAF,
member of the senior staff and           Michalopoulos,                                                                          received the Man of Distinction
regularly participating in resident      MD, is the recipient                                                                    Award during a program celebrating
teaching conferences.                    of the American                                                                         Black History Month at the Pente-
                                         Liver Foundation’s                                                                      costal Temple Church of God in
Thomas Kleyman,                          Distinguished                                                                           Christ in East Liberty. Presented by
MD, has been                             Scientific Achieve- Dr. Michalopoulos                                                   the church pastor, Reverend Dr.
named this year’s                        ment Award for 2010, honoring                                                           Loran Mann, the award recognizes
Medical Gift of Life                     scientists who undertake novel work,                                                    Dr. Zivic for his years of service to
Awardee by the                           mentor other researchers and attract                                                    the community and to the church’s
National Kidney                          substantial funding over the course                                                     congregation. Dr. Zivic is clinical
Foundation (NKF)           Dr. Kleyman   of their careers. Dr. Michalopoulos                                                     assistant professor of family and
Serving the Alleghenies. Dr.             is professor in and chair of the                                                        community medicine at UPMC
Kleyman is being honored for his         University of Pittsburgh’s Depart-                                                      Shadyside Hospital.
contributions to kidney research. He     ment of Pathology.
is director of the Pittsburgh Center
for Kidney Research and chief of the
                                         ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○

                                         Send your Activities & Accolades items to Linda Smith at ACMS, 713 Ridge Ave., Pittsburgh,
University of Pittsburgh Renal           PA 15212 or e-mail lsmith@acms.org. We also encourage you to send a recent photograph
Electrolyte Division.                    indicating whether it needs to be returned.

April 2011 :: Bulletin                                                                                                                                                                                       155
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156                                                                                           Bulletin :: April 2011
Robert J. Carroll,                        Rupert H. Friday, MD, age 98,                Basil A. Marryshow,
MD, age 87, passed                        passed away on March 16. Dr.                 MD, age 81, passed
away on March 15.                         Friday (obstetrics and gynecology)           away on March 14.
Dr. Carroll (internal                     graduated in medicine from the               Dr. Marryshow
medicine) graduated                       University of Pittsburgh in 1938. He         (orthopaedic surgery)
in medicine from the                      completed an internship at Mercy             graduated in medi-
University of Pitts-        Dr. Carroll                                                cine from Howard           Dr. Marryshow
                                          Hospital and a residency at Temple
burgh in 1947 and completed an            University Hospital. Dr. Friday              University in 1962. He completed
internship at St. Francis General         served as president of the Pittsburgh        an internship at Youngstown Hospi-
Hospital and a residency at St. John’s    Society of Obstetricians and                 tal and a residency at Allegheny
Hospital. A long-standing member          Gynecologists and as chair of the            General Hospital. Dr. Marryshow
of the medical society, he served as      American College of Obstetrics and           served on the ACMS Board of
president in 1969 and as board chair      Gynecology, District 3. He is                Directors in 1988 and on the medi-
in 1970. Dr. Carroll also served as       survived by three daughters, Mary            cal society’s editorial board for six
district trustee of the Pennsylvania                                                   years. He is survived by his fiancé
                                          Lee Rafferty, Anne Friday Parker and
Medical Society. He is survived by                                                     Floy Wright; two sons, Terence and
                                          Marjorie Friday Roberts, 10 grand-
his wife Ruth and daughters Rose-                                                      Wayne; three daughters, Karen,
                                          children and 16 great-grandchildren.
mary, Nancy, Mary, Patricia                                                            Margaret Marryshow-Vincent and
Burkardt, Ruth Valchetti, and two                                                      Kathryn Marryshow-Katawcizk; 13
sons Thomas and Jack. He is prede-                                                     grandchildren and one great-
ceased by daughter Jean.                                                               grandchild.

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April 2011 :: Bulletin                                                                                                                    157
                                                                   CONTINUING EDUCATION
      We will help you with                                        REGIONAL MENTAL HEALTH TRAINING SERIES—Spring 2011.
                                                                   Sponsor: UPMC Western Psychiatric Institute and Clinic. For
        your diagnostic                                            information, call (412) 802-6918 or visit www.wpic.pitt.edu/
       equipment needs.                                            oerp.
                                                                   2011 MEDICAL OFFICE OCCUPATIONAL HEALTH & OSHA
                                                                   UPDATE—May 4, ACMS headquarters. Physicians & Physician
                 3 reasons                                         Assistants Category 2 credits. Sponsor: ACMS et al. For infor-
                                                                   mation, call (412) 321-5030 or visit www.acms.org/OSHA.

                 to consult                                        VISION RESTORATION: REGENERATIVE MEDICINE IN OPHTHALMOL-
                                                                   OGY—May 26-27, University Club in Pittsburgh. 8.5 AMA

                Mike Gomber                                        PRA Category 1 credits. Sponsor: Univ. of Pittsburgh et al. For
                                                                   information, call (412) 624-5247 or visit www.foxcenter.
           for your office diagnostic                              pitt.edu.
               equipment needs                                     HIV/AIDS TRAININGS—many available. Sponsor: Pennsylvania/
                                                                   MidAtlantic AIDS Education and Training Center, various
  1      Mike isn’t a “sales rep.” Mike is a                       locations. For information, visit www.pamaaetc.org.
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                                                                   This listing includes local events that are coming up soon; a more
                                                                                                                                        ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○

         MBA and 30 years experience in                            complete list is available on the medical society’s website at
         the medical supplies.                                     www.acms.org or by calling (412) 321-5030.

  2      Mike will help you make the best
         business decisions on the
         equipment that is right for your
         medical practice.
  3      Mike will guide you in choices
         that will reduce your medical and                                         Tissue Engineering Cellular Therapy
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                                                                                                   Prestigious industry speaker
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158                                                                                                                                                     Bulletin :: April 2011
                April is the month for the following national awareness
                programs: Autism, Donate Life and Minority Health. April
                23-30 is National Infant Immunization Week and April 24-
                30 is National Infertility Awareness Week. May 8-14 is
                National Women’s Health Week. (Source: U.S. Dept. of Health
                and Human Services, www.healthfinder.gov/library/nho/)
April 16, 8-11 am ............ Pittsburgh Ophthalmology Society
April 19, 8 pm ................. ACMS Finance Committee
April 26 ........................... ACMS Alliance Past-Presidents Luncheon
April 27, 5:30-8:30 pm .... Pittsburgh Pathology Society
April 27, 6 pm ................. ACMS Membership Committee
April 28, 6 pm ................. Pittsburgh Urological Association
                                     Capital Grill
April 28, 7:30-10 am ....... PAMED Practice Managers
April 30 ........................... ACMS Alliance
                                     International Brunch
May 4, 7:30 am .............. OSHA Seminar
May 9, 6 pm ................... ACMS Editorial Board
May 10, 9 am ................. ACMS Alliance
May 11, 11 am-6 pm ....... College of Surgeons
May 18, noon ................. Emergency Medical Services
May 19, 5:30-pm ............ Pittsburgh Pathology Society
May 20, 9 am-1 pm ........ Three Rivers Adoption Council
May 24, 6 pm ................. ACMS Board of Directors

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               University of Pittsburgh School of Medicine, Center for Continuing Education in Health Sciences

                          This activity has been approved for AMA PRA Category 1 Credits™

April 2011 :: Bulletin                                                                                           159
When Can Minors Consent to
Their Own Medical Care?
○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○

        bsent an emergency, parental consent generally is                                                                                 formal court action and would be free to make their
        required to provide medical care to minors (less                                                                                  own health care decisions.
         than 18 years of age). But under what situations                                                                                   As a general rule, the right to control access to health
may minors consent to their own care? When are par-                                                                                     information is tied to the right to consent to the care.
ents normally entitled to have access to their child’s                                                                                  When parents are the health care decision-makers for
health care information?                                                                                                                their children, they generally are entitled to access their
    As a general rule, minors may not consent to medi-                                                                                  children’s health information and to control its disclo-
cal care. An authorized representative must make medi-                                                                                  sure to others.
cal decisions on behalf of minors who are unable to                                                                                         However, when minors are allowed to consent to
make their own health care decisions. This person                                                                                       medical care, their parents generally have no right to
usually is a parent. Other persons—such as a legal                                                                                      access information about that care or to control its
guardian or foster parent—generally may provide                                                                                         disclosure to others without the minor’s authorization.
consent for a minor, subject to some limitations. Penn-                                                                                     The HIPAA privacy rule and licensing regulations
sylvania law also provides an exception to the parental                                                                                 for professionals and health care facilities are the primary
consent requirement for emergency medical care.                                                                                         source of confidentiality rules. (For more about HIPAA
Minors who are otherwise competent may consent to                                                                                       privacy rules and confidentiality rules, see Medical
medical care in some limited circumstances.                                                                                             Records and Other Protected Health Information at
• Status—Pennsylvania law permits a minor who has                                                                                       www.pamedsoc.org/legalbriefs.)
  graduated from high school, has married or has been                                                                                       Special confidentiality rules apply to certain super-
  pregnant to consent to all medical, dental and other                                                                                  protected information, such as HIV-related information,
  health services, with the exception of abortion.                                                                                      mental health care, and drug and alcohol abuse care.
• Specific care—Pennsylvania law permits all minors to                                                                                  The AMA Council on Ethical and Judicial Affairs also
  consent to certain types of medical care such as vene-                                                                                has issued Opinion 5.055: Confidential Care for Minors.
  real disease testing and treatment. In addition, under                                                                                (Go to www.ama-assn.org and search for “Opinion
  federal law, minors may consent to reproductive care                                                                                  5.055.”)
  (including birth control) from health care providers                                                                                      Even when minors are not authorized to provide
  who are funded by Title X of the Public                                                                                                               consent, it may be ethically and legally
  Health Service Act; minors may have                                                                                                                     appropriate for physicians to involve
  the right to do so in certain other                                                                                                                      them in the medical decision-making
  circumstances as well.                                                                                                                                     process to the degree commensurate
• Emancipated minors—A court can                                                                                                                              with their abilities. Vice versa, when
  “emancipate” a minor for the                                                                                                                                minors are authorized to consent on
  purpose of consenting to all                                                                                                                                their own, it may be ethically or
  medical care or to specific medical                                                                                                                         legally appropriate to encourage
  care, including abortion. Certain                                                                                                                           them to consult with their parents
  self-sufficient minors also might                                                                                                                           or another person acting in loco
  qualify as emancipated without                                                                                                                              parentis (in the position of parents).
160                                                                                                                                                                                                                         Bulletin :: April 2011
    Members of the Allegheny County Medical Society                              This is general legal information and is not intended
have access to more information on this topic at                            as legal advice. The law can change and is subject to
www.pamedsoc.org/legalbriefs, including:                                    differing interpretations. Physicians should consult their
• Pennsylvania statutory exceptions to parental consent,                    attorney if they need legal guidance on a specific situa-
• frequently asked questions about minor confidentiality                    tion. Nothing in this information should be construed
  and consent,                                                              as defining a standard of care.
• a model medical consent authorization (which parents                      ○     ○   ○   ○   ○   ○   ○   ○   ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○

  may use to authorize an adult relative or family friend                   Ms. Metz is general counsel for the Pennsylvania Medical Society; she
  to consent to medical care for their minor children),                     can be reached at (800) 228-7823.
• links to other resources.

                  Legal Summary
                Jury Verdict for Defense Overturned on Informed Consent Issue
 A trial court judge urged the Pennsylvania Superior Court to grant         became merely advisory. Nevertheless, it urged the Superior Court to
 plaintiffs a new trial on the issue of damages1 after determining that     grant the patient’s appeal on the informed consent issue and grant
 the jury verdict for the defendant physicians on the issue of informed     them a new trial solely for the determination of damages. Arguments in
 consent was against the weight of the evidence.                            the appeal before the Superior Court were scheduled to be held the
 Facts. The plaintiffs’ infant child was diagnosed with hydrocephalus in    week of March 21, 2011.
 utero. After its premature birth, it was transferred to Hershey Medical    Import. This case highlights the importance of basic concepts of
 Center where a pediatric neurosurgeon implanted a shunt with an            informed consent:
 anti-siphon valve. While that neurosurgeon was out of town, the            • Take the time required to thoroughly discuss the content of the
 hospital-employed physicians who took over the infant’s care were
                                                                                 informed consent form as well as any legitimate alternatives with
 concerned that there were no external signs of improvement and
                                                                                 your patient. A patient’s prior consent to a similar high-risk procedure
 sought the parent’s permission to revise the shunt because they were
                                                                                 does not obviate the need for valid, informed consent to the specific
 concerned that it was not functioning properly. The parents’ consent
                                                                                 risks of the planned procedure.
 for the procedure was obtained over the telephone in a “one minute,
 maybe two” conversation, according to the resident who spoke with          • Be clear as to what procedure is planned. Vagueness does not
 them. The covering physicians removed the shunt, but discovered                 necessarily give you latitude. Rather, it can vitiate whatever consent
 with intra-operative testing that it was functioning within the param-          you managed to obtain.
 eters intended. Nevertheless, without consulting the parents (who          • If you decide to change the course of treatment during a procedure
 were steps away), the surgeons replaced the valve with a different
                                                                                 and there is an opportunity to obtain informed consent, seek it.
 valve that did not have an anti-siphon valve. Subsequently, the infant
                                                                                 Unless you have outlined possible alternative procedures or
 suffered from brain collapse, a massive subdural hematoma and
                                                                                 treatments in your consent form or unless there is an emergency,
 acute infection resulting from over-drainage of his cerebrospinal fluid.
                                                                                 you must seek informed consent.
 A complex and disastrous clinical course followed for the infant.
                                                                            Informed consent is not a formality. Rather, it is a patient’s right and an
 Procedure of the Case. In their Motion for Post-Trial Relief, plaintiffs
                                                                            ethical and legal imperative that must be considered to be an integral
 asserted as error that the verdict was against the weight of the
                                                                            part of any surgical procedure and allotted the time to be obtained
 evidence. The trial court found for the plaintiffs on the issue of
 consent but not on the issue of negligence, citing two discrete
 instances of failure to obtain informed consent. First, the court          1
                                                                                Hartman v Hershey Medical Center, 124 Daugh.243 (Sept.14, 2010).
 reasoned, there was no way that the resident could have reviewed
 the 11-paragragh, two typewritten pages consent form in its entirety                                             ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○       ○

 with the plaintiffs in a one- or two-minute conversation. Second, the                                            Ms. Jackson is the sole member of Beth Anne
 court stated that the physicians should have consulted the parents                                               Jackson, Esq. LLC, a law firm that serves the legal
 and obtained their informed consent prior to replacing the existing,                                             needs of health care practitioners and facilities in
 functional shunt with a different device that did not have an anti-                                              southwestern and central Pennsylvania. She can be
 siphon valve. Because the plaintiffs filed an appeal with the Pennsyl-                                           reached at (724) 941-1902 or bjackson-law@
 vania Superior Court prior to this decision, the trial court’s order                                             verizon.net. Visit www.jacksonhealthlaw.com

April 2011 :: Bulletin                                                                                                                                                                                                                                                                        161
    What Does ACMS Membership Do For Me?
         Does ACMS Membership Do For

   ACMS members have exclusive access to vendors of physician
   supplies and services at special rates. We screen all vendors for
               quality and value, so you don’t have to.
Membership Group Insurance            Medical Supplies                      Records Management
Programs                              Allegheny Medcare                     Business Records Management
Blue Cross/Blue Shield, Disability,   Michael Gomber, 412.580.7900          Inc. (BRM)
Property and Casualty                                                       Autumn McGinnis-Gollob,
USI Affinity                          Medical Waste Removal                 412.321.0600
Bob Cagna, 724.873.8150               Medical Waste Recovery Inc.
                                      Mike Musiak, 724.309.9261             Auto and Home Insurance
Banking, Financial and                                                      Liberty Mutual
Leasing Services                      Printing Services and                 Angelo DiNardo, 412-859-6605,
Medical Banking, Office VISA/MC       Professional Announcements            ext. 51902
Service                               Service for New Associates, Offices
PNC Bank                              and Address Changes                   Member Resources
Brian Wosniak, 412.779.1692           Allegheny County Medical              BMI Charts, Where-to-Turn cards
                                      Society                               Allegheny County Medical
Medical Liability Insurance           Susan Brown, 412.321.5030             Society
PMSLIC                                                                      412.321.5030
Marketing Department                  Life, HIV Coverage
Lisa Klinger, 717.802.9236            Malachy Whalen & Co.                  Staffing Services
                                      Malachy Whalen, 412.281.4050          Liken Health Care Staffing
                                                                            Judy Thompson, 888.366.4545

 162                                                                                         Bulletin :: April 2011
2011 ACMS Community
Awards Gala: Pittsburgh Proud
○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○                       ○                ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○

                                                                                                                                     T    he Allegheny County Medical Society
                                                                                                                                          and ACMS Foundation Community
                                                                                                                                     Awards Gala—Pittsburgh Proud—recognized
                                                                                                                                     the achievements of the medical society’s
                                                                                                                                     2010 award winners and raised funds for the
                                                                                                                                     foundation’s charitable works in the
                                                                                                                                     community. The event included installation
                                                                                            all photos by Viglione Photography

                                                                                                                                     of the medical society’s 2011 president, Dr.
                                                                                                                                     Leo R. McCafferty, and other officers at a
                                                                                                                                     VIP reception prior to the gala celebration.
                                                                                                                                     (Note: The February 2011 issue of the Bulletin provided details
                                                                                                                                     on award recipients, and the January 2011 issue featured the
                                                                                                                                     2011 ACMS officers.)
                                                                                                                                                                                                                                                                 A crowd of nearly
                                                                                                                                                                                                                                                                 400 people was on
                                                                                                                                                                                                                                                                 hand at the March
                                                                                                                                                                                                                                                                 19, 2011, ACMS
                                                                                                                                                                                                                                                                 Foundation Commu-
                                                                                                                                                                                                                                                                 nity Awards Gala,
                                                                                                                                                                                                                                                                 held once again at
                                                                                                                                                                                                                                                                 Heinz Field East
                                                                                                                                                                                                                                                                 Club Lounge. The
                                                                                                                                                                                                                                                                 Gala celebration
                                                                                                                                                                                                                                                                 featured the Pitts-
                                                                                                                                                                                                                                                                 burgh Proud recep-
                                                                                                                                                                                                                                                                 tion, silent auction,
                                                                                                                                                                                                                                                                 entertainment by the
                                                                                                                                                                                                                                                                 Cadillac Jazz Trio,
                                                                                                                                                                                                                                                                 dinner, awards
                                                                                                                                                                                                                                                                 presentation and live
                                                                                                                                                                                                                                                                 auction. Proceeds
                                                                                                                                                                                                                                                                 from the event will
                                                                                                                                                                                                                                                                 benefit the ACMS
                                                                                                                                                                                                                                                                 Foundation Medical
                                                                                                                                                                                                                                                                 and CCAC Nursing
                                                                                                                                                                                                                                                                 Student Scholarship

April 2011 :: Bulletin                                                                                                                                                                                                                                                                               163
PHOTO FEATURE                            (from page 163)

Jan D. Smith, MD, accepted the 2010           Judith S. Black, MD, MHA, accepted the       Rebecca Caserio, MD, accepted the 2010
Physician Volunteer Award.                    2010 Frederick M. Jacob Outstanding          Nathaniel Bedford Primary Care Physician
                                              Service Award.                               Award on behalf of her husband, the late
                                                                                           Chris Allen, MD.

                     Congratulations on 50 Years!
50-year award winners in attendance this year included (l. to r.): Drs. Charles M. Diez,
Jan D. Smith, David L. Katz, Barry Tenenouser, Philip G. Pollice and Robrt H. Trivus.
Not pictured are (alphabetically): Drs. Stuart S. Burstein, Sung W. Chang, Murray T.
Charlson, C. Charles Iannuzzi, James R. Johnson, John S. Kennerdell, Charles Krifcher,
Harry E. Lanauze, Howard N. Lang, Peter M. Melotti, Everett F. Oesterling Jr., Kook-
Sang Oh, Anne N. Tessaro, Robert L. Wittig and Neal Zweig.
                                                                                           Top (l. to r.): 2011 ACMS President Leo
                                                                                           McCafferty, MD, and Immediate Past
        Leadership and Advocacy for Patients and Physicians                                President John Delaney, MD. Bottom:
                                                                                           Mike Clark, WTAE-TV, gala emcee.
164                                                                                                           Bulletin :: April 2011

                                                                                   The Allegheny County Medical
                                                                                   Society Foundation would like
                                                                                   to express its sincere gratitude
                                                                                   to the following sponsors of the
                                                                                   2011 Community Awards Gala.

                                                                                       Championship Level

John A. Straka, MD, FACS, accepted the   Mark J. Laskow, Esq., accepted the 2010
2010 Ralph C.Wilde Award.                Benjamin Rush Individual Public Health

                                                                                     Most Livable City Level

                                         Mim Siedel and Scott Lammie, accepted
                                         the 2010 Benjamin Rush Community
                                         Organization Health Service Award on
                                         behalf of the Greater Pittsburgh Commu-
        ACMS Foundation                  nity Food Bank.
        Gala Committee
           Doris K. Cope, MD
  John F. Delaney Jr., MD, MPH, DrPH         ACMS Foundation Board
   Rose H. Delaney, RN, MBA, DrPH
                                                    Daniel H. Brooks, MD
        Deval M. Paranjpe, MD                                                         Good Neighbor Level
           John R. Senay Jr.                      Douglas C. Clough, MD
   The Honorable Mary Jane Bowes                  Richard E. Dietrick, MD
           Steven Evans, MD                 John F. Delaney Jr., MD, MPH, DrPH
         Leo R. McCafferty, MD                     Leo R. McCafferty, MD
           Susan McCafferty                  The Honorable Mary Jane Bowes
          G. Alan Yeasted, MD                        Rajiv R. Varma, MD

April 2011 :: Bulletin                                                                                            165
PHOTO FEATURE                           (from page 165)

Eva Tansky Blum accepted a Pride in          Ann L. McGaffey, MD, accepted a Pride in   Fredric V. Price, MD, accepted a Pride in
Pittsburgh Award on behalf of the PNC        Pittsburgh Award for her work in helping   Pittsburgh Award for his international
Grow Up Great Program.                       develop Fitwits.                           volunteer work.

                                                                                        Autumn Stewart, PharmD, accepted a
                                                                                        Pride in Pittsburgh Award on behalf of the
                                                                                        Duquesne University Mylan School of

Immediate Past-President John                                                           Greta K. Rooney was unable to be present
Delaney Jr., MD, passed the gavel                                                       to accept her Pride in Pittsburgh Award,
to 2011 ACMS President Leo R.                                                           which recognized her work raising funds
McCafferty, MD, at a VIP                                                                for the Thomas E. Starzl Transplantation
Reception prior to the gala                                                             Institute at UPMC and the Cancer Caring
festivities.                                                                            Center.
166                                                                                                         Bulletin :: April 2011

                          Sights &
                         Gala 2011

April 2011 :: Bulletin               167
PHOTO FEATURE   (from page 167)

                                  Meet &

168                                        Bulletin :: April 2011

                                              The ACMS Foundation would like to
                                              thank the following individuals, businesses
                                              and organizations for their generous
                                              support and contributions to the 2011
                                              Gala auction and program:

                                              Bettis Floral
                                              Blocher Jewelers
                                              Dr. Robert Bragdon
                                              Chapel Hills Jewelry
                                              Charlet’s Web
                                              Dr. Doris Cope
                                              Davis Innovation Volunteers
                                              Drs. John & Rose Delaney
                                              Fairmont Pittsburgh
                                              Laser & Rejuvenation Center of
                                              Liberty Mutual
                                              London Dock
                                              The Marlene Harris Collection
                                              Marriott City Centre
                                              Dr. & Mrs. Leo McCafferty
                                              Dr. Karl Olsen
                                              Omni William Penn Hotel
                                              The Pittsburgh Steelers
                                              Pittsburgh Transportation Company
                                              Plastic Surgical Associates of
                                              Proper Gardens
                                              RJC Fox Chapel Dermatology, PC
                                              Rob Rogers
                                              Adina Schiffman
                                              Sephora South Hills Village
                           Save the Date!!!   Dr. Robert Trivus
                                              Viglione Photography
                         Saturday, March 24   VisitPittsburgh
                                              Dr. Cyril Wecht
                             Gala 2012        Westin Convention Center
                                              Wexford Post Office Catering
                                              Dr. & Mrs. John Williams

                                              Special thanks to Mike Clark from
                                              WTAE-TV for emceeing our awards/
                                              live auction program.

April 2011 :: Bulletin                                                                 169

                                                                        Read the Literature:
                                                                        Investing Lessons from
                                                                        Mark Twain
                                                                        GARY S. WEINSTEIN, MD, FACS
○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○

      am honored to be co-writing this month’s column                                                                                   reduce the number of reinvestment cycles, especially the
     with Mark Twain. Although he is considered                                                                                         larger ones occurring later in time. Late blooming
     America’s greatest writer, his literary skills did not                                                                             investors require more substantial investments to “catch
transfer to investing. As a young man he lost his wealth                                                                                up” and compensate for early failures. Develop sound
investing in a single company that ultimately failed.                                                                                   investing and savings habits now to harness the power of
Today’s physicians can learn from his mistakes and use                                                                                  compounding for as long as possible.
evidence-based financial knowledge and diversified                                                                                           Twain believed his investment in a single company
products to avoid them.                                                                                                                 was “safe” because he understood publishing and person-
    Early in his career, Twain liked to “take little chances                                                                            ally knew the inventor. Physicians often use the same
in the stock market,” but that changed in 1890 after                                                                                    rationale to justify investing in pharmaceutical and
attending a typesetting machine demonstration. He met                                                                                   medical device companies, but individual stocks are
the machine’s inventor and talked with a friend who                                                                                     exposed to random and unpredictable factors. In Twain’s
claimed to be a “considerable owner” planning to invest                                                                                 case, the inventor procrastinated and was scooped by the
more. His small initial investment was followed by                                                                                      competition, but companies face potential price wars,
increasingly larger ones needed for the inventor’s “final                                                                               regulatory issues, management problems, labor troubles,
improvements.” By 1893 he had invested $300,000                                                                                         environmental factors and terrorism. These risks usually
($7,500,000 in today’s dollars), but lost everything when                                                                               harm specific industries or companies more than the
the invention was rendered obsolete by a newer linotype                                                                                               overall market. Physicians can reduce their
machine. After Twain declared personal bankruptcy,                                                                                                     risk and increase their returns by focusing
a Wall Street executive and admirer managed                                                                                                             on asset allocation and index fund selec-
his bankruptcy and financial rehabilitation.                                                                                                             tion rather than searching for the next
    Twain rationalized his early small                                                                                                                    Facebook or Google.
stock market gambles, but the cumula-                                                                                                                           Like many investors, a friend
tive losses were significant because of the                                                                                                                 influenced Twain to invest in the
time he lost to compound wealth.                                                                                                                            typesetting company. Joining others
Investment income can be reinvested to                                                                                                                      provides social approval, inclusion, the
generate its own income stream, initiat-                                                                                                                    lure of wealth and affirmation of an
ing a sequentially expanding positive                                                                                                                       investment’s worth. Similar influences
feedback loop. Early monetary losses                                                                                                                        lead to herd behavior during bull and
170                                                                                                                                                                              Bulletin :: April 2011
bear markets. Successful investors write an Investment
Policy Statement defining their asset allocation, portfolio
holdings and rebalancing targets. It helps investors resist
the temptation to alter their portfolios based on current
news or market conditions. To avoid Twain’s fate, con-
sider ignoring the next great investing “opportunity” you
hear about!
     Individual stocks also subject investors to fraud risk,
even when they possess valuable inside company knowl-
edge. Twain may not have been technically defrauded,
but the inventor repeatedly misled him about the
machine’s readiness for production. He had a similar
experience investing in gold mines, leading him to
conclude that a mine is “a hole in the ground owned by
a liar.” Most modern financial fraud results from “cre-
ative” accounting practices. Owners of individual stocks
should be wary when a company without unique prod-
ucts or services outearns its peers.
     Twain learned enough from his mistakes to authori-
tatively dispense investment wisdom. He wrote, “There
are two times in a man’s life when he should not specu-
late: when he can’t afford it, and when he can.” He
humbly observed that he was “seldom able to see an
opportunity until it had ceased to be one,” and “It is
easier to stay out than get out.” He also noted,
“October…is one of the peculiarly dangerous months to
speculate in stocks. The others are July, January, Septem-
ber, April, November, May, March, June, December,
August and February!” His words warn against speculat-
ing or becoming too enamored with a single company or
fund. Twain realized that investing is risky and impos-
sible to accurately time.
                                                                                                                                           A Professional Corporation
     Finally, Mark Twain’s experience advises physicians
                                                                                                                                           Certified Public Accountants
not to confuse medical expertise with investing prowess:
“Don’t let schooling interfere with your education,” and                                                                            "Specializing in Physician Practices Since 1978"
“The trouble with the world is not that people know too
little, but that they know so many things that aren’t
true.” Consider putting aside preconceived notions,
reading the investment classics and learning to invest
based on academic-based financial research. Although
few physicians can match Mark Twain the writer, he can
teach all of us how to become better investors.
○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○       Let us be the key to your future . . .
Dr. Weinstein co-authored a retirement planning chapter in J.K.
Lasser’s Expert Financial Planning, taught financial planning at the                                                                                412-281-1901
American Academy of Ophthalmology and lectures to physician groups                                                                                 www.3kcpa.com
on this topic. Dr. Weinstein also serves as associate editor of the ACMS
Bulletin. He can be reached at weinstein.gary@gmail.com.
April 2011 :: Bulletin                                                                                                                                                                 171

Free Resources for Physicians
Help Cancer Patients & Families
Stay Well, Get Well, Find Cures and Fight Back
○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○

            ore than 20,000 Western Pennsylvanians are                                                                                  beauty techniques to women in active treatment, all of
            diagnosed with cancer each year. For physi-                                                                                 which are non-medical and product-neutral. In these
            cians and their staff helping patients and                                                                                  sessions, trained volunteer cosmetologists teach women
families deal with this devastating illness, there is good                                                                              how to cope with skin changes and hair loss using
news about easing the burden of care. The American                                                                                      cosmetics and skin care products donated by the cos-
Cancer Society provides more free resources than ever                                                                                   metic industry. These free kits are available in light,
before to help health care providers save lives by helping                                                                              medium, dark and extra dark shades to enhance all
people Stay Well, Get Well, Find Cures and Fight Back.                                                                                  complexion types. Women also learn ways to disguise
Physician referrals often play a key role in influencing                                                                                hair loss with wigs, scarves and other accessories.
overwhelmed patients and their families to take advan-                                                                                       Reach to Recovery Breast Cancer Support. Reach to
tage of the society’s vast resources that provide broad                                                                                 Recovery helps both women and men cope with breast
access to additional sources of care.                                                                                                   cancer. This typically begins when someone is faced
    Road to Recovery. Long-term treatments may place a                                                                                  with the possibility of a diagnosis and may continue as
burden on patients to make frequent returns to treatment                                                                                a patient begins and completes treatment and upon any
centers, sometimes daily, for weeks and months. Every                                                                                   future recurrence. In Pennsylvania in 2009 alone, some
patient requiring radiation therapy could need anywhere                                                                                 9,380 new cases of breast cancer were diagnosed in
from 20 to 30 daily treatments, five days each week, for                                                                                women, with a 79 percent survival rate.
four to six weeks. Others receiving chemotherapy might                                                                                       Upon receiving a breast cancer diagnosis, a patient
need to report for treatment weekly for more than a year.                                                                               or health care provider can request a visit from a Reach
That’s where the society’s Road to Recovery helps ease                                                                                  to Recovery volunteer. The volunteer provides practical
the driving burden.                                                                                                                     guidance, emotional support and information related to
    More than 300 Road to Recovery volunteers in 18                                                                                     the disease and its treatment. No medical comparisons
Western Pennsylvania counties drive cancer patients to                                                                                  or advice are given, but the volunteer has the knowl-
treatment centers and home again. These rides are                                                                                       edge to refer the patient back to the health care profes-
scheduled through the Patient Service Center coordinator                                                                                sional.
and driver. All drivers are thoroughly trained, well moni-                                                                                   As with Man to Man (see below), volunteers with
tored and have passed background checks.                                                                                                Reach to Recovery are breast cancer survivors who have
    Road to Recovery program pairs community volun-                                                                                     fully adjusted to their surgery and are carefully selected
teers with patients to provide rides to and from treat-                                                                                 and trained. They offer unbiased facts and emotional
ments. Volunteers can drive as little or as much as they                                                                                support in a completely confidential format.
want, with some volunteering as little as one afternoon a                                                                                    Man to Man Prostate Cancer Support. Prostate
month and others as often as several days a week.                                                                                       cancer is the second leading cause of cancer deaths
    Look Good, Feel Better. Because physical side effects of                                                                            among men. In 2010 an estimated 8,130 new cases of
cancer treatment often rob women of their self-confi-                                                                                   prostate cancer in men will be diagnosed in Pennsylva-
dence, the society provides free programs that teach                                                                                    nia, resulting in approximately 1,440 deaths.
172                                                                                                                                                                           Bulletin :: April 2011
     Man to Man provides men with free, community-                As the nation’s largest non-governmental investor in
based group education, open discussion and support.           cancer research, contributing more than $3.4 billion,
Volunteer coordinators organize monthly meetings for          ACS turns what it knows about cancer into its activities.
patients to learn about the facts regarding side effects of   As a result, more than 11 million people in America
treatment and coping with the strain. Men may partici-        who have had cancer, and countless more who have
pate through personal visits and telephone support, as        avoided it, will be celebrating birthdays this year.
well as in a group setting among peers.                           To learn more, physicians and their patients may call
     All Man to Man volunteers are prostate cancer            any time, day or night, at (800) 227-2345 or visit
survivors. Each is specifically trained to honestly, confi-   www.cancer.org.
dentially and openly discuss concerns, but none offers        ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○

any medical advice under any circumstances.                   Ms. Patterson is the health initiatives director at the American Cancer
     Continuing Medical Education. The society provides       Society, East Central Division.
free online CME for physicians and CEUs for nurses on
such aspects as cancer prevention and diagnosis, treat-
ment and palliative care. This can range from improving
and maintaining knowledge and skills relevant to all
                                                                          Free Cancer Awareness Presentations
aspects of cancer control, including cancer prevention,
early detection and diagnosis, to treatment and rehabili-             The Chronic Disease Prevention Program of the Allegheny
                                                                      County Health Department (ACHD) has received a grant through
tation. For more, visit http://CME.AmCancerSoc.org.
                                                                      the Pennsylvania Department of Health’s Pennsylvania Cancer
     CA: A Cancer Journal for Physicians. CA is a peer-
                                                                      Education Network (PCEN). The purpose of this grant is to raise
reviewed journal of the American Cancer Society that                  public awareness about colorectal, prostate, skin and ovarian
provides up-to-date information on all aspects of cancer              cancers.
prevention, early detection, treatment of all forms,
                                                                      Free presentations will cover a brief overview of the above
palliation, advocacy, quality of life and more. Published
                                                                      mentioned cancers, risk factors, prevention approaches,
six times per year, CA is the most widely circulated                  symptoms and recommended screenings. Geared to lay people,
oncology journal in the world, with a circulation of                  the presentations are about 20-40 minutes in length, depending
approximately 88,000. Although CA is an oncology                      on the needs of the group, with a required pre-test and a post-
journal, it is not just for oncologists. Articles cover a             test following the talk. Organizations, community groups and
wide range of oncology topics relevant to diverse inter-              churches are urged to take advantage of this special opportunity
ests. Recently the ISI Journal Citation Reports showed                to provide free health education to their members.
that CA has retained its top ranking as the #1 cited                  For example, colorectal cancer is the second leading cause of
journal in the category of oncology. To subscribe, visit              cancer-related deaths in the United States. The federal Centers
www.ezsub.net/ca.                                                     for Disease Control (CDC) estimates that if everyone aged 50 or
     About the American Cancer Society. With more than                older received regular colorectal cancer screenings, as many as
25,000 volunteers in Western Pennsylvania, the Ameri-                 60 percent of deaths from this cancer could be avoided.
can Cancer Society combines an unyielding passion with                Lorraine Starsky RN, BSN, a public health nurse with the ACHD
nearly a century of experience to save lives and end                  Chronic Disease Prevention Program, will conduct the colorectal
suffering from cancer. With the benefit of having a                   cancer presentations. As an experienced nurse and someone
global grassroots force of more than three million                    who has had regular screening for colorectal cancer, Ms. Starsky
volunteers nationwide, ACS fights for every birthday                  can discuss overcoming the “ick” factor surrounding the screen-
threatened by every cancer in every community.                        ing for this cancer. She can be reached at (412) 247-7816.
     This ranges from volunteering to help patients                   For education on prostate, ovarian and skin cancers, contact
during and after a cancer diagnosis and by investing in               Jason Simonson, a health educator and nutritionist with the
groundbreaking research, to rallying lawmakers to pass                Chronic Disease Prevention Program. He can be reached at
laws to defeat cancer and rallying communities world-                 jsimonson@achd.net or (412) 247-7813.
wide to join the fight. Some 44 researchers funded by
ACS grants have won Nobel Prizes in Medicine.
 April 2011 :: Bulletin                                                                                                                                                                   173
Accountable Care Organizations:
Western PA Physicians and
Hospitals Prepare for Reform
○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○

         he marriage of both quality of care and payment                                                                                ing providers will have the opportunity to form an ACO
         is evident in the creation of accountable care                                                                                 and share in the cost savings achieved for the Medicare
         organizations as outlined in the Patient Protec-                                                                               program.
tion and Affordable Care Act. When the act passed more                                                                                       Qualifying organizations include physician group
than a year ago, only seven pages were devoted to the                                                                                   practice arrangements, networks of practices, hospital-
creation of accountable care organizations (ACOs).                                                                                      physician joint ventures, hospitals employing physicians
     Yet, these soon-to-be new entities will impact the                                                                                 and other clinical professionals such as physician assis-
delivery of health care to Medicare beneficiaries and, at                                                                               tants, nurse practitioners or clinical nurse specialists.
the same time, change the payment system for hospitals,                                                                                 Other qualifying organizations may be determined as
physicians and others. While the goal is to provide                                                                                     appropriate by the Secretary of Health and Human
incentives to improve quality of care, ACOs are also                                                                                    Services.
designed to save the Medicare program at least $4.9                                                                                          Under an ACO, payments will still be made through
million through 2019.                                                                                                                   Medicare’s traditional fee-for-service program; however,
     The Hospital Council of Western Pennsylvania is                                                                                    an ACO will be offered incentives when providers keep
still waiting to see what the regulations will require for                                                                              costs down and meet specific quality requirements.
an ACO. There are still legal and regulatory barriers to                                                                                Those ACOs meeting the requirements for the incen-
physician-hospital sharing of financial incentives. These                                                                               tives would be able to share in the savings generated.
barriers would have to be addressed before ACOs could                                                                                   There will be no financial penalty if savings are not met.
be implemented as defined under the health reform law.                                                                                       The health reform law did outline certain require-
     While the regulations defining the details of the                                                                                  ments to become an ACO. ACOs must have a formal
requirements for an ACO have not yet been released,                                                                                     legal structure to receive and distribute shared savings;
independent physicians, physician group practices,                                                                                      there must be a sufficient number of primary care
hospital-physician partnerships and other clinical profes-                                                                              physicians to care for at least 5,000 Medicare beneficia-
sionals along the continuum of care are trying to deter-                                                                                ries; an ACO must agree to participate for not less than
mine their role in an ACO model.                                                                                                        a three-year-period; processes must be defined to pro-
     The Centers for Medicare and Medicaid Services                                                                                     mote evidence-based medicine and patient engagement,
(CMS) defines an ACO as “an organization of health                                                                                      report on quality and cost measures and coordinate care
care providers that agrees to be accountable for the                                                                                    and demonstrate that it meets patient-centeredness
quality, cost and overall care of Medicare beneficiaries                                                                                criteria as determined by the Secretary of Health and
who are enrolled in the traditional fee-for-service pro-                                                                                Human Services. This could incorporate requirements of
gram and who are assigned to an ACO.”                                                                                                   other programs such as the Physician Quality Reporting
     The concept of an ACO goes to the heart of both                                                                                    Initiative (PQRI), Electronic Prescribing (eRx), elec-
the cost of providing health care and the quality of care                                                                               tronic health records and coordination of care.
provided. Beginning January 1, 2012, groups of qualify-                                                                                      An ACO will be required to cover 5,000 Medicare
174                                                                                                                                                                             Bulletin :: April 2011
beneficiaries, yet the ACO assignment to a Medicare              continue to prepare for elements of health reform,
beneficiary will be invisible. While a provider within an        including new care delivery and payment systems such
ACO may refer the beneficiary within the ACO for                 as ACOs.
services, the beneficiary may seek services from other
                                                                 ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○
providers, even if the physician or provider is not part of      Ms. Raffaele is vice president of advocacy and communications for
his or her assigned ACO.                                         Hospital Council of Western Pennsylvania. She can be reached at (724)
    To earn incentive payments, ACOs must meet                   772-7202 or raffaelep@hcwp.org.
certain quality thresholds. They must have a defined
process to promote evidence-based medicine, and
reporting measures will be determined by the Secretary                   RESOURCES
of Health and Human Services. These will include
                                                                         American Hospital Association
clinical processes and outcomes, patient and caregiver
                                                                         Centers for Medicare and Medicaid Services
perspectives on care and utilization and costs. The ACO
                                                                         The Advisory Board
will then be able to share in any savings generated to the
Medicare program at a rate determined by the secretary.
    Beginning in 2012, state Medicaid programs can
begin demonstration projects that will allow pediatric           Editor’s Note: At press time, the government released the
medical providers to form ACOs and receive incentive             new ACO regulations. Please watch for the May issue of
payments.                                                        the Bulletin for a “Legal Report” by Attorney William
    Western Pennsylvania hospitals and physicians will           Maruca detailing these regulations.

                                                                                                                         A subsidiary of the Pennsylvania Medical Society

                                            Wisdom in Practice
   We help medical practices by solving their business problems and helping them realize new opportunities to grow.
   Each practice has its own challenges so we work with you to identify the most important areas and create a solution that
   fits your specific needs. Some of our services include:

    •     Documentation and coding audits and individual or      •        HR manuals, job descriptions, and general advice
          group coding education                                 •        Compensation system development
    •     Electronic Health Records (EHR) selection, imple-      •        Benchmarking of revenue, expenses, accounts
          mentation, and ongoing assistance                               receivable
    •     Medicare and commercial payor bonus programs           •        Fee schedule review and development
          assistance (i.e. PQRI and e-Rx)                        •        Presentations/Education/Speakers Bureau
    •     Practice startups and mergers                          •        Website Customization
    •     Practice and billing assessments                       •        Mini-COBRA Administration

        If you would like more information about PMSCO, please visit www.consultPMSCO.com. You may also contact us by
                           email at experts@consultPMSCO.com or by calling toll-free: 1-888-294-4336.

                                          777 E. Park Drive    Harrisburg, PA 17111

April 2011 :: Bulletin                                                                                                                                                                       175
         Doctors and Patients. Preserve the Relationship.®

Free. Members-Only Information
From the Pennsylvania Medical Society
Of the thousands of calls and e-mails we receive from Members every year, many concern the
same issues and questions. So, we’ve developed a series of brief publications that address
these common Concerns. They’re free and available only to Members.

Regulations                                                    Practice Management
Practice Guidelines for Physician Assistants                   Policy and Procedural Manuals/Employee
and Certified Registered Nurse Practitioners                   Handbooks for Medical Practices
A resource for physician practices to understand licen-        Use this brief publication to find out the basic informa-
sure, scope of practice, and reimbursement rules and           tion that should be included in a comprehensive
guidelines for these positions.                                employee handbook for your practice.

Setting the Record Straight: What You Need to Know             Selecting Computer Hardware
About Medical Records                                          and Software for Your Medical Practice
From Ownership rights to copying fees, “Setting the            Use this short paper to help you with the process of
Record Straight” will help you make sure you’re handling       selecting a practice management system for your
these vital documents appropriately and legally.               medical practice.

Disease Reporting                                              Setting Up a Practice—Areas to Consider
Includes lists of reportable diseases, how and where to        For physicians who are considering starting a practice.
report, confidentiality rules and penalties for failing to     With all there is to consider, you’ll probably miss
report.                                                        something without a checklist like this.

Reimbursement                                                  Medical Liability
Act 6: A Crash Course in Auto Accident                         Arbitration of Medical Liability Claims
Reimbursement                                                  Focuses on private arbitration outside the judicial
A concise run-down of the steps you need to take to get        system that takes place if the physician and patient
appropriately reimbursed for care of patients injured in a     have a voluntary agreement to engage in arbitration.
motor vehicle accident.
                                                               Medical Professional Liability Insurance Options
Your Right to Timely Payment Under Act 68                      Basic information and definitions for physicians consid-
Provides details of physician’s rights under the Quality and   ering new as well as traditional medical liability insur-
Health Care Accountability & Protection Act, including         ance options.
provisions for prompt payment of clean claims within 45
                                                               Lawsuit Protection Strategies
                                                               Designed to be an instructional tool for physicians so
                                                               that they can have a more informed discussion with
Collection Protocols for the Medical Practice
                                                               their legal and financial advisors.
Manage your accounts receivable and prevent them from
becoming delinquent. “Collection Protocols” includes tips
on managing accounts and also useful collection tech-
                                                                         Order any of these publications
Workers’ Compensation:                                                      by calling (800) 228-7823
The Application for Fee Review Process                               or on the Pennsylvania Medical Society
FAQs and sample forms for when you have trouble getting             Web site store, www.pamedsoc.org/store.
paid for workers’ compensation health care services or
when an insurer is making you wait for payment.

176                                                                                                     Bulletin :: April 2011
Medical Records FAQs
Who owns patient medical records?                             patients must be retained until he or    practice. As a general rule, patients
The Pennsylvania health facility                              she turns 19 (MD) or 21 (DO), a          (and their designees) are only en-
regulations specifically provide that                         minimum of seven years. For more         titled to review their medical record
hospital medical records are owned                            information on state regulations,        and obtain a copy. However, when
by the hospital. Although no Penn-                            visit www.pacode.com/secure/data/        requested by patients (or their
sylvania statute, regulation or case                          049/chapter 16/s16.95.html.              representatives) mammography
law directly addresses ownership of                                                                    facilities must provide original (not
physician office records, the general                         In the case of a physician who is in     copied) mammography films.
consensus is that the physician office                        a group practice or employed by a
records are owned by the physician,                           hospital or other facility, who owns     Is a subpoena required for patients
not by the patient.                                           the medical records?                     to obtain access to their medical
    Physicians in Pennsylvania are                            Physicians who are in a group            records?
required by state regulation to retain                        practice or employed by a hospital or    No. However, patients need to sign
medical records for adult patients                            other facility should address owner-     an authorization form and, if the
for seven years from the last date of                         ship of medical records in an appli-     patient would like someone other
service. Medical records for minor                            cable partnership, employment, or        than himself or herself to receive a
                                                              other legal agreement.                   copy of the medical record, it should
                                                                                                       be noted on the authorization form.
 Which financial and medical records
                                                              Are patients entitled to a copy of
  should I keep and for how long?
                                                              their medical records?                   When patients request a copy of
         Document .............. How Long to Save
                                                              Physicians are legally required under    their medical records, must the
  Accountant’s financials ........... permanently
                                                              state and federal law to provide         physician turn over records
  Corporate tax returns .............. permanently
                                                              patients with access to their medical    forwarded by other providers?
  Insurance records and claims . permanently
  Major legal correspondence .... permanently                 records. Patients must be permitted      The Pennsylvania laws and regula-
  Malpractice insurance policies permanently                  to review and obtain copies of their     tions say: “Clinical information
  Medical correspondence ......... permanently                medical records. Medical ethics also     pertaining to the patient which has
  Patient claims .......................... permanently       require that patients be given access    been accumulated by the physician,
  X-rays ...................................... permanently   to their medical records.                either by himself or through his
  Cancelled checks ........................ 7 years               However, in certain situations, it   agents, shall be incorporated in the
  Charge slips and days sheets ..... 7 years                  may be appropriate for a physician       patient’s medical record.” That
  Expired contracts ......................... 7 years
                                                              to withhold information from a           includes medical records forwarded
  Internal year-end financials ......... 7 years
                                                              patient to protect the patient or a      by another office. Any information
  Payroll records and tax returns ... 7 years
  Purchase invoices ....................... 7 years           third party from harm. These             in the medical record should be
  Third-party insurance claims ....... 7 years                situations typically involve patients    copied and forwarded to the patient,
  Business correspondence ........... 3 years                 who have received mental health          or the physician may face disciplin-
  Expired insurance policies .......... 3 years               treatment.                               ary action, not only at the state level,
  Internal monthly summaries ........ 3 years                                                          but the federal level under HIPAA.
  Personnel records ....................... 3 years           Must a physician turn over the
  Bank statements and reconciliation1 year                    original medical record to a patient?    ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○   ○    ○   ○

                                                                                                       This infomation is from the Pennsylvania
  Duplicate deposit slips ................. 1 year            As noted, office medical records         Medical Society’s website (www.pamedsoc.org).
       Check with your accounting                             generally are considered to be the       Our thanks to PAMED for permission to use it
      and/or legal advisers with any
           specific questions.
                                                              property of the physician or group       in this Special Report.

April 2011 :: Bulletin                                                                                                                                                             177
    HELP WANTED                            rent/unrestricted      license,
                                           ECFMG if foreign trained, and
PHYSICIAN with active/or can               BLS for HCPs. Send resume to
activate PA license, any spe-              lflores-graham@cprent.net or
cialty. Work 4-16 hours/                   contact Linda Flores-Graham at
monthly. Malpractice insurance             877-267-3728, ext 208.
provided. Ideal for retired phy-
sician. PITTSBURGH FAM-                              FOR LEASE
ILY PRACTICE. 412-734-
1100.                                      MEDICAL/OFFICE SPACE up
                                           to 1600 square feet, ample off-
FULL/PART-TIME Primary                     street parking: Mt. Royal Blvd.
Care Physician that is Board               Will remodel to suit. Contact
Certified or eligible for Family           Geoff Smathers, Century 21 Real
Practice/Urgent Care Center in             Estate. 412-491-5333.
the South Hills. Send CV to
Physician Search, 1691 Wash-
ington Rd., Pittsburgh PA                            FOR RENT
15228 or e-mail medihelp84@
gmail.com.                                 TWO MEDICAL OFFICES,
                                           newly renovated. Prime location,
EMERGENCY MEDICINE:                        Moon Township, 960 Beaver
Unique opportunity for BE/BC               Grade Road. Approximately
ED physician. Loan repayment               2,000 sq. ft., private street level
on all medical loans, potential            parking, two entrances. Includes
signing bonus for right indi-              three exam rooms, waiting room,
vidual. 12-hour shifts, 1926               nurse’s reception room,
work hours, low volume, work               physician’s private office, labora-
156 days per year. $300,000                tory, kitchen, and two restrooms;
guaranteed, plus generous ben-             all furnished, ready to move in.
efits. 1 hour from Monroeville.            Security system in place. Some
For complete information in                utilities included. Two similar of-
                                                                                   The medical society appreciates
confidence, please contact                 fices in same building, separate
sternd@danielstern.com or call             parking lots. Call 412-922-3333.
412-720-0642. (Prefer ABEM,
but may consider highly expe-                                                      and depends on its advertisers.
                                              Call (412) 321-5030
rienced ED physician.)
                                                   today and                        Please remember to tell them
                                              place your ad here!
                                                                                   you saw their ad in the Bulletin.
PHYSICIANS and Physician
Assistants/Nurse Practitioners
needed for our Pittsburgh                         ALLEGHENY COUNTY
MEPS facility. Healthcare pro-                     MEDICAL SOCIETY
viders will perform physical ex-                     Box Replies:
aminations, evaluations & pro-
                                              ACMS/box number
filing of applicants to enter
military. Must be: MD/DO or                   713 Ridge Avenue
PA/NP, able to work 2-3 times                Pittsburgh PA 15212
a week in the a.m., have a cur-

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178                                                                                                                                    Bulletin :: April 2011
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800-445-1212                                           ALLEGHENY COUNTY MEDICAL SOCIETY
              :                                                                       179
 April 2011   : Bulletin
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180   peggymc@malachy.com             Medical Society                    Bulletin :: April 2011

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